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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

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. About ⅓ of extremely premature infants born in the United States at 23 weeks survive.1

21
Weeks
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. By comparison, in US hospitals, only 20% of babies born at 22 weeks survive. Thankfully many US hospitals are investing in the technology to save these miraculous newborns.2
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.3 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.4

Extremely premature babies often have trouble regulating their temperature, so special incubators and blankets keep them warm. 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.5

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,6 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: Chris Sternal-Johnson, May 30, 2009)
Back to The Voyage of Life
Sources
  1. Stoll, B.J., Hansen, N.I., Bell, E.F., Walsh, M.C., Carlo, W.A., Shankaran, S., Laptook, A.R., Sánchez, P.J., Meurs, K.P.V., Wyckoff, M., et al. (2015). Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993-2012. JAMA 314, 1039–1051.
  2. Katrin Mehler et al., “Survival Among Infants Born at 22 or 23 Weeks’ Gestation Following Active Prenatal and Postnatal Care,” JAMA Pediatrics 170, no. 7 (July 1, 2016): 671–77, https://doi.org/10.1001/jamapediatrics.2016.0207; Matthew A. Rysavy et al., “Between-Hospital Variation in Treatment and Outcomes in Extremely Preterm Infants,” New England Journal of Medicine 372, no. 19 (May 7, 2015): 1801–11, https://doi.org/10.1056/NEJMoa1410689; https://www.nichd.nih.gov/research/supported/EPBO
  3. Richard A. Polin, Waldemar A. Carlo, and Committee on Fetus And Newborn, “Surfactant Replacement Therapy for Preterm and Term Neonates With Respiratory Distress,” Pediatrics 133, no. 1 (January 1, 2014): 156–63, https://doi.org/10.1542/peds.2013-3443.
  4. Soraya Abbasi et al., “Antenatal Corticosteroids Prior to 24 Weeks’ Gestation and Neonatal Outcome of Extremely Low Birth Weight Infants,” American Journal of Perinatology 27, no. 1 (January 2010): 61–66, https://doi.org/10.1055/s-0029-1223269; Julian Vyas and Sailesh Kotecha, “Effects of Antenatal and Postnatal Corticosteroids on the Preterm Lung,” Archives of Disease in Childhood - Fetal and Neonatal Edition 77, no. 2 (September 1, 1997): F147–50, https://doi.org/10.1136/fn.77.2.F147.
  5. Cloherty, John P, Eric C Eichenwald, and Ann R Stark. Manual of Neonatal Care. 8th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2017.
  6. Mehler et al., “Survival Among Infants Born at 22 or 23 Weeks’ Gestation Following Active Prenatal and Postnatal Care”; Barbara J. Stoll et al., “Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993-2012,” JAMA 314, no. 10 (September 8, 2015): 1039–51, https://doi.org/10.1001/jama.2015.10244.
See Full Bibliography

All images and illustrations on The Voyage of Life were reviewed by credentialed scientists for accuracy.

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 June 6, 2023