Survival rates have improved dramatically in recent years for very preterm or tiny infants. However, such infants remain at significant risk for a wide array of long-term morbidities that are mostly inversely related to gestational age. In early childhood, neurodevelopmental disabilities and recurrent health problems take a significant toll. Subsequently “hidden disabilities” such as school difficulties and behavioral problems become apparent and persist through adolescence. Reassuringly, however, most children born very preterm adjust remarkably during their transition to adulthood. As mortality rates continue to fall, the focus for perinatal interventions must be strategies to reduce long-term morbidity. In addition, follow-up to middle age and later adulthood is warranted to determine the risks, especially for cardiovascular, respiratory, and metabolic problems, and other lifestyle issues likely to be confronted by very preterm or tiny survivors.

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