“It confirms that if you don’t do anything, these babies will not make it, and if you do something, some of them will make it,” said Dr. David Burchfield, the chief of neonatology at the University of Florida, who was not involved in the research. “Many who have survived have survived with severe handicaps.”
Results of the study, published Wednesday in The New England Journal of Medicine, are likely to influence a discussion taking place among professional medical associations about how to counsel parents and when to offer treatment to such tiny babies.
Such groups have already been discussing whether it is reasonable to offer parents active medical treatment for babies born at 23 weeks. Some hospitals already do so. A 2014 summary of a workshop that involved the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics said that “in general, those born at 23 weeks of gestation should be considered potentially viable” because more than a quarter of such babies survive when treated intensively. The report said nothing helps babies born at less than 22 weeks to survive.
But babies born at 22 to 23 weeks are a question mark, their chances for survival slim but varying by things like birth weight and whether the mother received treatment before delivery with corticosteroids that can help a baby’s lungs and brain.
About 18,000 very premature babies are born annually in the United States, with about 5,000 at 22 or 23 weeks.
The study, involving nearly 5,000 babies born between 22 and 27 weeks gestation, found that 22-week-old babies did not survive without medical intervention. In the 78 cases where active treatment was given, 18 survived, and by the time they were young toddlers, seven of those did not have moderate or severe impairments. Six had serious problems such as blindness, deafness or severe cerebral palsy.
Of the 755 born at 23 weeks, treatment was given to 542. About a third of those survived, and about half of the survivors had no significant problems.
Dr. Carl T. D’Angio, director of neonatal clinical research at the University of Rochester Medical Center, who was not involved in the study, said that his center decided several years ago to offer active treatment to 23-week-old babies, and that many sophisticated neonatal units are doing the same. At 22 weeks and five days into pregnancy, Rochester offers corticosteroids to mothers in danger of delivering early, hoping the drugs can have 48 hours to work before delivery at the 23-week mark. But for 22-week-olds, he said, “we don’t have enough to offer the babies to really offer them a reasonable chance of survival.”
As techniques for keeping babies alive improve, parents face wrenching choices that are sometimes based on whether the estimated age is 22 weeks and one day or six days. The study found that hospitals tend to “round up,” with babies closer to 23 weeks more likely to receive treatment.
But the authors and other experts also noted that gestational age is an educated guess, based on women’s recollection of their last menstrual period and estimated fetal size. Other factors, including prenatal care and the fact that girls are often a week more mature than boys, should also influence decisions, experts say.
“It’s very difficult to say to a mother, ‘If you deliver today, I’m going to do nothing, but if you deliver tomorrow, I’m going to do everything,’ ” said Dr. Neil Marlow, a neonatologist at University College London.
The study, which evaluated cases from 2006 to 2011 at 24 hospitals in a neonatal network supported by the National Institute of Child Health and Human Development, found that four of the hospitals intervened for no 22-week-olds, five intervened for all 22-week-olds and the rest varied. In all, about a fifth of the 357 babies that age were treated. The reasons could include family preferences and hospital policy, the authors wrote.
“We can’t really say whether the differences revolve around differences in values, that for some physicians or parents the risk of impairment might outweigh the decision for treatment,” said Matthew Rysavy, a medical student at the University of Iowa, who led the study with Dr. Edward Bell, a pediatrics professor there. At Iowa, Dr. Bell said, treatment is offered to most 22-week-olds, and he considers 22 weeks a new marker of viability.
“That’s what we think, but this is a pretty controversial area,” Dr. Bell said. “I guess we would say that these babies deserve a chance.”
Dr. Jeffrey M. Perlman, medical director of neonatal intensive care at NewYork-Presbyterian Hospital Weill Cornell Medical Center, takes a different view. He said it was important to consider that long months in neonatal units can be “like riding an obstacle course or flying in a plane with bad turbulence, and each of these down spirals can have an impact on the brain.”
At his hospital, “we go after the 24-weekers,” he said. “If it’s 23, we will talk to the family and explain to them that for us it’s an unknown pathway. At 22 weeks, in my opinion, the outcomes are so dismal that I don’t recommend any interventions.”
Dr. Bell pointed to success stories, including Chrissy Hutchinson, 32, of Manchester, Iowa. Her water broke in 2010 when she was 21 weeks and six days pregnant. The first hospital she went to “said there really was no chance of survival, and if the baby was born not breathing that they weren’t going to resuscitate or anything,” she said.
The Hutchinsons called the University of Iowa, and there, at 22 weeks and one day, Alexis was delivered, weighing 1.1 pounds. Alexis was treated and stayed in neonatal intensive care for almost five months. Now, Ms. Hutchinson, a pharmacy technician, said, aside from being more vulnerable to respiratory viruses, Alexis is a healthy 5-year-old.
Some of the study’s results suggest that among 22-week-olds who are treated, experiences like the Hutchinsons’ would be exceedingly rare because Ms. Hutchinson delivered so close to 22 weeks and did not have time for corticosteroids beforehand.
Danielle Pickering, 32, and her husband Clayton, a Baptist minister in Newton, Iowa, chose treatment when she was hospitalized in July 2012 at 22 weeks. “We figured he was our baby, and he was what the Lord had given us, and we would just do everything we could,” said Ms. Pickering. She received corticosteroids and delivered Micah four days later. He spent more than four months in intensive care, had heart surgery, and was “one of the sickest babies” there.
Now “he is a spunky almost 3-year-old,” who has chronic lung disease and a slight speech delay, said Ms. Pickering, who is now 33 weeks into a healthy second pregnancy. After Micah, she said, “I feel like this baby that I’m about to have — this will be a piece of cake.”
