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Charlotte Lozier Institute

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Fax: 571-312-0544

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Charlotte Lozier Institute

Phone: 202-223-8073
Fax: 571-312-0544

2776 S. Arlington Mill Dr.
#803
Arlington, VA 22206

The
Voyage of Life

Saving Extremely Premature Babies

Dive Deeper
What is the age of viability?

The age of viability is the gestational age when the fetus has a chance to live outside the womb. The youngest babies to survive have been born at 21 weeks gestation.1 By 23 weeks gestation, more than half of all extremely premature babies live.2 However, they are usually extremely small, sometimes less than a pound, and need intense medical intervention to survive.

Medical advances worldwide have made it possible to save extremely premature babies at earlier and earlier ages making the age of viability younger and younger. Years ago, doctors were surprised to save children born at 23 weeks gestation. Now, treating children at 23 weeks has become more commonplace. More than half of extremely premature infants born in the United States at 23 weeks survive, and about ¼ of babies born at 22 weeks survive.3 4 5

Currently, pioneering medical teams are attempting to save children at 21 and 22 weeks gestation. Survival rates for extremely premature infants are much higher in hospitals that have invested in special equipment and training. In fact, one hospital in Cologne, Germany specializes in treating extremely premature infants. In this hospital, over 60% of babies born at 22 weeks survive.6 By comparison, in US hospitals, only 25% of babies born at 22 weeks survive.7 Thankfully many US hospitals are investing in the technology to save these miraculous newborns.8

Medical advancements mean that extremely premature babies are more likely to survive than ever before.
Medical advancements mean that extremely premature babies are more likely to survive than ever before.
Premature baby in an incubator.  The baby's breathing, blood pressure, temperature and eating are closely monitored. (Image Credit: Science Source)
Premature baby in an incubator.  The baby's breathing, blood pressure, temperature and eating are closely monitored. (Image Credit: Science Source)

Many technological advances have increased the chance of survival for extremely premature infants. These infants’ lungs are underdeveloped. Mature lungs are full of tiny air sacs, called alveoli. Oxygen and carbon dioxide move into and out of the blood in the alveoli. The alveoli resemble balloons. To keep the alveoli from sticking shut when a person exhales, the body produces a substance called surfactant that helps the alveoli reopen.  Extremely premature infants do not produce enough surfactant, so doctors use a synthetic surfactant to help the alveoli stay open.9 10 Furthermore, doctors also help extremely premature infants create more of their own surfactant by giving the mother an injection of corticosteroids before anticipated preterm birth. The corticosteroids help the lungs mature more quickly, helping the infants breathe better outside the womb.11

Extremely premature babies often have trouble regulating their temperature, so special incubators and blankets keep them warm.12 Their blood pressure and blood flow are closely monitored, as is their nutritional intake. Special measures are taken to protect their eyes and skin from light and friction.13

Between 1998 and 2003, if a baby was born at 23 weeks gestation, she only had a 16% chance of surviving.14 Now, between 2020 and 2022, a baby born at 23 weeks gestation has a 55% chance of survival with active care.15

While premature babies face many challenges, a parent’s body can help meet them. Through kangaroo care—skin-to-skin contact—a mother or father’s body helps the baby regulate temperature, stabilize breathing and heart rate, support feeding and growth, and reduce infection risk. Starting immediately after birth and spending many hours this way leads to better outcomes.16 17

As more hospitals invest in medical equipment needed to save babies at the edge of viability, and as they train their obstetrics and neonatology teams to treat these miraculous patients, more and more of them will survive,18 19 bringing joy and hope to many families.

This premature baby girl was born at 26 weeks and 6 days gestation, weighing about 990 grams. This photo was taken about 24 hours after her birth. A mechanical ventilator helps her breathe in the neonatal intensive-care unit. (Image Credit: <a href="https://www.flickr.com/photos/ceejayoz/3579010939/" target="_blank">Chris Sternal-Johnson</a>, May 30, 2009)
This premature baby girl was born at 26 weeks and 6 days gestation, weighing about 990 grams. This photo was taken about 24 hours after her birth. A mechanical ventilator helps her breathe in the neonatal intensive-care unit. (Image Credit: Chris Sternal-Johnson, May 30, 2009)

