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For infants under 22 weeks, the survival rate has increased from 3.6% to 20% over the past decade, and for those born at 26 weeks, eight in ten survive.
Until the 1980s, doctors estimated that the youngest gestational age for a baby to be considered viable outside the womb was 28 weeks (AFP Photo
For infants under 22 weeks, the survival rate has increased from 3.6% to 20% over the past decade, and for those born at 26 weeks, eight in ten survive.
HEALTH
Survival rates of extremely premature infants have improved by leaps and bounds since the 1980s, with US and Swedish studies released this week providing new data on the trend.
Doctors had previously estimated that the earliest gestational age for a baby to be considered viable outside the uterus was 28 weeks, whereas it weighed about 2, 2 pounds (one kilogram), about 12 weeks less than the normal duration of a 40-week pregnancy. Babies are considered premature below 37 weeks.
However, over the last 40 years, this 28-week limit has been steadily declining. At present, some babies who give birth at 24, 23 or even 22 weeks (from their mother's last period) are able to survive, even if they weigh 1.1 kilograms. or less.
A Japanese baby who weighed only 9.44 ounces (268 grams) when he was born at 24 weeks made headlines in February: he was returning home healthy after five months in the hospital.
"I've been in this business for 40 years and have seen the viability threshold go back by about a week every 10 years or so," said neonatologist Edward Bell, a children's hospital at the University of Toronto. Iowa, AFP.
Sweden holds the world record for the earliest neonatal viability: 77% of babies born between 22 and 26 weeks in 2014 and 2016 have survived a year, compared to 70% about 10 years ago, according to a study published Tuesday in the Journal de la American Medical Association (JAMA).
During these 10 years, Sweden has standardized its advanced neonatal resuscitation procedures: immediate intubation at birth, drug delivery and rapid transfer to a neonatal intensive care unit.
In Sweden, nearly 90% of deliveries take place in one of the country's six hospitals with high-level intensive care units.
"Before, for a baby born at 22 or 23 weeks old, a doctor could say that it was worth nothing to do," said Mikael Norman, co-author of the Swedish study and neonatologist at the University Hospital Karolinska from Stockholm.
For infants under 22 weeks, the survival rate has increased from 3.6% to 20% over the past decade, and for those born at 26 weeks, eight in ten survive.
The United States is lagging behind
Since the 1990s, three major medical efforts have been made to improve the survival of premature infants.
Artificial surfactants help keep the baby's undeveloped lungs swollen when they expire, while maternal steroid injections just before birth can accelerate the development of the fetal lungs (a growth equivalent to that of a baby). week) and that improved techniques of mechanical ventilation babies.
These techniques are widely available in developed countries, but significant disparities remain – from one country to another and even between different hospitals.
In Britain, France and the United States, about half of extremely premature infants (under 26 or 27 weeks) survive, according to studies conducted in recent years.
And the American system is not equivalent to its Swedish counterpart. US health care is full of inequalities that can affect the level of antenatal care received by pregnant women in different demographic categories.
A study by JAMA shows that racial geographic segregation in the United States manifests itself in health care, given that black premature babies are more likely to be born in poor quality hospitals.
But the survival rate continues to improve, even in the very rare case of babies born weighing less than 14 ounces, is the focus of a third JAMA study – focused on US data – published Monday.
Among infants born between 22 and 26 weeks and weighing less than 14 ounces in 21 US hospitals between 2008 and 2016, 13% survived – one of them weighed only 11.6 ounces.
At such a low gestational age, the risk of complications is much higher, as three-quarters of children born too early have developmental delays at two years of age.
All in all, "it tells you that survival is possible," said Bell, co-author of one of the US studies.
"It's not clear that these babies should always be resuscitated," said Bell, "but parents deserve to have this information and should probably have their say when they are resuscitated."
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