Background: Preterm birth is considered to be associated with an estimated 27% of neonatal deaths, the majority in\nresource-poor countries where rates of prematurity are high. There is no information on medium term outcomes after\naccurately determined preterm birth in such settings.\nMethods and Findings: This community-based stratified cohort study conducted between Mayââ?¬â??December 2006 in\nSouthern Malawi followed up 840 post-neonatal infants born to mothers who had received antenatal antibiotic prophylaxis/\nplacebo in an attempt to reduce rates of preterm birth (APPLe trial ISRCTN84023116). Gestational age at delivery was based\non ultrasound measurement of fetal bi-parietal diameter in early-mid pregnancy. 247 infants born before 37 wk gestation\nand 593 term infants were assessed at 12, 18, or 24 months. We assessed survival (death), morbidity (reported by carer,\nadmissions, out-patient attendance), growth (weight and height), and development (Ten Question Questionnaire [TQQ] and\nMalawi Developmental Assessment Tool [MDAT]). Preterm infants were at significantly greater risk of death (hazard ratio\n1.79, 95% CI 1.09ââ?¬â??2.95). Surviving preterm infants were more likely to be underweight (weight-for-age z score; p,0.001) or\nwasted (weight-for-length z score; p,0.01) with no effect of gestational age at delivery. Preterm infants more often\nscreened positively for disability on the Ten Question Questionnaire (p = 0.002). They also had higher rates of developmental\ndelay on the MDAT at 18 months (p = 0.009), with gestational age at delivery (p = 0.01) increasing this likelihood.\nMorbidityââ?¬â?visits to a health centre (93%) and admissions to hospital (22%)ââ?¬â?was similar for both groups.\nConclusions: During the first 2 years of life, infants who are born preterm in resource poor countries, continue to be at a\ndisadvantage in terms of mortality, growth, and development. In addition to interventions in the immediate neonatal\nperiod, a refocus on early childhood is needed to improve outcomes for infants born preterm in low-income settings.
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