Early Outcomes in Babies Born Close to Term

Abstract

Advances in obstetric and neonatal care over recent years, together, make up one of the most impressive success stories of modern medicine. We can now manage problems and complexities in the care of preterm and sick neonates that we would not have thought possible only a relatively small number of years ago. Survival and neurodevelopmental outcomes have improved enormously, and this is cause for celebration. The boundaries of viability in terms of the very smallest and most immature babies are seemingly ever flexible, and we continue to push them back, with reports of survival following birth at 22 weeks of gestation becoming more common, albeit with mixed outcomes. Yet, while we count our achievements in advancing care for the tiny proportion of babies who are born extremely preterm, have we somehow forgotten the much larger number of more mature babies? For years, neonatal research has centred almost exclusively on the effects of very preterm birth; we have learnt much and the evidence base to guide our management of these babies is constantly increasing. In stark contrast, until recently, we knew almost nothing about babies born closer to “term”. The last decade, however, has seen some shift in focus. New and emerging evidence is challenging long and widely held beliefs, leading to a somewhat uneasy cognisance that we should probably look more closely at these more mature babies. This chapter will discuss the concept of gestational age as a continuum and the sometimes confusing terminology associated with birth closer to term. It will summarise recent research evidence with respect to the effects of gestational age at birth on outcomes in early life, highlight the gaps in current knowledge, explore the implications for clinical practice, and consider how we should respond to the challenges that this new evidence may present.