The true measure of success or failure of perinatal care is not merely neonatal survival, but survival with good health and well-being into childhood and beyond. Quantifying this measure is important for all babies, particularly for those born prematurely. The risks are highest for those with a birthweight less than 1 kg (extremely low birthweight) and/or at less than 26 weeks gestation. There is continuing concern about the burden of illness and disability amongst survivors in this vulnerable group. However, we must not forget that all preterm infants are at increased risk of disability later in childhood and that the same is true for babies born at term who are sick enough to require neonatal intensive care.

Hypoplastic Left Heart Syndrome (HLHS) was first described fifty years ago. It is characterised by underdevelopment of the left ventricle with associated aortic and mitral valve hypoplasia or atresia, and varying degrees of hypoplasia of the aortic arch (Figure 1). In utero a physiological right to left shunt of oxygenated blood through the ductus arteriosus bypasses the obstruction and allows normal fetal growth. Closure of the ductus arteriosus in the post-natal period interrupts systemic blood flow, resulting in rapid deterioration and death. Untreated it is a universally fatal condition, leading to neonatal death within the first few days or weeks of life. Although HLHS affects only one baby in 10,000 and accounts for less than 10% of all congenital heart disease, HLHS is responsible for 25% of all deaths due to congenital cardiac disease occurring within the first week of life.

Cigarette smoking continues to be the main preventable cause of premature death in industrialised countries. It is estimated globally to kill 3 million people annually and this figure is expected to rise to 10 million per year within the next 30–40 years. In the UK alone, smoking is responsible for 120,000 premature deaths per year and in the US the death toll from smoking is running at approximately 420,000. Most of the harm from cigarette smoking results from decades of exposure. Thus deaths generally do not occur in substantial numbers until the smoker has reached 40 years of age. However, there are some circumstances in which smoking has acute effects which can lead to serious illness or death. One of these is prior to surgery, where smoking is strongly associated with adverse post-operative outcomes. The other is during pregnancy. This review examines the health consequences of smoking as it relates to pregnancy, the effects of stopping smoking at this time, the prevalence of smoking and smoking cessation in pregnancy and factors associated with these and finally the effectiveness of interventions aimed at tackling this problem.

Premature birth is associated with substantial excess childhood mortality and morbidity and therefore represents an important public health problem worldwide. In the United Kingdom and other industrialised countries it is now the commonest cause of infant mortality. This review will outline the most recently available data for the incidence of premature birth at local, regional, national and international level, and compare them to previously published figures. Any variation in these incidences will be considered along with factors likely to account for these differences. Problems with data collection and analysis will also be discussed.