Correction: May 6, 2015
An earlier version of a picture caption with this article misstated the surname of a girl who was born prematurely. She is Alexis Hutchinson, not Richardson.
This week, your baby looks more like a newborn than ever before, and your body’s changing too. Here’s everything you need to know about your baby and your body at 22 weeks.
How big is my baby at 22 weeks?
If you love the food comparisons, then your baby is the size of a coconut - if not, she’s now the size of a small doll. She’s now over a pound and about eleven inches long. She’s about the size of a bag of sugar, which is heavier than it sounds!
What’s my baby doing at 22 weeks?
Your baby is starting to look more like a newborn than ever, with distinct lips, eyelids and eyebrows, and even tiny tooth buds.
Your baby is starting to look more like a newborn than ever, with distinct lips, eyelids and eyebrows, and even tiny tooth buds.
Your little one will also now be able to perceive light and dark better, even though her eyelids are still fused. Her hearing’s improving too: she’ll be able to hear your heartbeat, voice and even the noises of your blood circulating and your stomach gurgling.
What is my body doing at 22 weeks pregnant?
Your tummy’s getting bigger and bigger - but it’s not the only thing changing. You’ve probably noticed that your feet are swelling more than you might like. This is due to pregnancy swelling, or edema, as well as the pregnancy hormone relaxin, which loosens the ligaments in the feet so that the bones under them spread. This can mean your feet increase by a half or even a whole shoe size. Don’t try and squeeze into your old kicks: choose a bigger, comfortable pair that you can wear throughout your pregnancy, with no more than a two-inch heel: It’s hard enough as it is to keep your balance with your pregnancy belly, let alone with sky-high stilettos!
Common symptoms to look out for:
- Changing fingernails: Different women experience different symptoms: some find their nails grow faster than usual, some find theirs are harder than usual, and others notice theirs get softer or more brittle.
- Gorgeous hair: Yup, along with all the not-so-pleasant pregnancy symptoms, there are some great ones too. During pregnancy, your body sheds hair more slowly than it did before, giving your hair the appearance of being thicker and more lustrous than ever.
- More body hair: Unfortunately, this also applies to your body hair, with hormones causing more hair on your face (usually on your chin, upper lip, cheeks and jaw). You might also spot some on your stomach, arms, back and legs. You can tweeze, wax and shave these excess hairs if you’re not too fond of their appearance.
- Discoloured skin: You might find some patches of darker skin on your face due to the increased melanin in your body. Make sure you’re protecting your face with sunscreen with a high SPF, wear a hat and stay out of the sun in the strongest hours.
- Bigger, darker nipples: You might notice some changes in your breasts, namely bigger, darker nipples and areoles, more pronounced bumps on your areoles, and more noticeable veins on your breasts.
What to do this week:
- Slow down: It’s quite common to feel dizzy or light-headed during pregnancy – that’s because so much blood is being directed to your womb to help with your baby’s development. Get yourself into the habit of getting up slowly so the blood flow can adjust gradually.
- Keep snacking: Make sure you eat regular healthy snacks (carry some nuts or raisins or fruit like a banana, apple or seedless tangerine in your bag) and stay hydrated to keep energy levels up and ensure your blood sugar doesn’t rise or fall too quickly. If you feel faint or dizzy, sit down and put your head between your knees so the blood can return to your brain: the dizziness will soon disappear.
Your week 22 FAQ's answered:
How big should my bump be at 22 weeks pregnant?
A typical belly at 22 weeks pregnant will be around 20 to 24 centimeters from pelvic bone to the top of the uterus.
How much should my baby be moving at 22 weeks?
Most women start to feel their baby moving between 18 and 20 weeks pregnant, yet how strong or how much you feel these little flutters completely depends on your pre-pregnancy weight and how your baby is lying.
Take me back to week 21
Take me to week 23
Read next, the Mother & Baby award winning pushchairs:
Baby Jogger City Tour, £249.99, AmazonWinning a silver award this year, the City Tour from Baby Jogger is the lightest pushchair yet from this award-winning brand. Our panel of mum testers loved how easy and light the City Tour was to push, and the clever fold means you can fit it in a handy backpack. It’s worth noting, the handlebars are not adjustable, so this isn’t ideal for those tall parents out there.
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Out ‘n’ About Nipper Double V4, £379, AmazonWe love how robust this all-terrain double buggy looks, whilst still being super lightweight and easy to push. With quick release removable wheels and an easy fold, getting it into the boot of your car is a doddle. There isn’t a great deal of storage but it’s a small price to pay.
Joie Mytrax, £239.99, AmazonOur panel of parent testers loved the Joie Mytrax pushchair, finding it easy to fold up and down with one hand and a dream to manoeuver. The only downside is the rain cover, which is a bit difficult to get on and off, but overall, a great little pushchair from a brand you can trust.
Baby Style Hybrid Edge, £499, AmazonOur panel of parent testers loved the look and feel of the Hybrid Edge, commenting how easy it was to steer, even with the weight of two tots in tow. That said, it can be quite difficult to access the storage basket when using as a double buggy.
ABC Design Pepper Travel System, £850, AmazonA beautiful, high quality travel system that makes life easier when out and about with your baby. It’s easy to handle on multiple terrains, is suitable from birth and with a number of different car seats, and is a great option for taller parents thanks to the adjustable handlebars. It can also be folded completely flat, making it a good option for smaller car boots.
Author: Deborah CicurelDeborah Cicurel