Case Report from Japan: Intact Survival of a Marginally Viable Male Infant Born Weighing 268 Grams at 24 Weeks Gestation

[Stefan Johansson]

From prof Takeshi Arimitsu, invited speaker at our previously planned Meetup in April 2020 (but cancelled due to Covid), I got an email about an interesting case report from their large neonatal center in Tokyo.

They have published about a 268 gram 24-weeker with intact survival. I share the last sentences of the summary below.

The publication is available open-access and in full-text here: https://www.frontiersin.org/articles/10.3389/fped.2020.628362/full

Quote

The present case demonstrates that intact survival of a marginally viable male infant with a birth weight of <300 g is possible with minimal handling and family involvement beginning shortly after birth. Our detailed description of the clinical course of this case should provide invaluable information to physicians around the world who treat such infants. This report will aid in the progress of neonatal medicine and help to address many of the social and ethical issues surrounding their care.

Looking fw to follow the discussion about this extraordinary case.

 

[99nicu.org]

 

 

[Stefan Johansson]

 

[99nicu.org]

 

[Stefan Johansson]

 

[Leonora DEsposito]

Could genetic play at this outcome ?  Leonora D'Esposito.

[Takeshi Arimitsu]

Genetics may have something to play a role.
Worldwide, survival rates are increasing and complication rates are decreasing.
I believe that tomorrow's outcomes will be better than today's as a result of advances in treatment.
I am studying publications written by all of you, and I am implementing what I have learned every day in my practice.

[Francesco Cardona]

On 2/20/2021 at 10:16 AM, Takeshi Arimitsu said:

Genetics may have something to play a role.
Worldwide, survival rates are increasing and complication rates are decreasing.
I believe that tomorrow's outcomes will be better than today's as a result of advances in treatment.
I am studying publications written by all of you, and I am implementing what I have learned every day in my practice.

Thank you so much for sharing. Where do you see room for improvement in your daily practice? What will you be improving to achieve better outcomes?

[Takeshi Arimitsu]

Thank you for your response.
I try to reduce unnecessary examinations and treatments and perform only those that are necessary.
In addition, I try to avoid treatments with low evidence levels and to include treatments for which new evidence has been shown.
I am personally interested in circulatory management immediately after birth, early extubation, infection control, and factors that improve long-term prognosis, and so on.
I would also like to promote more family involvement in our NICU. This is because it is the safest treatment with no side effects and has evidence that shows its benefit.

[kishoreyv17]

Increasingly, we are finding long term morbidity and educational difficulty. Where do we draw the line for such ELBWs? 

[piatkat]

41 minutes ago, kishoreyv17 said:

Increasingly, we are finding long term morbidity and educational difficulty. Where do we draw the line for such ELBWs? 

I don't know where to draw the line for ELBWs infants of course, but there is a really nice lecture from our 99nicu Meetup in Vienna about infants surviving at the limits of viability. I have listened to it several times already! I like it because it draws attention to brain alterations that are much more subtle than "injuries" we clinically monitor in the NICU. It clearly shows the need of sustainable research efforts to find more or better ways to protect premature brain in order to facilitate a well-rounded development of structural networks.