Viability of infants born at 24 to 26 weeks gestation

81 inborn infants of 24-26 weeks gestation were studied. Overall survival rate excluding 2 lethal malformations was 44%: it was 36% at 24 wk, 32% at 25 wk and 57% at 26 wk. 68% of the multiparous mothers had a previous reproductive loss and 30% had a previous preterm birth. Antepartum haemorrhage and chorioamnionitis were the 2 most common obstetric associations. Perinatal asphyxia and severe respiratory disorders were significantly associated with increased mortality. Management of respiratory failure and provision of adequate nutrition were the 2 main therapeutic challenges. 30% of the deaths occurred in the delivery room and 68% by 24 hours. Periventricular haemorrhage was the most common necropsy finding. The mean gestation at discharge for the 35 survivors was 40 wk. On assessment at 2 years of age, corrected for prematurity, 10 (28%) had cerebral palsy, 3(9%) had developmental delay, 2 (6%) were blind, and 1 (3%) had sensorineural deafness. There were 4 children who had more than 1 disability; 9 of the 12 children with disability were considered to have a significant functional handicap. The proportions of survivors without significant functional handicap, born at 24-25 wk compared with those at 26 wk, were not statistically different (67% versus 80%). Common medical conditions in the first 2 years included respiratory illness, otitis media and gastroenteritis. 13 (37%) children required rehospitalisation for an average of 3 times; total days in hospital averaged 15 d. The most common reason for admission was respiratory illness. At 2 years, 24% were below the 10th centile for weight as were 26% for height; head circumferences were normal.(ABSTRACT TRUNCATED AT 250 WORDS)