{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:05:18Z","timestamp":1747181118048,"version":"3.40.5"},"reference-count":13,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2023,1,13]],"date-time":"2023-01-13T00:00:00Z","timestamp":1673568000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,1,13]]},"abstract":"<jats:sec>\n            <jats:title>Rationale:<\/jats:title>\n            <jats:p>A gestational age of 22 to 23 weeks is the lower threshold for selective active intervention. Few infants delivered at a gestational age of 22 to 23 weeks survive if resuscitated. Among those who survive, most develop severe complications, especially in cases of multiple births at the limit of viability.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Patient concerns:<\/jats:title>\n            <jats:p>We report the intact survival of extremely preterm twins, a girl (Twin A) and a boy (Twin B), weighing 504g and 475g, respectively, born at the edge of viability at 22 2\/7 weeks gestation without significant morbidity.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Diagnoses:<\/jats:title>\n            <jats:p>extremely preterm twins born at the edge of viability at 22 2\/7 weeks.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Interventions:<\/jats:title>\n            <jats:p>Twin A required 6 weeks of mechanical ventilation. She received conventional and high-frequency oscillation ventilation. She was extubated to noninvasive positive airway pressure ventilation at 28 weeks and 2 days post conception. Twin B required longer duration of invasive ventilation lasting 11 weeks. Moreover, he had several episodes of feeding intolerance and abdominal distension. However, his serial abdominal radiographs showed nonspecific findings. The gastric tubes were eventually removed from both twins. Full oral feeding was successful on discharge.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Outcomes:<\/jats:title>\n            <jats:p>Both infants are presently in good condition.They were discharged home with a full oral feeding, and without any respiratory support. Now they are 18-month-old with unimpaired development.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Lessons:<\/jats:title>\n            <jats:p>This report would support healthcare providers in decision-making. It highlights the importance of perinatal and neonatal management optimization to improve survival rates and clinical outcomes of periviable birth. In addition it emphasize the individuality of each case and the need to consider the parents\u2019 wishes in the management decision.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/md.0000000000032571","type":"journal-article","created":{"date-parts":[[2023,1,14]],"date-time":"2023-01-14T00:53:37Z","timestamp":1673657617000},"page":"e32571","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Unimpaired outcomes in 18-month-old borderline viable twins born at 22 weeks: A case report"],"prefix":"10.1097","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0078-7013","authenticated-orcid":false,"given":"Wafaa","family":"Alrawi","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates"},{"name":"SSMC Hospital in partnership with Mayo Clinic; and Khalifa University, Abu Dhabi, United Arab Emirates."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taisser","family":"Atrak","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates"},{"name":"SSMC Hospital in partnership with Mayo Clinic; and Khalifa University, Abu Dhabi, United Arab Emirates."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashraf","family":"Abuobayda","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates"},{"name":"SSMC Hospital in partnership with Mayo Clinic; and Khalifa University, Abu Dhabi, United Arab Emirates."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nabil","family":"Elmansoury","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omar","family":"Elnakeib","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abhijeet","family":"Lonikar","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates"},{"name":"SSMC Hospital in partnership with Mayo Clinic; and Khalifa University, Abu Dhabi, United Arab Emirates."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-20250504","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1001\/jamapediatrics.2016.0207","article-title":"Survival among infants born at 22 or 23 weeks gestation following active prenatal and postnatal care.","volume":"170","author":"Mehler","year":"2016","journal-title":"JAMA Pediatr"},{"key":"R2-20250504","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1542\/peds.106.4.659","article-title":"The EPICure study: outcomes to discharge from hospital for infants born at the threshold of viability.","volume":"106","author":"Costeloe","year":"2000","journal-title":"Pediatrics"},{"key":"R3-20250504","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1001\/jama.2015.10244","article-title":"Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012.","volume":"314","author":"Stoll","year":"2015","journal-title":"JAMA"},{"key":"R4-20250504","doi-asserted-by":"crossref","first-page":"e7961","DOI":"10.1136\/bmj.e7961","article-title":"Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies.","volume":"345","author":"Moore","year":"2012","journal-title":"BMJ"},{"key":"R5-20250504","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1056\/NEJMoa041367","article-title":"Neurologic and developmental disability at six years of age after extremely preterm birth.","volume":"352","author":"Marlow","year":"2005","journal-title":"N Engl J Med"},{"key":"R6-20250504","doi-asserted-by":"crossref","first-page":"e20170103","DOI":"10.1542\/peds.2017-0103","article-title":"Two-year neurodevelopmental outcome of an infant born at 21 weeks\u2019 4 days\u2019 gestation.","volume":"140","author":"Ahmad","year":"2017","journal-title":"Pediatrics"},{"key":"R7-20250504","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1080\/13854046.2016.1224802","article-title":"Birth at 22 gestational weeks: case report of cognitive resilience.","volume":"31","author":"Hopp","year":"2017","journal-title":"Clin Neuropsychol"},{"key":"R8-20250504","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1542\/peds.2015-2336","article-title":"Antenatal counseling regarding resuscitation and intensive care before 25 weeks of gestation.","volume":"136","author":"Cummings","year":"2015","journal-title":"Pediatrics"},{"key":"R9-20250504","first-page":"34","article-title":"Ethical decisions in fetal medicine and neonatal intensive care.","volume":"19","author":"Teasdale","year":"2007","journal-title":"PaediatrNurs"},{"key":"R10-20250504","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1136\/archdischild-2019-318402","article-title":"Perinatal management of extreme preterm birth before 27 weeks of gestation: a framework for practice.","volume":"105","author":"Mactier","year":"2020","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"R11-20250504","doi-asserted-by":"crossref","first-page":"1672","DOI":"10.1056\/NEJMoa073059","article-title":"Intensive care for extreme prematurity\u2014moving beyond gestational age.","volume":"358","author":"Tyson","year":"2008","journal-title":"N Engl J Med"},{"key":"R12-20250504","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1542\/peds.2009-1607","article-title":"Risk factors and estimation tool for death among extremely premature infants: a national study.","volume":"125","author":"Bader","year":"2010","journal-title":"Pediatrics"},{"key":"R13-20250504","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1038\/jp.2014.70","article-title":"Periviable birth: executive summary of a joint workshop by the Eunice Kennedy Shriver national institute of child health and human development, society for maternal-fetal medicine, American academy of pediatrics, and American college of obstetricians and gynecologists.","volume":"34","author":"Raju","year":"2014","journal-title":"J Perinatol"}],"container-title":["Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/MD.0000000000032571","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,4]],"date-time":"2025-05-04T02:38:03Z","timestamp":1746326283000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/MD.0000000000032571"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,13]]},"references-count":13,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.1097\/md.0000000000032571","relation":{},"ISSN":["1536-5964"],"issn-type":[{"type":"electronic","value":"1536-5964"}],"subject":[],"published":{"date-parts":[[2023,1,13]]}}}