Of 7 tertiary care centers in Sweden, the University Hospitals in Uppsala and Umeå have consistently had an aggressive approach to the treatment of newborns with gestational age (GA) of < 25 weeks.

From Jan 1992 to June 1996, 63 infants were born alive at 23 and 24 weeks at these 2 centers. Twentytwo infants were born at 23 weeks, 41 at 24 weeks; 40 were males and 23 females. 36% (21/58) of the mothers were delivered by cesarean section (CS), in 38% (8/21) on fetal indications. Antenatal steroids were given to 48% (29/58) of the mothers, 24% (14/58) received a complete course. The mean (SD) birth weight (BW) was 645 (111) g. Of all infants 61%(37/61) had a heart rate of < 100 per min at birth. The mean (SD) Apgar scores at land 5 min were 4.2 (2.0) and 6.4 (1.8), respectively. All infants were resuscitated. There were no delivery room deaths and all were admitted for intensive care. All but 2 infants (both survived) required mechanical ventilation. Of the cohort 94% (54/63) were alive at 8 hours, 83% (52/63) at 24 hours, 68% (43/63) at 7 days and 54% (34/63) at 28 days; 49% (31/63) were discharged to home alive. The survival rate of infants born at 23 weeks was 36% (8/23), at 24 weeks 56% (23/41), of males 40% (16/40) and of females 65%(15/23). The mean (SD) GA and BW did not differ significantly between infants who survived (GA 23.7 (0.7) weeks; BW 650 (106) g) and infants who died (GA 23.5 (0.6) weeks; BW 642 (116) g). The mean (SD) Apgar scores at land at 5 min were marginally higher in survivors.

Of the 31 surviving infants, one infant had intraventricular hemorrhage grade 3 or more (IVH), 3 had retrolental fibroplasia stage 3 or worse (ROP) and 26% required supplemental oxygen at 36 weeks of postconceptional age(BPD). One infant received kryotherapy, none was blind or discharged home on supplemental oxygen. Of surviving infants, 83% (24/29) were discharged home without IVH, ROP or BPD.

To conclude: A significant number of infants born at 23 or 24 weeks survive. Survival is superior in females. Most infants require intensive resuscitation. It seems impossible to predict at the time of birth which infants will ultimately survive. The low incidence of IVH, ROP and BPD among survivors is encouraging.