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We sought to delineate the in-hospital outcome for infants born alive and universally resuscitated at an estimated gestational age (GA) of 23(0)/(7) to 23(6)/(7) weeks and to document when and why death occurred. We performed a cohort study of prospectively collected data on 100 consecutive infants born alive at 23 weeks GA from June 16, 1990 through August 6, 2006. All deliveries were attended by a neonatologist and resuscitation was universally attempted. At the time of death, a primary cause was determined by the attending neonatologist. Forty infants survived and 60 died prior to hospital discharge. Survivors were more likely to have higher Apgar scores and be male gender. Ten infants could not be resuscitated and died in the delivery room. Twenty-eight other infants died in the first 4 days mainly from respiratory failure (10 from respiratory distress syndrome [RDS], 12 from RDS with interstitial emphysema, 5 from RDS with pulmonary hemorrhage). Twenty-two infants died after day 4 (8 from respiratory failure, 10 from necrotizing enterocolitis, and 4 from sepsis). In our experience, universal resuscitation at 23 weeks' estimated GA resulted in a survival rate of 40%.

Infants born at 22 weeks GA were more likely to be resuscitated if they were larger or if the delivery was attended by a neonatologist. We encourage neonatal groups to follow the recommendations of the American Academy of Pediatrics Committee on the Fetus and Newborn regarding initiation of resuscitation in these infants: inform parents that a good outcome is very unlikely and respect the parents' choice of whether resuscitation should be initiated.