Earliest viable gestational age?

[everthesame]

What is the earliest gestational age you have seen survive?

I ask this question because a co-worker told a high risk mom who is currently 19 wks that she only has to make it another week for the baby to be viable. This co-worker insists that her own child was born at 20 weeks and is just fine today. I work in a prison now, but when I worked in a hospital, I don't think NICU even went on the delivery of a 20 weeker. I am not thrilled that my co-worker is telling this mom that if she delivers next week her baby could possibly survive...especially right after I told the mom something different when she asked me how early a baby could survive.

Have any of you ever seen a 20 weeker survive?

[morte, LPN, LVN]

TiffyRN said:

Absolutely possible. My husband (also NICU nurse) admitted an infant that by mom's dates was 24 weeks (so of course everyone was geared up for quite the difficult & extensive admission). When the infant came out at 1800 grams and screaming vigorously the MD was happy to inform the mother that though her infant was premature and would be admitted the MD felt the hospitalization would not be long as she estimated the infant's gestational age at 34 weeks. The mom then looked at the "dad" and started yelling, "no, 24 weeks, 24 weeks!". Apparently dad had not been back from service in the middle east 34 weeks ago.

Yup.....or since this one was apparently a fair bit in the past....just not "post wedding date" enough, LOL.

[IronRN]

I basically agree with everyone on the 22/23 weeks being the cut off due to lung development and anyone out there who claims to have a sub 23 weeker, I'd bet my liscence there are dating issues. My issue is with the term viable, I think when we tell parents antenatally that 23 weeks is the point of "viability" they misinterpret that as meaning "my baby will be ok" Vialbility is a really grey word.... I've seen a number of 23+ weeks infants survive, but none that I can say are truely "normal" in terms of physical, intellectual, sensory, markers, Some will be functioning adults but have disabilities. I have seen many 25 weekers do very well however. I feel that 25 seems to be the point at which at truely well child can result. Our unit standardly wont attend deliveries under 24 weeks/500g which is higher than the unit I previously worked on, the cut off there was 23+0 and 450g.

Cheers All

[dawnebeth]

I have heard of the occasional 22 weeker surviving, but that is extremely rare. I've always seen 22 weekers who did not make it. 23-24 weeks is the earliest I have seen be viable and most are damaged or not normal when they grow older. Once in a great while there is a 23 weeker who comes through unscathed.

[heymama1plus1]

We had a 22 week IVF baby... actually did quite well considering (just ROP and some DD)... funny thing, mom was PG (on her own) before the 1st baby was discharged!

[littleneoRN]

We routinely attend deliveries at 23 weeks with no weight limit. Obviously, if the baby is too small to intubate, then that would be a weight limit of sorts. We discuss in advance if possible parents desires and the prognosis. Many (but certainly not all!) of our 23 weekers survive. Some have become healthy, productive children and adults. Some have mild health issues, and some have significant healthy problems and disabilities.

[usameisje]

Nope, not 20 weeks. The earliest surviving gestational age I have ever cared for was 23 weeks, 0 days. She was a miracle baby and I doubt I will see another 23 weeker do so well.

At my old job the Neonatologist would attend any delivery 20 weeks and up , just in case the dates were wrong. Upon OB request the Neo would also examine fetuses at delivery to give families more reassurance that the baby really was below 20 weeks. Of course 95 percent of cases were no prenatal care so we had to guess a LOT.

[texas2007, BSN, RN]

We get a lot of calls to transfer babies who are "24 weeks" or "26 weeks" etc. When our transport team gets there, it is quite obvious that the baby is no where near "26 weeks", more like 22 weeks with thin, plethoric, gelaneous skin and eyes fused etc. You have no idea how often this happens. These babies rarely do well (bouncing around in an ambulance or helicopter isn't the best for head bleeds). It is frustrating to say the least.

[NeoPediRN]

The smallest I've seen is 22 weeks, 14 oz

[dawnebeth]

One time, we had a small for gestational age 29 weeker (13 oz--one of the smallest babies we've ever had) right next to a 22 weeker. It was fascinating to see the babies side by side since they were almost of a size--except that the 29 week baby was doing all sorts of appropriate baby things like sucking her fist and flexing her limbs, etc while the 22 week baby was just flacid and limp with gel like skin. That one didn't survive. the 29 week baby did fine, luckily!

[BabyRN2Be]

I always get so very sick of seeing these "miracle babies" on TLC or what have you. The parents always claim that the kiddo was born at 21 weeks, got out of the hospital after a 2 week stay, is now 8 years old and already a NASA candidate as a pilot for the Mars mission. Of course, I'm exaggerating and give this example with my tongue firmly planted in my cheek, but I think you all know what I'm talking about. It gives the parents the impression that if their baby arrives at ~23-24 weeks, everything is all going to be hunky dory.

However, a few weeks ago they had a great program on about triplets who were born at 24 weeks, and all three of them are blind and deaf. The program did a great job showing the challenges this family contends with on a daily basis. I'm so glad that TLC took the responsibility of showing that micropreemies (especially something along the line of triplets) do not always do so great. Not to say that these trips are not miracle babies with all they go through and show their amazing resiliency, but so many babies are born at 24 weeks and either a) die before discharge or b) live live with a long list of challenges.

Thinking of micropreemies, it's going to be very interesting to see how Josie Duggar will do. This family was on TV before her birth, not BECAUSE of her birth and it may give families a chance to see what challenges micropreemies face on a more or less day today basis. Not that I want to see the family go through difficult times.