Many women, especially those who are anxious after a past pregnancy loss, breathe a sigh of relief after the pregnancy reaches the point at which the baby would be able to survive if born early. What point, though, is that really? The answer is somewhat complicated.
Most doctors define the age of viability as being about 24 weeks of gestation. In many hospitals, 24 weeks is the cutoff point for when doctors will use intensive medical intervention to attempt to save the life of a baby born prematurely.
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.
Experts said 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.
It was gathered that 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 is not clear whether treatment will help an infant live—with or without disability—or will only make the dying process take longer.
In Nigeria, fewer than 1 percent of babies are born earlier than 28, but these babies have the most complications.
Most of these babies are born at extremely low birth weight. Almost all require treatment with oxygen, surfactant, and mechanical assistance to help them breathe.
These babies are too immature to suck, swallow, and breathe at the same time, so they must be fed through a vein (intravenously) until they develop these skills. They often can’t yet cry (or you can’t hear them due to the tube in their throat), and they sleep most of the day. These tiny babies have little muscle tone, and most move very little.
Babies born at this time look very different than full-term babies. Their skin is wrinkled and reddish-purple in colour and is so thin that you can see the blood vessels underneath. Their face and body are covered in soft hair called lanugo. Because these babies haven’t had time to put on fat, they appear very thin. Most likely, their eyes are closed and they have no eyelashes.
These babies are at high risk for one or more medical complications. However, most babies born after about 26 weeks’ gestation do survive to one year (about 80 percent of those born at 26 weeks and about 90 percent of those born at 27 weeks), although they may face an extended stay in the neonatal intensive care unit, NICU.
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.
The experts said in the hands of experienced specialists, though, babies born slightly earlier may have a chance at survival. Babies born at 23 weeks may survive with these specialists in a state-of-the-art NICU, but the odds of survival are much lower. The earliest baby to have ever survived premature birth was born at 21 weeks and 6 days, and this was reported in the news as having been a “miracle.”
Odds of survival increase as the pregnancy progresses, and even an extra week in the womb can make a difference. In general, premature babies born closer to 37 weeks will be much better off than those born before 28 weeks.
However, the World Health Organization estimates 15 million babies are born premature every year — and every year, almost a million of these babies die from complications. The survival rate, however, may vary depending on the type of treatment or care provided after birth, according to a new study published in The New England Journal of Medicine.
“We were interested in the differences in outcomes that exist for the earliest preterm infants among US academic medical centres,” Matthew A. Rysavy, study author, said in a press release. “There are large differences in outcomes, like mortality and childhood delays and disabilities, and we looked at this variation and wanted to understand why it exists.”
A study also revealed that of thousands of premature births, found that a tiny minority of babies born at 22 weeks who were medically treated survived with few health problems, although the vast majority died or suffered serious health issues. Leading medical groups had already been discussing whether to lower the consensus on the age of viability, now cited by most medical experts as 24 weeks.
For most parents and doctors, the new study will intensify the agonizing choices faced about how intensively to treat such infants.
The study, one of the largest and most systematic examinations of care for very premature infants, found that hospitals with sophisticated neonatal units varied widely in their approach to 22-week-olds, ranging from a few that offer no active medical treatment to a handful that assertively treat most cases with measures like ventilation, intubation and surfactant to improve the functioning of babies’ lungs.
“It confirms that if you don’t do anything, these babies will not make it, and if you do something, some of them will make it,” said Dr. David Burchfield, the chief of neonatology at the University of Florida, who was not involved in the research. “Many who have survived have survived with severe handicaps.”
Explaining on what fast decision to be taken when a baby is born prematurely, experts said if the baby cannot 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 does not work or is not 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.
They, however, said that the matter is not always as simple as being past a particular point in the pregnancy at the time of the birth. Multiple factors can play into whether or not a baby will survive premature birth, for example, the baby’s birth weight.
Low birth weight is independently linked to reduced odds of survival and a higher risk of disabilities and health problems.
In addition, if the early birth resulted from induction or C-section due to a medical condition, such as placental abruption, the effects of that condition can affect the baby’s health and survival also — such as if there was oxygen deprivation before the delivery.
Another factor can be if doctors had time before the birth to treat the baby with steroids to speed up lung development. The patient/mother gets the steroids, which then pass through the placenta to the fetus. A very premature baby treated with steroids before birth is more likely to survive than a baby born premature unexpectedly, because the steroids can make a difference in whether or not the baby is able to breathe outside the womb.
Girls may also be more likely to survive very early premature birth, as are babies born in singleton vs. multiple pregnancies.