SURVIVAL AT THE BORDERLINE OF VIABILITY (22-24 WEEKS). 1484:

With parental informed consent 38 of 49 infants of 22-24 weeks have been treated intensively at our institution during 1990-94. Of the 49, 17 (35%) survived. Mean weights were 650g (survivors) and 539g (deaths). Survival rates were higher at 24 than 22 weeks (53% vs 23%), with higher Apgar scores (53% vs 16%), and when a full course of steroids was given (63% vs 21%). Survival was not influenced by route of delivery, nor by infant sex. Mean hospital stay in survivors was 129 days, discharge at 42 weeks. Deaths mainly occurred day 1, only 1 after 2 weeks. Deaths were due to failure to initiate breathing (11), infection, usually I.U. (10), RDS (7), pul. hypoplasia (3), and BPD (1). Grade IV IVH developed in 4, 1 survived. Surfactant was used in 10 cases, 3 survived. Among 17 survivors, treatment included IPPV (17-aver 54d), IV nutrition (17- aver 64 d), dexamethasone (10), indomethacin for PDA (9, with 6 later ligated), insulin (7) and cryotherapy for ROP (3). Followup of 16/17 survivors showed 4 severely, 3 mildly and 9 not impaired. Hydrocephalus and cerebral palsy were not significant problems. Conclusion: It is now possible to achieve 35% survival at 22-24 weeks with 75% of survivors functioning well later.