37% of child survivors of intrauterine or neonatal insults experience at least one long-term sequela, the most common being neurodevelopmental delay.

Context More than 40% of mortality in children younger than 5 years occurs in the neonatal period (0–28 days), and the common causes include preterm birth complications, intrapartum-related factors, acquired infections and other conditions such as jaundice and congenital infections. 2 Intrauterine and neonatal insults contribute to both premature mortality and long-term disability as neonates who survive major insults may suffer varying degrees of long-term neurodevelopmental impairments resulting in major socioeconomic burden, especially in resource-poor countries. However, little is known about the severity and distribution of these long-term impairments and estimates of the global burden of disease are not precisely known. Thus, the authors addressed three major questions: (1) What are the long-term outcomes after intrauterine and neonatal insults?; (2) What is the risk and severity of at least one sequela and of multiple sequelae reported after these insults? and (3) What is the risk and severity of sequelae after multiple insults for one infant? Methods The authors reviewed 153 studies published between 1966 and mid-2011 that met strict inclusion criteria: insults occurring during the intrauterine and neonatal period verified with appropriate diagnostic methods or criteria; follow-up for at least 6 months to exclude transient impairments; use of standardised tests for neurodevelopmental assessment; and at least 80% of neonates surviving the insult.