Extremely Preterm Infants

Classification and Survival Rates

The World Health Organization (WHO) classifies infants born before 28 weeks of gestation as extremely preterm, with a neonate of 27 weeks falling into this category 1
Extremely preterm infants have significantly better survival rates than those born before 24 weeks, with survival rates to discharge ranging from 23-27% at 23 weeks, 42-59% at 24 weeks, 67-76% at 25 weeks, and a better prognosis at 27 weeks 1

Extremely preterm infants are at high risk of complications, including respiratory problems, neurological alterations, ophthalmological issues, and gastrointestinal problems 1

The American Academy of Pediatrics recommends that extremely preterm infants, such as those born at 27 weeks, receive care in level III or IV units, with availability of neonatologists, specialized nurses, and respiratory therapists 24 hours a day, and capacity for prolonged assisted ventilation and advanced physiological monitoring 2
The decision on interventions and resuscitation should consider multiple factors, including gestational age, estimated weight, use of antenatal steroids, multiplicity, and gender, and should be coordinated between specialists in maternal-fetal medicine and neonatology 3

Follow-up studies show that extremely preterm infants are at risk of neurodevelopmental alterations, with approximately 30% of those born at 24 weeks experiencing moderate to severe impairment at 30 months, and a decreasing incidence of neurocognitive impairment with each additional week of gestation 1