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Premature Baby Survival

How Young Can Preemies Be Born and Survive?

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Updated July 05, 2012

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

A micropreemie holding an adult's thumb.

With good NICU care, even very small preemies can survive.

Image copyright Anthony Saffery / Getty Images
In the past three decades, the survival rate of premature babies has increased dramatically. Younger and smaller preemies are being saved all the time, and their long-term health is improving. Although extremely premature birth still carries high mortality and morbidity rates, stories of children like Amillia Taylor and Madeline Mann give hope to parents whose babies are born at the edges of viability.

How Early Can a Premature Baby Be Born and Survive?

The earliest baby to be born and survive was James Elgin Gill, born in Canada at 21 weeks and 5 days gestation. James is now a healthy young man, but he is the exception. The chances of survival for babies born at 21 weeks gestation is very low, and the chance of severe disability is high in the few babies who live.

Babies born at the earliest ages of viability are often called micropreemies. Survival rates have increased dramatically since the 1980s, and many babies born at even very young ages will not only live, but thrive.

  • 22 Weeks: Less than 10% of babies born at 22 weeks live to NICU discharge.
  • 23 Weeks: Survival varies greatly. Between 1/4 and 2/3 of babies born at this gestational age will survive.
  • 24 Weeks: About 1/2 to 3/4 of babies will live.
  • 25 Weeks: Up to 85% of babies will survive.
  • 26 Weeks: 80% to 93% of babies born at this gestational age will live.

There are some factors that increase a baby's chances of surviving to NICU discharge and beyond. Girls have better outcomes than boys, as do children born to non-Caucasian mothers. Babies who were given surfactant and who were born to moms who received steroids also have better odds. Health in the NICU is also important, as babies who have normal head ultrasounds (no IVH or other brain problems) and babies who do not have chronic lung disease have better chances for survival.

How Young is Too Young for the NICU?

When deciding whether or not to try to save a very premature baby, doctors look at the overall chances of survival combined with quality of life. The UK-based Nuffield Council on Bioethics recommends the following guidelines on intensive care for very premature babies:

  • 25 Weeks or Greater: Babies born at 25 weeks or later should be resuscitated and admitted to the NICU for further care, unless there is a severe abnormality incompatible with life.

  • 24 to 24.6 Weeks: Babies should be given full resuscitative care and admitted to the NICU unless parents and doctors agree together that the baby's condition does not warrant intensive care.

  • 23 to 23.6 Weeks: Long-term outcome in babies this young is hard to predict. Clinicians and parents should decide together if intensive care should be given.

  • 22 to 22.6 Weeks: Resuscitation at this age should only be started at the parents' request, and if that request is reiterated after consultation with a pediatrician or neonatologist.

  • Before 22 Weeks: Infants born before 22 weeks should only be resuscitated if enrolled in a research study that has been approved by a research ethics committee, and only with the parents' consent.

It's important to remember that these are just guidelines, not law. Policies vary among individual hospitals and doctors. If you expect to deliver an extremely premature baby, talk early with the doctors who will be caring for your baby about what type of resuscitation you would want for your baby at which gestational ages.

Sources:

Hoestraka, R., Ferrara, B., Couser, R., Payne, N., & Connet, J. (Jan. 2004) Survival and Long-Term Neurodevelopmental Outcome of Extremely Premature Infants Born at 23 - 26 Weeks Gestational Age at a Tertiary Center. Pediatrics 113:1, e1-e7.

Epicure: Population based studies of survival and later health status in extremely premature infants. Accessed 6/28/12 from http://www.epicure.ac.uk/overview/overall-outcome/

Canwest News Service. (Feb. 2006) Miracle Child. Accessed 6/29/12 from http://www.canada.com/topics/bodyandhealth/story.html?id=db8f33ab-33e9-429f-bedc-b6ca80f61bdc

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