Survival after birth before 27 weeks of gestation
As neonatal care has improved the chances of survival have improved but for the smallest children there has always been a point beyond which survival is unlikely. Doctors monitor survival at very low gestations because we need to give parents accurate information about a group of babies for whom the risks are high.
In the first EPICure study we showed that survival was unusual before 24 weeks in the UK in 1995. What we did not know at the time was whether there had been a decision to provide active care or whether a decision had been made that the risks were too high and the doctors and midwives would simply make the baby comfortable after birth and not intervene. Some parents quite rightly prefer this option.
In the second EPICure study in 2006 we had much more information on whether the baby had a heart beat when labour or delivery commenced, what decisions had been made about active care and many more babies were transferred before they were born with their mother to specialist units for care. We can be much more specific in our information to support counselling because of this.
Survival for births of 24 and 25 weeks has risen significantly between 1995 and 2006 as is shown in the graph – we have also indicated where a decision was made for comfort (i.e. no active care) rather than intended care. Babies born at 26 weeks of gestation have higher survival still.
These are the risks for babies at birth if they are born alive. Once babies are admitted to the neonatal unit their chances of survival are higher (see section on overall outcome).
Most babies die in the first week after birth and therefore babies who are alive at seven days have approximately doubled chances of survival as relatively few babies die after this age, although some unfortunately do.
There are a few babies who die later on but these are the exception - only 10 in over 1000 babies discharged home died before 3 years of age in 2006 – and these babies usually have other associated problems.