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Back to The Voyage of Life
Sources
  1. ^ Millward, A. (2021, June 11). World’s most premature baby, given 0% odds of survival, celebrates first birthday. Guiness World Records. https://www.guinnessworldrecords.com/news/2021/6/worlds-most-premature-baby-given-0-odds-of-survival-celebrates-first-birthday-663394/.
  2. ^ Edwards, E. M., Ehret, D. E., Soll, R. F., & Horbar, J. D. (2024). Survival of infants born at 22 to 25 weeks’ gestation receiving care in the NICU: 2020–2022. Pediatrics, 154(4), e2024065963. https://doi.org/10.1542/peds.2024-065963
  3. ^ Venkatesan, T., Rees, P., Gardiner, J., Battersby, C., Purkayastha, M., Gale, C., & Sutcliffe, A. G. (2023). National trends in preterm infant mortality in the United States by race and socioeconomic status, 1995-2020. JAMA pediatrics, 177(10), 1085-1095. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2808782
  4. ^ Bell, E. F., et al. (2022). Mortality, in-hospital morbidity, care practices, and 2-year outcomes for extremely preterm infants in the US, 2013-2018. Jama, 327(3), 248-263. https://jamanetwork.com/journals/jama/fullarticle/2788142
  5. ^ Edwards, E. M., Ehret, D. E., Soll, R. F., & Horbar, J. D. (2024). Survival of infants born at 22 to 25 weeks’ gestation receiving care in the NICU: 2020–2022. Pediatrics, 154(4), e2024065963. https://publications.aap.org/pediatrics/article/154/4/e2024065963/199459/Survival-of-Infants-Born-at-22-to-25-Weeks
  6. ^ Mehler, K., Oberthuer, A., Keller, T., Becker, I., Valter, M., Roth, B., & Kribs, A. (2016). Survival among infants born at 22 or 23 weeks’ gestation following active prenatal and postnatal care. JAMA pediatrics, 170(7), 671-677. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2524795
  7. ^ Edwards, E. M., Ehret, D. E., Soll, R. F., & Horbar, J. D. (2024). Survival of infants born at 22 to 25 weeks’ gestation receiving care in the NICU: 2020–2022. Pediatrics, 154(4), e2024065963. https://publications.aap.org/pediatrics/article/154/4/e2024065963/199459/Survival-of-Infants-Born-at-22-to-25-Weeks
  8. ^ Rysavy, M. A., Li, L., Bell, E. F., Das, A., Hintz, S. R., Stoll, B. J., ... & Higgins, R. D. (2015). Between-hospital variation in treatment and outcomes in extremely preterm infants. New England Journal of Medicine, 372(19), 1801-1811. https://www.nejm.org/doi/10.1056/NEJMoa1410689
  9. ^ Polin, R. A., et al. (2014). Surfactant replacement therapy for preterm and term neonates with respiratory distress. Pediatrics, 133(1), 156-163. https://doi.org/10.1542/peds.2013-3443
  10. ^ Härtel, C., Kribs, A., Göpel, W., Dargaville, P., & Herting, E. (2024). Less invasive surfactant administration for preterm infants–state of the art. Neonatology, 121(5), 584-595. https://doi.org/10.1159/000540078
  11. ^ McGoldrick, E., Stewart, F., Parker, R., & Dalziel, S. R. (2020). Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane database of systematic reviews, (12). https://pmc.ncbi.nlm.nih.gov/articles/PMC6464568
  12. ^ Dunne, E. A., O’Donnell, C. P., Nakstad, B., McCarthy, L. K., & European Society for Paediatric Research (ESPR) Neonatal Resuscitation Section Writing Group. (2024). Thermoregulation for very preterm infants in the delivery room: a narrative review. Pediatric Research, 95(6), 1448-1454. https://www.nature.com/articles/s41390-023-02902-w
  13. ^ Tang, W., Gao, T., Cao, Y., Zhou, W., Song, D., & Wang, L. (2022). Narrative review of perinatal management of extremely preterm infants: what’s the evidence?. Pediatric Medicine, 5. https://pm.amegroups.org/article/view/6498/html
  14. ^ NICHD calculator from 1998-2003 available at https://neonatal.rti.org/index.cfm?fuseaction=calculator.start
  15. ^ Edwards, E. M., Ehret, D. E., Soll, R. F., & Horbar, J. D. (2024). Survival of infants born at 22 to 25 weeks’ gestation receiving care in the NICU: 2020–2022. Pediatrics, 154(4), e2024065963. https://publications.aap.org/pediatrics/article/154/4/e2024065963/199459/Survival-of-Infants-Born-at-22-to-25-Weeks
  16. ^ Lawn, J. E., Mwansa-Kambafwile, J., Horta, B. L., Barros, F. C., & Cousens, S. (2010). Kangaroo mother care to prevent neonatal deaths due to preterm birth complications. International journal of epidemiology, 39(suppl_1), i144-i154. https://doi.org/10.1093/ije/dyq031
  17. ^ Sivanandan, S., & Sankar, M. J. (2023). Kangaroo mother care for preterm or low birth weight infants: a systematic review and meta-analysis. BMJ Global Health, 8(6). https://gh.bmj.com/content/8/6/e010728
  18. ^ Mehler, K., Oberthuer, A., Keller, T., Becker, I., Valter, M., Roth, B., & Kribs, A. (2016). Survival among infants born at 22 or 23 weeks’ gestation following active prenatal and postnatal care. JAMA pediatrics, 170(7), 671-677. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2524795
  19. ^ Edwards, E. M., Ehret, D. E., Soll, R. F., & Horbar, J. D. (2024). Survival of infants born at 22 to 25 weeks’ gestation receiving care in the NICU: 2020–2022. Pediatrics, 154(4), e2024065963. https://publications.aap.org/pediatrics/article/154/4/e2024065963/199459/Survival-of-Infants-Born-at-22-to-25-Weeks
Learn more about Gestational Age

Credentialed scientists reviewed all the material on The Voyage of Life for accuracy. Ages are listed in gestational weeks, measured from the first day of the mother’s last menstrual period, unless otherwise noted. This standard medical practice differs from post-conception age, used by embryologists and medical textbooks cited here, which starts at conception, about two weeks later.

Medical art animation was used to provide a schematic representation of fetal development, with some features, including timing, not to scale. The animation was chosen as an ethically uncompromised guide to fetal development. There are many real human images at each developmental age showing the most accurate fetal forms throughout development. A concerted effort was made to use images and material in which the human embryo or fetus did not undergo any known harm.

Page last updated on August 10, 2026