Survival of Extremely Premature Infants Possible, Improving

Charles A. “Chuck” Donovan  

In a new video released by commentator William Saletan at Slate magazine, the author critiques videos released by the activist group Live Action regarding clinics that perform late-term abortions.  In those videos, Live Action shows interactions between women whose pregnancies are in the range of 23 completed weeks of gestation.  Saletan critiques the editing of the video to omit points he argues show the clinics in a more favorable light, then states, “Here’s the big thing… even if you didn’t administer an injection, that kills the fetus inside the womb, which nearly all of these clinics do, the mere expulsion of the fetus, even at 21, 22, or 23, weeks is, itself, fatal.  That fetus is not prepared to survive the womb.”


What do established sources say about the survival rates of babies born at various stages of gestation?  These rates are a product of many factors, including the child’s weight, whether the mother took drugs to aid lung development with foreknowledge of an extremely premature birth, the proximity of the prematurely delivered baby to a neonatal intensive care unit and the technical skill of its treatment team.  The Lozier Institute will publish more on this subject in the future but here is one source, the   Eunice Kennedy Shriver National Institute of Child Health and Human Development on the outcomes with babies born in the 22-25 week range in terms of gestation (note that these rates acknowledge that a range of disability occurs in babies born at these ages and that the disabilities decline in both incidence and severity as the gestational age at delivery increases).


Outcomes Only for Mechanically Ventilated Infants in the Sample

Gestational Age
(In Completed Weeks)
Death Before
NICU Discharge
Outcomes at 18 to 22 Months Corrected Age**
Death Death/ Profound
Death/Moderate to Severe Neuro-
developmental Impairment
22 Weeks 79% 80% 90% 95%
23 Weeks 63% 63% 76% 87%
24 Weeks 40% 41% 55% 70%
25 Weeks 23% 24% 37% 54%

**For mechanically ventilated infants, determination of Death/Profound Neurodevelopmental Impairment and Death/Moderate to Severe Neurodevelopmental Impairment based on 3,421 infants whose outcomes were known at 18 to 22 months corrected age; determination of Death based on a denominator of all 3,702 cohort infants.


Fetal development information compiled by the Mayo Clinic acknowledges that, at 23 weeks’ gestation, “With intensive medical care, some babies born this week might be able to survive.”  Thus, even with the application of mechanical ventilation in an effort to save the live of the extremely premature baby, 79 percent will die before discharge from the Neonatal ICU.  But for the extremely premature baby at 23 weeks the corresponding number is 63% and at 24 weeks it is 41%.  Specialists in the treatment of premature and extremely small neonates cite the thumbnail that over the past 40 years the survivability  for these children has improved by approximately one week each decade.  It is not a fixed number.


Saletan is correct that roughly 1 percent of U.S. abortions are done at these late stages of pregnancy, but the state of U.S. abortion reporting and the likelihood that these late-term abortions are not fully reported must be factored into the assessment.  Even at 1% there would be some 12,000 infants a year in the United States born near, at or after a stage of significant survivability.


Finally, if Saletan were correct that babies in this gestational range cannot and do not survive, there would be no justification for subjecting the woman to the injection of digoxin or another lethal medicine in the first place.  Induction of labor would certainly accomplish the objective of fetal demise.  It is to assure that outcome, or spare the mother the sight and/or sound of her child struggling for life and breath, that prompts the administration of a lethal injection through her addominal wall.


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