The Limit of Viability – Neonatal Outcome of Infants Born at 22 to 25 Weeks' Gestation

Marilee C. Allen, Pamela K. Donohue, Amy E. Dusman

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343 Scopus citations

Abstract

With improved survival of preterm infants, questions have been raised about the limit of viability. To provide better information and counseling for parents of infants about to be delivered after 22 to 25 weeks' gestation, we evaluated the mortality and neonatal morbidity of preterm infants born at these gestational ages. We studied retrospectively all 142 infants born at 22 to 25 weeks' gestation (as judged by best obstetrical estimate) from May 1988 through September 1991 in a single hospital. Mortality in the first six months, including stillbirths, and neonatal morbidity (i.e., the presence of intracranial pathologic conditions, chronic lung disease, and retinopathy of prematurity) were analyzed. Fifty-six infants (39 percent) survived for six months. Survival improved with increasing gestational age; none of 29 infants born at 22 weeks' gestation survived, as compared with 6 of 40 (15 percent) born at 23 weeks, 19 of 34 (56 percent) born at 24 weeks, and 31 of 39 (79 percent) born at 25 weeks. There were seven stillbirths at 22 weeks' gestation and four stillbirths at 23 weeks. The more immature the infant, the higher the incidence of neonatal complications as determined by the number of days of mechanical ventilation, the length of the hospital stay, and the presence of retinopathy of prematurity, periventricular or intraventricular hemorrhage, or periventricular leukomalacia. Only 2 percent of infants born at 23 weeks' gestation survived without severe abnormalities on cranial ultrasonography, as compared with 21 percent of those born at 24 weeks and 69 percent of those born at 25 weeks. We believe that aggressive resuscitation of infants born at 25 weeks' gestation is indicated, but not of those born at 22 weeks. Whether the occasional child who is born at 23 or 24 weeks' gestation and does well justifies the considerable mortality and morbidity of the majority is a question that should be discussed by parents, health care providers, and society., Improved obstetric and neonatal interventions and aggressive techniques of resuscitation have gradually improved the survival of preterm infants and lowered the limit of viability110. Although the prophylactic administration of surfactant has further improved the survival of extremely-low-birth-weight infants, its effect on morbidity is unclear,1114 and the quality of life of the survivors remains a concern. These developments have created a new difficulty in counseling obstetricians and the parents of infants about to be born at the limit of viability. Options for delivery and resuscitation need to be weighed against the infant's chance of survival and normal life…

Original languageEnglish (US)
Pages (from-to)1597-1601
Number of pages5
JournalNew England Journal of Medicine
Volume329
Issue number22
DOIs
StatePublished - Nov 25 1993

ASJC Scopus subject areas

  • General Medicine

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