Survival and Favorable Neurological Outcome Following Home Delivery at 22 Weeks of Gestation: A Case Report

We encountered a male infant with extremely low birth weight born at 22 weeks and 0 days of gestational age in the toilet at home. He was resuscitated with chest compression and bag-valve-mask ventilation by the emergency medical service crew and was transported to our institution 50 minutes after birth. The patient was intubated and given intratracheal artificial surfactant after admission. After he recovered from the initial hypotensive phase, we maintained the blood pressure at an appropriate level using nitroglycerin to avoid cerebral overcirculation. He was discharged home at 170 days of life with no signs of intraventricular hemorrhage or periventricular leukomalacia. His overall developmental quotient at one year and seven months of corrected age was 104, and he showed no apparent developmental delay. This case demonstrates that appropriate medical management can save the lives of extremely preterm infants born outside medical institutions.