Can Babies Survive at 22 Weeks or 23 Weeks?


The viability limit for pre-term babies continues to get lower as technology and hospital processes improve. The current guidance in the US is to recommend resuscitation for babies born at 24 weeks and to only consider resuscitation for those born at 22 and 23 weeks. Many U.S. hospitals decide not to treat these very young babies. However, there is some interesting international data on survival rates of babies delivered at 22 and 23 weeks.

Survival rates for babies alive at birth, with active/NICU treatment
Country in which study occurred
22-week live birth
23-week live birth
Dates
Germany[1]
61%
71%
2010 - 2014
Sweden[2]
58%
66%
2014 - 2016
UK[3]
54% (NICU)
35% (active)
45% (NICU)
38% (active)
2016
USA[4]
39% (active treatment, including antenatal steroids)
55% (active treatment, including antenatal steroids)
2012 - 2016

These rates can give us a lot of hope. 

For an individual baby, there is no way to know whether the child will have any disabilities; they may grow up and be perfectly healthy or only have mild impairment. A majority will not have any severe disabilities; the British Association of Perinatal Medicine reports that 2/3 of 22-week babies will NOT have a severe disability, and 3/4 of 23-week babies will NOT [3]. 

Parents should insist on intensive treatment for their babies as soon as they're born (a level III NICU is best). If doctors say no, parents can show them the survival rates in the table above. 

If parents do not feel ready to handle a child who MIGHT have a disability (the doctors really don't know, and plenty of children born at this age are now fine), they can always place the child with a loving family who is ready. 

There were 4,596 22-week and 23-week babies born alive in the US in 2017 (1,829 and 2,767 babies, respectively).[6] Extrapolating from the US data in the table above, active treatment could result in an estimated 713 22-week babies and 1,522 23-week babies surviving per year.

The youngest baby to survive was 21 weeks and 4 days; she is alive and well.[7]

The treatment guidelines given in the German study listed above are as follows:

"Key Features of Active Prenatal and Postnatal Care at University of Cologne Medical Centre.

Use of prenatal steroids after parental counseling from 22 weeks of gestation

Cesarean delivery with local anesthesia as preferred mode of delivery

Delayed cord clamping

Comfort positioning (lateral) of the infant

Establishment of spontaneous breathing via a stepwise increase in positive end-expiratory pressure

Less invasive surfactant application (LISA)" [1]


[1] Survival Among Infants Born at 22 or 23 Weeks’ Gestation Following Active Prenatal and Postnatal Care. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2524795
[2] Association Between Year of Birth and 1-Year Survival Among Extremely Preterm Infants in Sweden During 2004-2007 and 2014-2016. https://www.ncbi.nlm.nih.gov/pubmed/30912837
[3]New BAPM Framework on Extreme Preterm Birth Published. https://www.bapm.org/posts/109-new-bapm-framework-on-extreme-preterm-birth-published
[4] Association of Antenatal Steroid Exposure With Survival Among Infants Receiving Postnatal Life Support at 22 to 25 Weeks’ Gestation. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2706493
[5] Between-Hospital Variation in Treatment and Outcomes in Extremely Preterm Infants. https://www.nejm.org/doi/full/10.1056/NEJMoa1410689

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