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Home > Wellness > Health Library > What to Expect When You Have an Extremely Premature Infant
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.
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
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.
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.
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.
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.
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.
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
intellectual disability, cerebral palsy, blindness,
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.
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:
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.
March 22, 2013
Sarah Marshall, MD - Family Medicine & Kimberly Dow, MD, FRCPC - Neonatology
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