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Survival and Neurodevelopment of Periviable Infants.

To the Editor: Younge et al. (Feb. 16 issue)1 report changes over time in survival and neurodevelopmental outcomes among infants born at 22 to 24 weeks of gestation. Although the overall percentage of infants born at 22 to 24 weeks of gestation who survived without neurodevelopmental impairment increased from 16% to 20%, only 1% and 13% of infants born at 22 and 23 weeks, respectively, survived without neurodevelopmental impairment. In the context of the uncertain long-term outcomes in periviable infants, considerable ethical dilemmas have arisen for physicians and parents when considering whether to resuscitate extremely preterm neonates.2,3 The decision to resuscitate should rely on an impartial assessment of the potential long-term benefits and harms to the infant, with the very high rates of death, disability, and complications taken into account.2,3 A systematic review of 34 national and international guidelines for the care of extremely premature infants showed that no guideline recommended active care at 22 weeks.4 With the knowledge that 87 to 99% of infants born at 22 to 23 weeks of gestation will either not survive or survive with neurodevelopmental impairment,1 how ethical is it to attempt resuscitation in these infants? In addition, given these rates, how justified are the high costs associated with resuscitating these extremely premature infants?5 Despina D. Briana, M.D., Ph.D.