Can you provide a brief one-page summary of the early and late complications of prematurity?

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Last updated: November 14, 2026 • View editorial policy

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Complications of Prematurity: Early and Late

Premature infants face significant morbidity and mortality risks that vary by timing of onset, with complications arising from multiorgan system immaturity that persists well beyond the neonatal period.

EARLY COMPLICATIONS (First Days to Weeks of Life)

Respiratory System

  • Respiratory Distress Syndrome (RDS): The hallmark early complication, occurring in up to 41-50% of preterm infants, caused by surfactant deficiency 1, 2
  • Pneumothorax and pulmonary interstitial emphysema: Air leak syndromes from lung immaturity 1
  • Pulmonary hemorrhage: Particularly in infants <27 weeks' gestation 1
  • Pulmonary hypoplasia: Major contributor to early mortality, especially after previable PPROM 2
  • Transient tachypnea of the newborn (TTN): Common in late preterm infants 3

Cardiovascular System

  • Patent ductus arteriosus (PDA): Occurs in 21% of preterm infants <34 weeks, with earlier clinical presentation after surfactant therapy 1, 4, 5
  • Hemodynamic instability: Arterial hypotension in first 3 days increases IVH risk 6
  • Persistent pulmonary hypertension (PPHN): Particularly in late preterm infants 3

Neurological System

  • Intraventricular hemorrhage (IVH): Occurs in 9% of infants <34 weeks, with risk factors including chorioamnionitis, hypotension, hypercapnia, and thrombocytopenia 6, 4
  • Periventricular leukomalacia (PVL): White matter injury from ischemia 7

Metabolic/Thermoregulation

  • Hypoglycemia: Common due to limited glycogen stores and immature glucose regulation 3, 8
  • Temperature instability: Inability to maintain body temperature from inadequate brown fat and large surface area 3, 8
  • Hypernatremia: High sodium intake is an independent risk factor for IVH 6

Gastrointestinal System

  • Feeding difficulties: Universal challenge requiring gavage or gastrostomy support 9, 3, 8
  • Necrotizing enterocolitis (NEC): Occurs in 1.7-5% of preterm infants 2, 4

Hematologic/Infectious

  • Neonatal sepsis: Affects up to 47% of infants <34 weeks, with early-onset (E.coli) and late-onset (CoNS) patterns 2, 4, 5
  • Thrombocytopenia: Common and increases IVH risk 6

Hepatic

  • Hyperbilirubinemia: Prolonged physiologic jaundice from immature hepatic conjugation 9, 8

LATE COMPLICATIONS (Weeks to Months and Beyond)

Chronic Respiratory Disease

  • Bronchopulmonary dysplasia (BPD): Occurs in 5.8-50% of survivors, representing chronic lung injury from mechanical ventilation and oxygen toxicity 1, 2, 7
  • Long-term respiratory problems: 50-57% of children require respiratory medications at ages 2-5 years 2
  • Impaired lung function: Worse pulmonary function, mild pulmonary hypertension, and lower peak oxygen consumption persist to age 10 years 2

Neurodevelopmental Outcomes

  • Cerebral palsy: Risk increased 80-140% with chorioamnionitis 6
  • Neurodevelopmental delay: Approximately 31% have abnormal neurodevelopment at ages 2-5 years 2
  • Educational and behavioral problems: Increased risk across the lifespan, even in late preterm infants 10, 11

Ophthalmologic

  • Retinopathy of prematurity (ROP): Occurs in 3.6-25% of preterm infants, requiring routine screening 1, 2, 4, 5

Cardiovascular/Metabolic

  • Cardiometabolic disorders: Increased risk of chronic conditions extending into adulthood 10
  • Chronic kidney disease: Long-term renal complications 10

Skeletal

  • Skeletal deformities: Occur in 5-25% of cases, particularly after previable PPROM 2
  • Positional skull deformity: From prolonged supine positioning 9

Mortality

  • Neonatal mortality: 9% in infants <34 weeks 4
  • Overall survival after previable PPROM: Only 38.8% survive to hospital discharge when PPROM occurs <24 weeks 2
  • Long-term mortality: Excess mortality risk persists into adulthood, even for late preterm infants 10, 11

Key Clinical Considerations

The earlier the gestational age, the higher the risk and severity of complications 2. Late preterm infants (34-36 weeks) constitute 75% of all preterm births and, despite appearing relatively mature, carry significantly elevated risks compared to term infants 10, 11. These infants are not "almost term" and require adapted follow-up 11.

Critical risk factors for complications include:

  • Gestational age <30 weeks
  • Chorioamnionitis with elevated IL-6
  • Low birth weight
  • Hemodynamic instability in first 72 hours
  • Lack of antenatal corticosteroids

Hospital readmission rates are substantially higher for preterm infants, particularly late preterm infants who may be discharged before full physiologic maturity 9, 10.

References

3
Research

Health issues of the late preterm infant.

Pediatric clinics of North America, 2009

8
Research

Complications of the late preterm infant.

The Journal of perinatal & neonatal nursing, 2009

10
Research

Late preterm birth: how big is the problem?

European journal of obstetrics, gynecology, and reproductive biology, 2026

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