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Preterm infants are a population at high risk for mortality and adverse health outcomes. With recent improvements in survival to childhood, increasing attention is being paid to risk of long-term morbidity, specifically during childhood and young-adulthood. Although numerous tools for predicting the functional outcomes of preterm neonates have been developed in the past three decades, no studies have provided a comprehensive overview of these tools, along with their strengths and weaknesses. The purpose of this article is to provide an in-depth, narrative review of the current risk models available for predicting the functional outcomes of preterm neonates. A total of 32 studies describing 43 separate models were considered. We found that most studies used similar physiologic variables and standard regression techniques to develop models that primarily predict the risk of poor neurodevelopmental outcomes. With a recently expanded knowledge regarding the many factors that affect neurodevelopment and other important outcomes, as well as a better understanding of the limitations of traditional analytic methods, we argue that there is great room for improvement in creating risk prediction tools for preterm neonates. We also consider the ethical implications of utilizing these tools for clinical decision-making. Impact Based on a literature review of risk prediction models for preterm neonates predicting functional outcomes, future models should aim for more consistent outcomes definitions, standardized assessment schedules and measurement tools, and consideration of risk beyond physiologic antecedents.Our review provides a comprehensive analysis and critique of risk prediction models developed for preterm neonates, specifically predicting functional outcomes instead of mortality, to reveal areas of improvement for future studies aiming to develop risk prediction tools for this population.To our knowledge, this is the first literature review and narrative analysis of risk prediction models for preterm neonates regarding their functional outcomes.

The authors take a longitudinal and intergenerational approach to studying infants born at extremely early gestational age, highlighting the extent to which a high-risk pregnancy is experienced by both mother and infant, with potentially lasting effects on the physical – and mental – health of the dyad. They focus their study on what they call positive child health outcomes at 10 years of age, measured using an index of chronic health problems. Yet concepts of positive health include attributes beyond the absence of disease, such as participation, resilience, and happiness. To study positive health outcomes – an endeavor that has much merit in light of the developmental plasticity children possess – we should use measures that explicitly and more fully encompass the many facets of well-being. Otherwise, we risk simply rebranding negative disease as positive health by providing it a new name.