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Volume 329:1597-1601 November 25, 1993 Number 22 Next

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ABSTRACT

Background 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.

Methods 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.

Results 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.

Conclusions 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.

Source Information

From the Department of Pediatrics, Johns Hopkins University School of Medicine (M.C.A., P.K.D.), and the Department of Pediatric Nursing, Johns Hopkins Hospital (A.E.D.), both in Baltimore.

Address reprint requests to Dr. Allen at the Johns Hopkins Hospital, CMSC 210, 601 N. Wolfe St., Baltimore, MD 21287-3200.

Full Text of this Article

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Viability of Infants Born at 22 to 25 Weeks' Gestation
Reuss M. L., Merritt T. A., Boynton B. R., Hallman M., Tyrala E. E., Clark F., Allen M. C., Donohue P. K., Dusman A. E.
Extract | Full Text  
N Engl J Med 1994; 330:1234-1236, Apr 28, 1994. Correspondence

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• Tyson, J. E., Younes, N., Verter, J., Wright, L. L. (1996). Viability, Morbidity, and Resource Use Among Newborns of 501-to 800-g Birth Weight. JAMA 276: 1645-1651 [Abstract]  
• Saigal, S., Feeny, D., Rosenbaum, P., Furlong, W., Burrows, E., Stoskopf, B. (1996). Self-perceived Health Status and Health-Related Quality of Life of Extremely Low-Birth-Weight Infants at Adolescence. JAMA 276: 453-459 [Abstract]  
• Jijon, C. R., Jijon-Letort, F. X. (1995). Perinatal Predictors of Duration and Cost of Hospitalization for Premature Infants. CLIN PEDIATR 34: 79-85 [Abstract]  
• Magann, E. F., Perry, K. G., Chauhan, S. P., Graves, G. R., Blake, P. G., Martin, J. N. (1994). Neonatal Salvage by Weeks' Gestation in Pregnancies Complicated by HELLP Syndrome. Reproductive Sciences 1: 206-209 [Abstract]  
• Baker, R. D. (1994). Nutrition of the Low Birthweight Infant. JPEN J Parenter Enteral Nutr 18: 377-377  
• Hanson, K., Pasulka, P. S. (1994). Binge Eating: Nature, Assessment and Treatment. JPEN J Parenter Enteral Nutr 18: 377-378  
• Reuss, M. L., Merritt, T. A., Boynton, B. R., Hallman, M., Tyrala, E. E., Clark, F., Allen, M. C., Donohue, P. K., Dusman, A. E. (1994). Viability of Infants Born at 22 to 25 Weeks' Gestation. NEJM 330: 1234-1236 [Full Text]  
• Hack, M., Fanaroff, A. A. (1993). Outcomes of Extremely Immature Infants -- A Perinatal Dilemma. NEJM 329: 1649-1650 [Full Text]