Perhaps you’re facing a high-risk pregnancy, or you’re pregnant after a previous loss, and now you’re wondering how early a premature baby can be born and survive.
If you are facing difficulties in your pregnancy, it’s understandable that you constantly check your calendar.
You might find yourself wishing the days would turn into weeks, and weeks quickly turn into months.
What’s the earliest a baby can be born and survive?
Like many women who face a high-risk pregnancy, or experience anxiety, when you reach the 13th week of pregnancy you’ll feel a sense of relief. You’ve achieved the first big milestone, and the risk of miscarriage is reduced.
After that, you might start to wonder at what week a baby can be born and survive. Certainly, no one hopes to have a premature baby.
If you’re facing a high-risk pregnancy, reaching a week where baby can survive brings a little more relief.
And then, with every week that follows, you breathe a little easier, knowing the short and long-term odds improve with each passing day and week.
At what week in pregnancy can a baby survive outside the womb?
The earliest a baby has been born and survived is 21 weeks and 5 days. Two premature babies hold the record for this.
Surprisingly, the first record holder was born in 1987, a time when the medical care of premature babies (neonatology) was a very new field.
However, this is well before the accepted age of viability. Usually, the earliest a baby can survive is about 22 weeks gestation. The age of viability is 24 weeks.
At 22 weeks, there’s a 0-10% chance of survival; at 24 weeks the survival rate is 40-70%.
What does ‘age of viability’ mean?
What does it mean when a 22-week baby can survive but isn’t considered to be at the age of viability?
The age of viability is based upon a survival rate of at least 50%. This means there are good odds a baby can survive with medical support.
Although some 22- and 23-weekers do quite well, because fewer than 50% survive, the age of viability is still considered to be 24 weeks.
Some hospitals are not equipped or don’t routinely attempt, to treat 22- or 23-weekers, and only offer palliative-type care.
In the US and many other countries, 24-week babies must be given treatment if they survive birth.
With advancements in medical technology, some experts are calling for more 22- and 23-weekers to be given a chance at survival.
Some believe the reason for such low survival rates is simply that these babies aren’t treated. For now, however, the age of viability remains at 24 weeks.
What is the survival rate at each gestational week?
There are many variables that come into play for individual preemies and their survival. The reason for prematurity – congenital conditions, prenatal care, etc. – can affect the outcome for a premature baby.
Current data shows the following rates for preemies at each gestation:
- 21 weeks or less: 0%
- 22 weeks: 0-10%
- 23 weeks: 10-35%
- 24 weeks: 40-70%
- 25 weeks: 50-80%
- 26 weeks: 80-90%
- 27 weeks: more than 90%
- 28 weeks: 92% or more
- 29 weeks: 95% or more
- 30 weeks: more than 95%
- 31 weeks: more than 95%
- 32 weeks: 98%
- 33 weeks: 98%
- 34 weeks: 98% or more
For gestations under 24 weeks, some of the variations in percentages are due to different standards, or availability, of treatment for those born at these early gestations. Smaller community hospitals might not be equipped to treat micro-preemies.
If you’re facing a high-risk pregnancy, an important part of your care will involve doing some research into which hospitals have the highest level Newborn Intensive Care Unit (NICU).
For more detailed information, week by week, be sure to read Premature Survival Rates By Week.
What’s the earliest a baby can be born and be healthy?
Babies born at 24 weeks have a high chance of survival, but what’s their long-term prognosis?
Many variables are involved; all of them have an impact on a premature baby’s short and long term health.
If babies are born early due to an infection or congenital health problem, they might be more likely to face complications, compared with babies who aren’t dealing with infection or health problems.
Prenatal care and treatment also play a role. If a woman is at obvious risk for preterm birth prior to 34 weeks, two steroid injections given 24 hours apart can greatly improve her baby’s lung development. Magnesium given via IV can also offer neuroprotection for infants born under 32-34 weeks gestation.
Both steroid injections and magnesium can improve a baby’s short and long-term health. However, each baby is a unique individual.
In some cases, a newborn baby is given a dose of surfactant, which can help with lung function. A variety of other medications might be given to improve a baby’s immediate health and, in some cases, to improve long-term health.
