Preeclampsia is a multiorgan, heterogeneous disorder of pregnancy associated with significant maternal and neonatal morbidity and mortality. Optimal strategies in the care of the women with preeclampsia have not been fully elucidated, leaving physicians with incomplete data to guide their clinical decision making. Because preeclampsia is a progressive disorder, in some circumstances, delivery is needed to halt the progression to the benefit of the mother and fetus. However, the need for premature delivery has adverse effects on important neonatal outcomes not limited to the most premature infants. Late-preterm infants account for approximately two thirds of all preterm deliveries and are at significant risk for morbidity and mortality. Reviewed is the current literature in the diagnosis and obstetrical management of preeclampsia, the outcomes of late-preterm infants, and potential strategies to optimize fetal outcomes in pregnancies complicated by preeclampsia.

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Objective: Transport of infants born at the threshold of viability (<27 weeks) may negatively impact outcomes. Our neonatal intensive care unit (NICU) is an all-referral unit, and therefore all patients have been transported. This study examined survival rates and the factors that influenced survival in this specific population of extremely premature infants.Study design: The study setting was at an all-referral tertiary care NICU within a children's hospital. Data were collected from December 2004 to August 2008, and included 227 patients.Results: Overall, the survival-to-discharge rate for these infants was 78%. The primary causes of death were sepsis (41%), necrotizing enterocolitis (NEC) (27%), respiratory failure (18%), and severe intraventricular hemorrhage (IVH) (10%). By logistic discrete time hazard analyses, patients receiving dopamine (p < 0.01) or insulin (p < 0.01), with NEC (p < 0.05), or of gestational age 22, 23 or 24 weeks (p < 0.01) were more likely to die; while those born in the same county as the NICU (p < 0.01), receiving patent ductus arteriosis (PDA) treatment (p < 0.01) or peripheral intravenous central catheters (p < 0.01) were more likely to survive. Within the group of survivors the rate of cerebral palsy was 9% and the mean scores on the Bayley-III at 18 months corrected age were 95 ± 13, 90 ± 15, and 92 ± 14 in the cognitive, communication, and motor scales respectively.Conclusion: Infection, NEC, and respiratory failure were the primary causes of death among extremely premature infants in an all-referral NICU. New approaches to preventing infection, NEC, and bronchopulmonary dysplasia are needed for this population.