Research published ahead of print in the Fetal & Neonatal Edition of Archives of Disease in Childhood indicates that despite lengthier active resuscitation of very preterm babies over the past 15 years, their survival rates have not improved.

The findings are based on a case note review of babies born between 1993 and 2007, in one region in the north of England. All the babies were born alive after 22 or 23 completed weeks of pregnancy.

There were a total of 480,662 live births during the study period. Of these, 229 babies were born at 22 or 23 weeks. This time point is considered to be at the “margins of viability.”

Records indicate that a total of 210 of these babies died. One in three (34 percent) of lived for more than six hours. The length of time they lived gradually increased between 1993 and 2007.

The average survival of those who were actively resuscitated but died, was:

• 11 hours from 1993 to 1997
• 20 hours from 1998 to 2002
• 3.7 days from 2003 to 2007

In the last five years of the trends analysis, the accompanying documentation clearly showed the types of treatment given to these very premature babies.

Forty six out of seventy seven babies (60 percent) were actively resuscitated, forty three of whom survived for at least six hours. Ten of these babies underwent surgery.

The authors explain that these figures indicate that babies born at 22 to 23 weeks are receiving more active treatment. Also they remained for a significantly longer time in intensive care. However, the outcome is still the same.

As time went on, there was little evidence that a greater number of babies survived. Among the total of nineteen survivors over the study period:

• Six survived between 1993 and 1997
• Six survived between 1997 and 2002
• Seven survived between 2003 and 2007

The authors draw attention to the fact that survival rates for babies born at 24 weeks and above have increased. This may be the reason why those born under 24 weeks are increasingly being actively treated as well.

The authors note that despite guidelines, the cut off point for providing active treatment for those born under 24 weeks remains “extremely contentious.” In addition, parents push for treatment.

“Our local (anecdotal) experience is that most parents request an active approach immediately after delivery at 23 weeks’ gestation, despite counseling from experienced clinicians using nationally consistent survival data,” the authors comment.

“Survival in infants live born at less than 24 weeks’ gestation: the hidden morbidity of non-survivors”
Ravi Swamy, Sitikant Mohapatra, Mary Bythell, Nicholas D Embleton
Arch Dis Child Fetal Neonatal Ed 2010;
doi 10.1136/adc.2009.171629
Archives of Disease in Childhood

Written by Stephanie Brunner (B.A.)