Skertich NJ, Ingram MCE, Ritz E, et al. - As survival rates amongst premature infants have improved, prematurity remains a leading contributor to neonatal surgical morbidity and mortality, researchers have sought to better assess the impact of prematurity on surgical outcomes. The NSQIP-Pediatric database was used for comparing outcomes from 2012 to 2017 between preterm and term infants undergoing surgical repair of identified congenital anomalies. Prematurity has been categorized as extremely preterm (EP) (< 29 weeks), very preterm (VP) (29–32 weeks), moderate to late preterm (MLP) (33–36 weeks), and term (≥ 37 weeks). Four thousand eight hundred fifty-two infants have been identified with 45 (0.9%) EP, 211 (4.3%) VP, 1492 (30.8%) MLP, and 3,104 (64.0%) term. Premature populations reported higher rates of sepsis, pneumonia, bleeding requiring transfusion and 30-day mortality. Prematurity increases morbidity and mortality among surgically treated neonates. Premature risk adjustment is required and premature infants can have specific goals for quality improvement.