Outcomes at 21 weeks’ gestation: a case series with neurodevelopmental follow-up

Objective To describe survival, short- and long-term outcomes of infants born at 21 weeks’ gestation who received neonatal resuscitation. Methods Single-center retrospective case series of infants born at 21 + 0/7 to 21 + 6/7 weeks resuscitated from 2004–2024. Resuscitation was offered to selected infants with early physiological stability and, preferably, birth weight > 400 g. Outcomes were compared between 2004–2012 and 2013–2024. Results Among resuscitated infants, survival was 5/19 (26%) in period 1 and 6/16 (37%) in period 2. Lung morbidity and severe retinopathy of prematurity were higher in the later period. Of 11 survivors, 8 (73%) had 2- year follow-up; 3/8 (38%) had severe neurodevelopmental impairment (2/5 vs 1/3). Four survivors attended mainstream schools. Conclusion Survival at 21 weeks’ gestation is limited to highly selected cases. These data add to the limited evidence base and may inform individualized counseling at this gestational age, where the role of routine neonatal resuscitation is not established.