1. Section Editor(s): STOKOWSKI, LAURA A. RN, MS

Article Content

One of the most difficult situations in neonatology is counseling parents about potential survival and long-term disability in extremely premature infants (22-25 weeks' gestation). Many parents consider this information when expressing their wishes regarding intensive care or comfort care for their extremely premature infants.


Gestational age is traditionally the primary, or even only, factor used to estimate an infant's chances of survival and permanent disability.1 Gestational age, however, can be difficult to assess accurately. For this reason, researchers conducting a National Institutes of Health study, led by Jon E Tyson, MD, of the University of Texas Medical School at Houston, observed 4446 extremely low birth-weight infants born at level III centers until they reached 18 to 22 months' corrected age.2 Published in the New England Journal of Medicine, this study identified 4 factors (in addition to gestational age) that can be used to estimate the likelihood of a favorable outcome with intensive care: gender, birth weight, whether infant was a single or one of multiples, and whether or not the mother was given antenatal steroids.2


These data have now been made available to assist healthcare providers and families who are considering the most appropriate treatment options for extremely low birth-weight infants. A simple-to-use online tool prompts users to enter known characteristics (best obstetric estimate of gestational age in completed weeks, birth weight, sex, singleton or multiple birth, and whether antenatal steroids were given within 7 days before delivery).3 The tool then generates estimated outcomes (eg, chances of survival and survival without moderate, severe, or profound neurodevelopmental impairment) for all infants and for mechanically ventilated infants.3


Users are reminded that these data are not intended to predict individual outcomes but to provide a range of possible outcomes based on specific characteristics. Furthermore, the statistics apply only at the time of birth and may not apply to infants born at level I or level II facilities.




1. Eunice Kennedy Shriver National Institutes of Child Health and Human Development. NIH study reveals factors that influence premature infant survival, disability. NIH News. Published April 16, 2008. Accessed May 9, 2008. [Context Link]


2. Tyson JE, Parikh NA, Langer J, Green C, Higgins RD. Intensive care for extreme prematurity: moving beyond gestational age. N Engl J Med. 2008;358:1672-1681. [Context Link]


3. NICHD Neonatal Research Network. Extremely preterm birth outcome data [online tool]. Accessed May 9, 2008. [Context Link]