Premature babies have a better chance of surviving with fewer health complications now than they did 20 years ago. However, the survival rates for the earliest babies have not improved much. Extremely premature babies are the ones born between 22 and 28 weeks of pregnancy who weigh as little as just below a pound.
What Helps the Babies?
A study published in the Journal of the American Medical Association looked at the medical records for more than 34,600 babies born between 1993 and 2012 at 26 different academic medical centers in the United States.1 All were born at 22 to 28 weeks of pregnancy and weighed between 401 and 1500 grams (14 ounces to 3.3 pounds).
The study found that the survival rate has risen modestly from 70% in 1993 to 79%, primarily because premature babies are receiving more treatments and interventions to keep them alive and to prevent or minimize later health problems. Two treatments have had a large impact on survival. When a mother is in danger of delivering a very premature baby, she is treated with steroids that help the baby’s lungs develop faster. This reduces the risk of lung problems after birth. If a premature birth cannot be delayed any longer, the baby is delivered by cesarean section, which may be safer for very fragile, premature infants than a vaginal delivery.
Longer is Better
The study showed how keeping a pregnancy going even if only for a week or two longer can help improve overall survival rates for very premature babies. The longer the pregnancy lasts, the more likely it is for the baby to survive and to be healthy.2
The biggest improvements in survival are for the babies who remained in the womb longer, those born at 28 weeks or later. Their chances of going home from the hospital with no lasting health problems rose from 43% to 59% between 1993 and 2012.
Serious Health Problems Continue
However, the earliest and smallest of these babies usually have serious health problems when they do survive. Babies born before the 25 week of pregnancy, if they survive, are more likely to have continuing health problems such as poor vision, brain damage from bleeding in the brain, and chronic lung problems. About 90% of babies born before week 25 who survive have health problems. This rate did not improve over the course of the study.
In 1993, 6% of babies in the study born at 22 weeks survived long enough to leave the hospital, compared to 9% in 2012. Of the 1,550 infants born at 22 weeks only 99 survived until at least hospital discharge, and only five had no major complications.
About one in 10 babies is born prematurely, according to the March of Dimes, whose mission is to prevent premature birth. A premature birth is one where the baby is born more than three weeks before the expected due date, or before week 37 of the pregnancy. We don’t know why many women go into labor prematurely. But we do know that every week counts and longer (up to 42 weeks) is better.
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- Stoll BJ, Hansen NI, Bell EF, et al.: Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA. 2015;314(10):1039-1051.
- Preemies’ survival rates improve, but many challenges remain.