Survival, neonatal and subsequent problems associated with extreme prematurity

Significant progress has been made in improving the outcome of newborn infants with advances in perinatal care over the last two decades. The most dramatic changes have been seen at the margins of viability (infants less than 26 weeks gestation) and the expectations for survival are high.

Short-term morbidity is great and many babies require prolonged periods of intensive care. Many of the pathophysiological problems encountered in very immature infants are much more complex than similar conditions seen in more mature infants, and although the understanding of these differences is quite advanced, therapeutic advances are less clear. It is important not to lose sight of the long-term implications for this group of babies, as new evidence suggests that the burden of physical and cognitive impairment is far higher than in any other group of infants.

It is crucial that all healthcare professionals are aware of the immediate and long-term outcomes of extremely pre-term delivery to enable effective counselling of the parents and to facilitate their involvement in clinical management.