Moderate Preterm, Late Preterm and Early Term Births
Preface L a t e P r e t e r m a n d E a r l y Te r m Births
Lucky Jain, MD, MBA
Tonse N.K. Raju, MD, DCH Editors
In 2006, we edited a special issue of Clinics in Perinatology on late preterm births1; this was a byproduct of the 2005 workshop on this topic organized by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). After reviewing the then available meager literature on “near-term infants,” the panel concluded that the phrase be replaced with “late preterm” to underscore the fact that infants born between 340/7 through 366/7 weeks of gestation are immature and vulnerable and require close monitoring, evaluation, and follow-up. The workshop highlighted clinical care priorities and proposed a research agenda.2,3 Neither the NICHD workshop panel nor the authors of the 2006 Clinics in Perinatology special issue could have predicted the enormous impact these events had on the clinical practice and research concerning late preterm births. The special issue of the Clinics in Perinatology promptly sold out and publications began appearing in reputable journals highlighting problems related to late preterm infants. Much progress has been made in this field since then; the National Library of Medicine PubMed page search under “late preterm” will now yield over 300 publications, including original research, review articles, systematic reviews, editorial opinions, and practice guidelines. The focus on the late preterm infant seems to have uncovered two other understudied gestational age groups, one on each side of the late preterm spectrum: studies related to “moderate preterm” and “early term” births,4 further highlighted our lack of understanding of consequences of early birth, even if it is by 2 to 3 weeks and the importance of maintaining the gestational maturational continuum. We are pleased that this issue of the Clinics in Perinatology has given us an opportunity to highlight advances in our collective knowledge on late preterm births with an added focus on the less studied moderate preterm group. Many review articles in this issue confirm that late preterm infants are a vulnerable subset of newborn infants and
Clin Perinatol 40 (2013) xix–xx http://dx.doi.org/10.1016/j.clp.2013.07.013 perinatology.theclinics.com 0095-5108/13/$ – see front matter Ó 2013 Published by Elsevier Inc.
outline additional research priorities to rectify our knowledge gaps. Articles by leading experts cover epidemiology and recent trends in moderately preterm, late preterm, and early term births. In addition to an extensive discussion of clinical problems related to global immaturity, this issue provides comprehensive information about the causes of late preterm birth and their footprint on short-term and long-term outcomes.5 This is an exciting time in clinical medicine for quality improvement and standardized care. Joint efforts by obstetricians, perinatologists, and neonatologists everywhere are beginning to show a measurable effect on late preterm and early term births and have set up a model of care to be emulated for other complex clinical challenges. Lucky Jain, MD, MBA Emory University School of Medicine and Children’s Healthcare of Atlanta 2015 Uppergate Drive Atlanta, GA 30322, USA Tonse N.K. Raju, MD, DCH Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health 6100 Executive Boulevard, Room 4B03, MSC 7510 Bethesda, MD 20892, USA E-mail addresses: [email protected]
(L. Jain) [email protected]
(T.N.K. Raju) REFERENCES
1. Jain L, Raju TNK. Preface: Late preterm pregnancy and the newborn. Clin Perinatol 2006;33(4):xv–xvi. 2. Raju TN. The problem of late-preterm (near-term) births: a workshop summary. Pediatr Res 2006;60(6):775–6. 3. Engle WA. Morbidity and mortality in late preterm and early term newborns: a continuum. Clin Perinatol 2011;38:493–516. 4. Reddy UM, Bettegowda VR, Dias T, et al. Term pregnancy: a period of heterogeneous risk for infant mortality. Obstet Gynecol 2011;117:1279–87. 5. Spong CY, Mercer BM, D’Alton M, et al. Timing of indicated late-preterm and early-term birth. Obstet Gynecol 2011;118(2 Pt 1):323–33.