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What to Expect When You Have an Extremely Premature Infant
Infants born before 28 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 estimates based on two sources.
Weeks of pregnancy
Nearly 2 to 3 out of 10 survived (about 7 to 8 out of 10 died)
5 out of 10 survived (5 out of 10 died)
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.footnote 2
Many problems can't be found until after an infant's more urgent problems are under control. For example:
- The signs of cerebral palsy may not be noticed until a child is 1 to 3 years old.
- Learning disabilities are often not found until the early school years.
- Behavioral problems such as attention deficit hyperactivity disorder (ADHD) may not be noticed until the child is older.
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.
Weeks of pregnancy, or birth weight
Number of infants who had problems later on
Weight less than 1000 g (2 lb)
23 to 25 weeks
At age 2½, about 3 out of 10 had one or more of the severe problems listed above.footnote 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.footnote 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.footnote 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.
- Tyson JE, et al. (2008). Intensive care for extreme prematurity—Moving beyond gestational age. New England Journal of Medicine, 358(16): 1672–1681.
- Carlo WA (2011). Prematurity and intrauterine growth restriction. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 555–564. Philadelphia: Saunders.
- Hack M, et al. (2005). Chronic conditions, functional limitations, and special health care needs of school-aged children born with extremely low-birth-weight in the 1990s. JAMA, 294(3): 318–325.
- Costeloe K on behalf of the EPICure Study Group (2006). EPICure: facts and figures: Why preterm labour should be treated. British Journal of Obstetrics and Gynaecology, 113(Suppl 3): 10–12.
- Samara M, et al. (2008). Pervasive behavior problems at 6 years of age in a total-population sample of children born at 25 weeks of gestation. Pediatrics, 122(3): 562–573.
- Hille ETM, et al. (2007). Functional outcomes and participation in young adulthood for very preterm and very low-birth-weight infants: The Dutch project on preterm and small for gestational age infants at 19 years of age. Pediatrics. Published online August 31, 2007 (doi:10.1542/peds.2006-2407).
Other Works Consulted
- Batton DG, Committee on Fetus and Newborn (2009). Antenatal counseling regarding resuscitation at an extremely low gestational age. Pediatrics, 124(1): 422–427.
- Committee on Fetus and Newborn, American Academy of Pediatrics (2007, reaffirmed 2010). Noninitiation or withdrawal of intensive care for high-risk newborns. Pediatrics, 119(2): 401–403. Also available online: http://aappolicy.aappublications.org/cgi/reprint/pediatrics;119/2/401.pdf.
- Eichenwald EC (2012). Care of the extremely low-birth-weight infant. In CA Gleason, SU Devaskar, eds., Avery's Diseases of the Newborn, 9th ed., pp. 390–404. Philadelphia: Saunders.
- Johnson S (2007). Cognitive and behavioural outcomes following very preterm birth. Seminars in Fetal and Neonatal Medicine, 12(5): 363–373.
- Msall ME (2007). The limits of viability and the uncertainty of neuroprotection: Challenges in optimizing outcomes in extreme prematurity. Pediatrics, 119(1): 158–160.
- Pignotti MS, Donzelli G (2008). Perinatal care at the threshold of viability: An international comparison of practical guidelines for the treatment of extremely preterm births. Pediatrics, 121(1): e193–e198.
Current as of: September 20, 2021
Author: Healthwise Staff
Sarah Marshall MD - Family Medicine
Kathleen Romito MD - Family Medicine
John Pope MD - Pediatrics
Jennifer Merchant MD - Neonatal-Perinatal Medicine
Current as of: September 20, 2021
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