Discussion
Infants born at periviability at 22–25 weeks of gestation could
potentially survive with active support. However, their risk for
mortality and morbidity is high. Furthermore, the survival of extremely
preterm newborns has increased steadily during the last decade due to
advances in intensive care and the greater willingness of obstetric and
neonatal care providers to provide active care.3-7
The risk of severe disability increases with increasingly extreme
preterm births. Among actively managed infants, the rate of severe
disability is approximately one in seven at 24 weeks gestation, one in
four at 23 weeks gestation, and one in three at 22 weeks gestation.
Patients born at 22 and 23 weeks of gestation have a higher risk of
severe disability, even though data for babies at 22 weeks is based on
small numbers.5,8-10
Absolute survival and survival without severe impairment have been
associated with protective factors. These include, but are not limited
to, exposure to antenatal corticosteroids, female sex, singleton birth,
higher birth weight, and an advanced clinical setting with experienced
staff. However, the decision to administer intensive care at the lower
end of viability between 22–23 weeks gestational age is challenging for
clinicians and parents due to variable and complex ethical components
and institutional practices and policies.5,11
Risk assessment and effective parental counseling should be undertaken,
including explaining the risks and aiding in decision-making. The family
needs support to help them understand the expected outcomes, bearing in
mind that each case is individualized, and the parents’ wishes should be
considered in the decision to resuscitate.