Clinical Review

The extremely premature neonate: anticipating and managing care

BMJ 2009; 338 doi: (Published 22 June 2009) Cite this as: BMJ 2009;338:b2325
  1. Natalie K Yeaney, consultant in neonatology1,
  2. Edile M Murdoch, consultant in neonatology1,
  3. Christoph C Lees, consultant in obstetrics and fetal-maternal medicine2
  1. 1Department of Neonatology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 2QQ
  2. 2Department of Fetal-Maternal Medicine, Addenbrooke’s Hospital
  1. Correspondence to: C Lees christoph.lees{at}

Summary points

  • Improvements in neonatal care mean that many extremely preterm infants now survive, but neurodevelopmental and other morbidities are common

  • The incidence of extremely preterm birth is increasing

  • Survival rates improve greatly with each week of gestation

  • The use of antenatal corticosteroids and the baby’s sex, birth weight, and condition at delivery affect survival and should inform decisions about resuscitation

  • Guidelines can aid the clinician at delivery, but detailed discussions with parents, obstetricians, and neonatologists should be undertaken, ideally before delivery

  • Sustained support of families is essential

  • Prevention is the best way to limit the mortality and morbidity associated with extreme prematurity

Preterm deliveries are increasing in absolute numbers and as a proportion of all births. According to NHS data for England in 2006, 2000 births—0.3% of all births—were extremely preterm (23-25+6 weeks’ gestation).1 Similar numbers are reported by other western European countries. Preterm births have increased by 20% over the past two decades in the United States, mainly because of the 42% increase in twin births.2 Advances in neonatal intensive care for babies born at the margins of viability have improved survival, but these infants are more likely to have long term morbidities and to use healthcare resources extensively in the first 2 years of life. Data from the Neonatal Research Network show that babies born before 26 weeks’ gestation spend at least 111 days in hospital during infancy and incur intensive care costs of more than £100 000 (€114 000; $160 000).3 An emotional and financial burden is often placed on families and community support systems. One or more family member may leave paid work to care for the baby, or skilled day care providers may help care for a child with serious ongoing medical conditions.4

Sources and selection criteria

We used our knowledge of the current literature, guidance statements from national …

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