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Sir—The relation of perinatal health to child health was addressed by Gissler et al. 1 using unique data resources in Finland. The Medical Birth Register allowed them to study a cohort of over 60 000 births with virtually complete follow-up for most outcomes over a 7-year period. While they documented the expected increased mortality and long-term morbidity associated with being born early or small, they had an opportunity to examine effects of mild degrees of prematurity or small size but did not present the data to do so. Preterm birth, for example, is usually defined as birth prior to completion of 37 weeks' gestation, but in the obstetric community, births as early as 34 weeks are of little concern and births of 35 or 36 weeks are considered normal. Similarly, infants below 2500 g at birth are defined as low birthweight, but there is a widely held view that births as low as 2000 g are of little or no concern. This perception is valid, in part at least, because modest degrees of prematurity or small size have limited adverse consequences for short-term survival, though there is still a measurable increase in mortality as late as 36 weeks' gestation (US National Center for Health Statistics, personal communication). The question of whether there are long-term, subtle adverse health effects associated with marginally early or small births is an important and unresolved public health question. Many intervention trials evaluate such endpoints as preterm birth but not severe preterm birth, 2 and the large number of marginally preterm or low birthweight infants may result in sizeable impact on a population basis even if the increments in risk are modest. Therefore, the question of whether mild degrees of prematurity or reduced size are worthy of concern is critical, and the only way to address that issue is in studies of large populations of births with long-term follow-up of outcomes more sensitive than death alone. Gissler et al. 1 present data on gestational age grouped as 22–27, 28–36, and 37–44 weeks, but stratification within the 28–36 week group would be necessary to answer the question of what degree of prematurity incurs increased risk. Similarly, dividing the birthweight interval of 1500–2499 g into two groups, 1500–1999, 2000–2499 would be informative. If there are truly no measurable adverse consequences to being born at the margins of prematurity or low birthweight, the standards should be revised. If there …

Can children's health be predicted by perinatal health?