title: Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort.
abstract: Although preterm birth <37 weeks' gestation is the leading cause of neonatal morbidity and mortality in the United States, the majority of data regarding preterm neonatal outcomes come from older studies, and many reports have been limited to only very preterm neonates. Delineation of neonatal outcomes by delivery gestational age is needed to further clarify the continuum of mortality and morbidity frequencies among preterm neonates.
  
  
  
  We sought to describe the contemporary frequencies of neonatal death, neonatal morbidities, and neonatal length of stay across the spectrum of preterm gestational ages.
  
  
  
  This was a secondary analysis of an obstetric cohort of 115,502 women and their neonates who were born in 25 hospitals nationwide, 2008 through 2011. All liveborn nonanomalous singleton preterm (23.0-36.9 weeks of gestation) neonates were included in this analysis. The frequency of neonatal death, major neonatal morbidity (intraventricular hemorrhage grade III/IV, seizures, hypoxic-ischemic encephalopathy, necrotizing enterocolitis stage II/III, bronchopulmonary dysplasia, persistent pulmonary hypertension), and minor neonatal morbidity (hypotension requiring treatment, intraventricular hemorrhage grade I/II, necrotizing enterocolitis stage I, respiratory distress syndrome, hyperbilirubinemia requiring treatment) were calculated by delivery gestational age; each neonate was classified once by the worst outcome for which criteria was met.
  
  
  
  In all, 8334 deliveries met inclusion criteria. There were 119 (1.4%) neonatal deaths. In all, 657 (7.9%) neonates had major morbidity, 3136 (37.6%) had minor morbidity, and 4422 (53.1%) survived without any of the studied morbidities. Deaths declined rapidly with each advancing week of gestation. This decline in death was accompanied by an increase in major neonatal morbidity, which peaked at 54.8% at 25 weeks of gestation. As frequencies of death and major neonatal morbidity fell, minor neonatal morbidity increased, peaking at 81.7% at 31 weeks of gestation. The frequency of all morbidities fell >32 weeks. After 25 weeks, neonatal length of hospital stay decreased significantly with each additional completed week of pregnancy; among babies delivered from 26-32 weeks of gestation, each additional week in utero reduced the subsequent length of neonatal hospitalization by a minimum of 8 days. The median postmenstrual age at discharge nadired around 36 weeks' postmenstrual age for babies born at 31-35 weeks of gestation.
  
  
  
  Our data show that there is a continuum of outcomes, with each additional week of gestation conferring survival benefit while reducing the length of initial hospitalization. These contemporary data can be useful for patient counseling regarding preterm outcomes.
authors.affiliation: Departments of Obstetrics and Gynecology of the University of Utah Health Sciences Center, Salt Lake City, UT. Electronic address: tmanuck@med.unc.edu.
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Manuck
authors.affiliation: George Washington University Biostatistics Center, Washington, DC.
authors.forename: Madeline Murguia
authors.initials: MM
authors.lastname: Rice
authors.affiliation: MetroHealth Medical Center-Case Western Reserve University, Cleveland, OH.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Bailit
authors.affiliation: Northwestern University, Chicago, IL.
authors.forename: William A
authors.initials: WA
authors.lastname: Grobman
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
authors.forename: Uma M
authors.initials: UM
authors.lastname: Reddy
authors.affiliation: Columbia University, New York, NY.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Wapner
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: John M
authors.initials: JM
authors.lastname: Thorp
authors.affiliation: University of Pittsburgh, Pittsburgh, PA.
authors.forename: Steve N
authors.initials: SN
authors.lastname: Caritis
authors.affiliation: Ohio State University, Columbus, OH.
authors.forename: Mona
authors.initials: M
authors.lastname: Prasad
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Alan T N
authors.initials: AT
authors.lastname: Tita
authors.affiliation: University of Texas Medical Branch, Galveston, TX.
authors.forename: George R
authors.initials: GR
authors.lastname: Saade
authors.affiliation: Wayne State University, Detroit, MI.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Sorokin
authors.affiliation: Brown University, Providence, RI.
authors.forename: Dwight J
authors.initials: DJ
authors.lastname: Rouse
authors.affiliation: University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, TX.
authors.forename: Sean C
authors.initials: SC
authors.lastname: Blackwell
authors.affiliation: Oregon Health and Science University, Portland, OR.
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Tolosa
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D055815:Young Adult
keywords: neonatal morbidity; neonatal mortality; prematurity