Arch Dis Child Fetal Neonatal Ed 98:F15-F20 doi:10.1136/fetalneonatal-2011-301572
  • Original articles

Babies born at the threshold of viability: changes in survival and workload over 20 years

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  1. David J Field
  1. Health Sciences, University of Leicester, Leicester, UK
  1. Correspondence to Sarah Emma Seaton, Health Sciences, University of Leicester, 22–28 Princess Road West, Leicester LE1 6TP, UK; sarah.seaton{at}
  1. Contributors The initial concept was devised by DF. SS and SK undertook the statistical analysis and wrote the first draft of the paper. BM, ED and DF all made substantial contributions to conception and design. All authors contributed to interpretation of the data and the writing of the paper. SS is the guarantor.

  • Received 19 December 2011
  • Accepted 17 February 2012
  • Published Online First 19 April 2012


Objective To assess the care given to the babies born at the threshold of viability over the last 20 years using regional and national data.

Design Population-based retrospective study.

Setting Former ‘Trent’ health region.

Participants Babies born between 1 January 1991 and 31 December 2010 at 22+0 to 25+6 weeks gestational age.

Main outcome measure Survival and use of respiratory support.

Methods Data of all babies born between 1 January 1991 and 31 December 2010 with a gestational age of 22+0 to 25+6 weeks and admitted to a neonatal unit were extracted from The Neonatal Survey. Use of respiratory support in terms of ventilation and continuous positive airway pressure (CPAP) for this group of babies was calculated as a proportion of the total used by the whole neonatal intensive care population within the defined study area.

Results The proportion of babies surviving to discharge increased significantly over time in those born at 24 and 25 weeks (p<0.01) but failed to achieve statistical significance for those at 23 weeks (p=0.08). No babies born at 22 weeks survived. The babies born at 22–25 weeks accounted for 26.3% of all ventilation and 21.5% of CPAP given.

Conclusion Our work concurs with the current UK guidelines. There could be advantages in focusing the care of babies born at 23 weeks to a small number of intensive care units to allow specialist expertise to develop in all aspects of the management of these babies. However, focusing care will not necessarily improve survival or reduce morbidity.


  • Funding NIHR.

  • Competing interests None.

  • Ethics approval The Neonatal Survey is given permission to collect data by the Patient Information Advisory Group (Now the National Information Governance Board for Health and Social Care).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Open Access This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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