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What to Expect When You Have an Extremely Premature Infant


Overview

Infants born between 22 and 26 weeks of pregnancy are called "extremely premature." If your infant is born this early, you likely will face some hard decisions.

Your premature infant has a much greater chance than ever before of doing well. A baby has the best chance of survival in a neonatal intensive care unit (NICU) that has a staff with a lot of experience.

When a baby is born too early, his or her major organs are not fully formed. This can cause health problems. Your infant may not respond well to attempts to keep him or her alive. Often it's not clear whether treatment will help an infant live—with or without disability—or will only make the dying process take longer. A specialist called a neonatologist can give you some idea of what may happen. But no one can predict what exactly will happen. In the end it will be up to you to decide how far to continue treatment.

Having a premature baby may be stressful and scary. To get through it, you and your partner must take good care of yourselves and each other. It may help to talk to a spiritual adviser, a counselor, or a social worker. You may be able to find a support group of other parents who are going through the same thing.

What can you expect after an extremely premature birth?

If the baby can't breathe, the first decision that may be faced by parents and doctors is whether to resuscitate the infant. This means bringing the baby alive by getting the heart and lungs to work. When resuscitation doesn't work or isn't done, babies get care that makes them comfortable instead of treatment to keep them alive.

Treatment decisions are usually based on whether the infant's brain has been damaged. This can happen from bleeding in the brain or a lack of oxygen. Other things that affect treatment decisions include how physically healthy the baby looks and how many weeks old the baby appears to be.

The first month after the birth is when most major problems occur. It is a critical decision-making period for parents. There may be laws in your area that affect your decisions. Talk to your doctor about this.

How many of these babies survive being born?

The more premature the baby is, the lower the chances of survival are. Very few infants survive when they are born at 22 to 23 weeks of pregnancy. The table below shows the results of two studies with similar results.

Chances of survival1, 2

Weeks of pregnancy

Survival rates

23

2 to 3 out of 10 survived (7 to 8 out of 10 died)

24

5 out of 10 survived (5 out of 10 died)

25

Nearly 8 out of 10 survived (about 2 out of 10 died)

It's important to remember that research results are only general numbers. Everyone's case is different, and these numbers may not show what will happen in your baby's case.

How many of these babies have problems later on?

In the first year of life, babies that have a very low birth weight are more likely to be in the hospital more often than babies who were born at a healthier weight.2

Many problems can't be found until after an infant's more urgent problems are under control. For example:

Below are examples from studies of children who survived being born extremely early. Researchers looked at how likely these children were to have problems later on, based on how early they were born and/or what they weighed at birth.

Chances of having problems

Weeks of pregnancy, or birth weight

Number of infants who had problems later on

Weight less than 1000 g (2 lb)

Up to 4 out of 10 had one or more moderate or severe problems by the time they were age 8.3 These problems included intellectual disability, cerebral palsy, blindness, and deafness.

23 to 25 weeks

At age 2½, about 3 out of 10 had one or more of the severe problems listed above.4 This means that about 7 out of 10 did not get these problems. At age 6, about 5 out of 10 children born at these early ages were more likely than other children to have attention problems, behavior problems, and problems adjusting to school.5

25 to 26 weeks

Nearly 4 out of 10 had problems at age 19, including problems with hearing, sight, intellectual disability, and having a job.6 This means that more than 6 out of 10 did not have these problems.

For a tool that can help estimate the outcome for babies born at 22 to 25 weeks of age, go to www.nichd.nih.gov/about/org/cdbpm/pp/prog_epbo/epbo_case.cfm.

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eMedicineHealth Medical Reference from Healthwise

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