Outcomes at 21 weeks' gestation: a case series with neurodevelopmental follow-up

Area of Science:

• Neonatalogy
• Perinatology
• Developmental Pediatrics

Background:

• Infants born at 21 weeks gestation represent the earliest viable gestations.
• Neonatal resuscitation practices for extremely preterm infants are evolving.
• Limited data exists on outcomes for infants born at the threshold of viability.

Purpose of the Study:

• To evaluate survival and short-term/long-term outcomes of infants born at 21 weeks gestation who underwent neonatal resuscitation.
• To compare outcomes between two distinct time periods (2004-2012 and 2013-2024) to identify trends.

Main Methods:

• Retrospective case series at a single center.
• Inclusion criteria: infants born between 21 weeks 0/7 and 21 weeks 6/7 gestation, resuscitated between 2004-2024.
• Selected infants had physiological stability and birth weight >400g; outcomes compared across two time periods.

Main Results:

• Survival rates were 26% (period 1) and 37% (period 2).
• Increased lung morbidity and severe retinopathy of prematurity were observed in the later period.
• Of 11 survivors, 8 had 2-year follow-up; 38% experienced severe neurodevelopmental impairment; 4 attended mainstream school.

Conclusions:

• Survival at 21 weeks gestation is achievable only in highly selected cases.
• Findings support individualized counseling for parents at this gestational age.
• The role of routine neonatal resuscitation at 21 weeks gestation remains undetermined.