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ViewAttendees 5

Clinical Investigation

Early Outcomes and Experience in Resuscitation of Infants Born at 21 Weeks' Gestation

Wednesday, September 17, 2025
1:30 PM - 1:45 PM CT
Location: Ann & Robert H. Lurie Children’s Hospital of Chicago Administration Offices- 2nd Floor (former ADA Building), 211 E. Chicago
Disclosure(s):
Rachael M. Hyland, MD: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Patrick McNamara, MD MSC: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Background: Advances in medical care and provider experience have lowered the gestational age at which resuscitation is considered for extremely premature infants. Some centers are now offering trials of resuscitation in selected infants born at 21 weeks' gestation. There are minimal data to guide this intervention and antenatal counseling.

Objectives: To describe outcomes and morbidities of 21-week gestation infants cared for at our center, delineated by survival to discharge versus death.

Design/Methods: This retrospective case series included all 21-week gestation infants born alive at a single level IV NICU from January 2010 through February 2025. Resuscitation was broadly defined as any attempted stimulation by a healthcare provider. Demographics, therapies, morbidities, and test results were collected throughout the hospitalization from the electronic medical record for infants who received any attempted resuscitation and their mothers. Post-discharge outcomes through the end of the study period were collected as available.

Results: Twenty-two infants were reported liveborn, and seventeen were resuscitated. Fourteen were admitted to the NICU. Six infants have survived to discharge (earliest in 2021, youngest 21+0), one remains hospitalized, and ten died. All were inborn. The survivors were less likely to have been part of a multiple gestation compared to non-survivors (14% vs 60%), and were more likely to have been exposed to a complete course of antenatal corticosteroids (43% vs 0%). Most survivors had early cardiorespiratory instability treated with vasoactive medications and/or inhaled nitric oxide (71%). Three survivors (43%) had no or grade 1 intraventricular hemorrhage (IVH), two (29%) had grade 2, and two had severe IVH (29%, both grade 3), although none required neurosurgical intervention. The six discharged did so on low-flow supplemental oxygen, and none required tracheostomy. Rates of resuscitation have increased over the study period.

Conclusions: Selective resuscitation of 21-week infants can result in survival to discharge, with some infants experiencing minimal morbidities. This, to our knowledge, is the first reported cohort. We hope these descriptive data will prompt prospective study, including long-term data, and additional reporting. Rates of resuscitation and NICU admission in this population are increasing at our center, which highlights the critical need for data to guide practice and antenatal counseling.