The Continuing Challenge of Preterm Delivery

Each year in the United States, approximately 31000 fetuses die before delivery and 22 000 newborns die during the first 27 days of life. Approximately 71% of fetal deaths and 74% of neonatal deaths occur among preterm infants (<37 weeks' gestation). The rate of severe morbidity is several times higher for preterm survivors than infants born at term.¹Because of the increased risks for death and morbidity associated with preterm delivery, its prevention is an important public health goal. Yet the rate of preterm delivery in the United States did not decrease during the 1980s. See also p 709. Wilcox and colleagues²conclude that an excess rate of preterm delivery in the United States, compared with Norway, accounts for excess perinatal mortality. This conclusion is supported by previous comparisons of the two countries in which a higher percentage of very low-birth-weight infants (<1500 g), nearly all of whom