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.