For example, some babies are given caffeine to help treat apnea of prematurity. A recent study found that premature babies treated with caffeine in the NICU had improved lung function at age 11, compared with preemies not treated with caffeine.
Statistically, the earlier a baby is born, the greater chance of short and long-term complications. Some 22- to 23-weekers have minimal health and developmental complications; others have severe health problems.
The same can also be said for later premature babies, although the risk of severe complications is reduced with each passing week in utero.
How do gestational age and size affect health?
Now that even the earliest premature babies can survive birth, we have more long-term statistics available. As mentioned above, every baby is unique. Statistics simply give parents a better idea of what they might experience; they do not provide any guarantees.
Some current statistics show:
- 66% of babies under 1.25 kg developed ROP (retinopathy of prematurity – a vision-related problem), but only 6% required treatment.
- About 25% of babies with a birth weight below 1.5 kg have a hearing impairment.
- Children with an extremely low birth weight have more hospital admissions throughout childhood than those with typical birth weight. Respiratory illness is one of the most common reasons for admission.
- One study found that in children aged 7-8 who were born before 32 weeks, 30% had a developmental coordination disorder, compared with 6% of children born at term.
- Premature infants have higher rates of motor delays and, even if they have normal intelligence, it can affect how well they do at school.
You can read more about these statistics, including links to the studies mentioned, on the Patient website.
If you are a parent facing a preterm birth, or if you’re already the parent of a premature baby, you might find these statistics scary to read. It’s important to remember, however, statistics provide us with information we can use to make informed choices and to be prepared.
What can be done to help?
Because we know preterm infants are at risk for vision and hearing problems, examinations are done routinely. This is done to make sure necessary treatment is given, to minimise risk, and so that therapies to manage effects can be started.
Because of the known risk of coordination and motor delays, and behavioural complications, it’s important to work with early intervention programs, and provide physical and occupational therapy, as soon as possible. This can reduce the risk of the infant experiencing delays, or help manage and minimise their effects.
Neuroplasticity is an amazing thing. With proper treatment and therapy, underdeveloped or damaged brains can still do incredible things. Many premature babies are a testament to early intervention. Their parents had been told of potential limitations, but the children went on to exceed expectations.
Although statistics show a premature baby is at risk for health and behaviour complications, other studies show many preemies do quite well. A recent study found that by kindergarten age, most preemies were ready for school, just like their term peers.
Be sure to read Premature Babies – What To Expect Week By Week for more detailed information about each gestational week.
What do parents need to know?
It’s important to know that every baby is a unique individual. It’s also important to know that every pregnancy is unique. If you are high risk or have previously experienced a loss or preterm birth, it doesn’t mean you’ll have the same experience again.
The most important thing is to be sure you have adequate and regular prenatal care. If you’re at risk, or feel at risk, make sure you work with a provider you trust, and one with whom you can keep an open line of communication.
If you feel you’re at imminent risk of preterm birth, always contact your midwife or doctor immediately, or head to the nearest hospital. Stalling or stopping labour can allow time for steroids, magnesium, and other medications to improve the odds for you and your baby.
If you have a premature baby, or you are likely to have one, there are many things you can do to help reduce their short and long-term risks, such as:
- Know the signs of preterm labour.
- Try to provide your baby with breastmilk to improve short and long-term health, reduce the risk of infections, and improve cardiovascular health.
- Use positive touch as early and as often as you can – in the NICU and when you go home. It is vital for helping brain development.
- Practise kangaroo care to bond with your baby, improve development, help with milk supply, and more.
- Work with early intervention therapists. You can do this during the NICU stay (primarily through positioning and feeding skills), and after discharge. The earlier a child works with the necessary therapists (occupational, physical, speech, etc.) the better the outcome.
- In the US, early intervention is provided through your state. Learn more on the CDC website, by clicking on your state.
- In Australia, visit the ECIA website for more information.
Facing a preterm birth can be scary. However, with today’s medical technology and an understanding of the importance of early learning support, many premature babies do quite well.
Be sure to check out Photo Series Celebrates The Strength Of Premature Babies to see just how well many premature babies do.
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