{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:15:09Z","timestamp":1787022909229,"version":"build-2736575974"},"reference-count":14,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,12,1]]},"abstract":"<jats:p>Recent literature confirms that, at the lower limit of extrauterine survival, substantial intercenter variability exists in resuscitation practice. The reasons for this variability are unclear, but may be related to disagreement on how to apply the best interests standard to extremely premature infants. Currently, both obstetric and pediatric societies recommend against assessing for viability or attempting resuscitation before 22 weeks\u2019 gestation. In this context, we report the unimpaired 2-year outcome of a female infant resuscitated after delivery at 21 weeks\u2019 4 days\u2019 gestation and 410 g birth weight. She may be the most premature known survivor to date. This infant had multiple risk factors for adverse outcome, including prolonged mechanical ventilation, bronchopulmonary dysplasia, and threshold retinopathy of prematurity. She achieved discharge from the hospital on low-flow oxygen at 39 weeks\u2019 4 days\u2019 gestation and 2519 g. At 24 months\u2019 and 8 days\u2019 chronological age, she achieved cognitive, motor, and language Bayley III scores of 90, 89, and 88, equivalent to 105, 100, and 103 at 20 months 2 days corrected age. It is known that active intervention policies at 22 weeks\u2019 gestation improves the outcome for those infants and it may be reasonable to infer that these benefits would extend, if to a lesser degree, into the 21st week. Ultimately, such limited data exist at this gestational age that the time may have arrived for obstetrical centers to begin systematically reporting fetal outcomes in the 21st week.<\/jats:p>","DOI":"10.1542\/peds.2017-0103","type":"journal-article","created":{"date-parts":[[2017,11,2]],"date-time":"2017-11-02T03:30:22Z","timestamp":1509593422000},"source":"Crossref","is-referenced-by-count":25,"title":["Two-Year Neurodevelopmental Outcome of an Infant Born at 21 Weeks\u2019 4 Days\u2019 Gestation"],"prefix":"10.1542","volume":"140","author":[{"given":"Kaashif A.","family":"Ahmad","sequence":"first","affiliation":[{"name":"Pediatrix Medical Group of San Antonio, San Antonio, Texas;"},{"name":"Department of Pediatrics, Baylor College of Medicine, San Antonio, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte S.","family":"Frey","sequence":"additional","affiliation":[{"name":"Pediatrix Medical Group of San Antonio, San Antonio, Texas;"},{"name":"San Antonio Pediatric Developmental Services, San Antonio, Texas; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario A.","family":"Fierro","sequence":"additional","affiliation":[{"name":"Pediatrix Medical Group of San Antonio, San Antonio, Texas;"},{"name":"San Antonio Pediatric Developmental Services, San Antonio, Texas; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander B.","family":"Kenton","sequence":"additional","affiliation":[{"name":"Pediatrix Medical Group of San Antonio, San Antonio, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank X.","family":"Placencia","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and"},{"name":"Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2017,12,1]]},"reference":[{"issue":"6","key":"2021121022423639300_B1","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1542\/peds.2011-1689","article-title":"Limits of human viability in the United States: a medicolegal review.","volume":"128","author":"Arzuaga","year":"2011","journal-title":"Pediatrics"},{"issue":"19","key":"2021121022423639300_B2","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.1056\/NEJMoa1410689","article-title":"Between-hospital variation in treatment and outcomes in extremely preterm infants.","volume":"372","author":"Rysavy","year":"2015","journal-title":"N Engl J Med"},{"issue":"10","key":"2021121022423639300_B3","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1038\/jp.2016.87","article-title":"Three decades after Baby Doe: how neonatologists and bioethicists conceptualize the Best Interests Standard.","volume":"36","author":"Placencia","year":"2016","journal-title":"J Perinatol"},{"issue":"11","key":"2021121022423639300_B4","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1056\/NEJM198803173181105","article-title":"Neonatologists judge the \u201cBaby Doe\u201d regulations.","volume":"318","author":"Kopelman","year":"1988","journal-title":"N Engl J Med"},{"issue":"2","key":"2021121022423639300_B5","doi-asserted-by":"crossref","first-page":"B2","DOI":"10.1016\/j.ajog.2016.04.017","article-title":"Periviable birth: interim update.","volume":"215","author":"American College of Obstetricians and Gynecologists and the Society for Maternal\u2013Fetal Medicine","year":"2016","journal-title":"Am J Obstet Gynecol"},{"issue":"3","key":"2021121022423639300_B6","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":"2021121022423639300_B7","unstructured":"Guinness World Records. Most premature baby. Available at: www.guinnessworldrecords.com\/world-records\/67461-most-premature-baby. Accessed January 5, 2016"},{"key":"2021121022423639300_B8","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1186\/1471-2431-13-59","article-title":"A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants.","volume":"13","author":"Fenton","year":"2013","journal-title":"BMC Pediatr"},{"key":"2021121022423639300_B9","volume-title":"WHO Child Growth Standards: Length\/Height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age: Methods and Development","author":"WHO Multicentre Growth Reference Study Group","year":"2006"},{"issue":"4","key":"2021121022423639300_B10","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1097\/01.AOG.0000454932.15177.be","article-title":"Committee opinion no. 611: method for estimating due date.","volume":"124","author":"The American College of Obstetricians and Gynecologists","year":"2014","journal-title":"Obstet Gynecol"},{"issue":"11","key":"2021121022423639300_B11","doi-asserted-by":"crossref","first-page":"1252","DOI":"10.1111\/apa.13591","article-title":"Resuscitation of potentially stillborn periviable neonates: who lives, who dies and who gets missed?","volume":"105","author":"La Gamma","year":"2016","journal-title":"Acta Paediatr"},{"issue":"3","key":"2021121022423639300_B12","first-page":"442","article-title":"Perinatal ethics: a practical method of analysis of obligations to mother and fetus.","volume":"66","author":"Chervenak","year":"1985","journal-title":"Obstet Gynecol"},{"issue":"8","key":"2021121022423639300_B13","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1053\/j.semperi.2016.09.009","article-title":"Measuring and communicating meaningful outcomes in neonatology: a family perspective.","volume":"40","author":"Janvier","year":"2016","journal-title":"Semin Perinatol"},{"issue":"5","key":"2021121022423639300_B14","doi-asserted-by":"crossref","first-page":"F375","DOI":"10.1136\/archdischild-2016-310466","article-title":"Delivery room practices for extremely preterm infants: the harms of the gestational age label.","volume":"101","author":"Janvier","year":"2016","journal-title":"Arch Dis Child Fetal Neonatal Ed"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2017-0103\/911453\/peds_20170103.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2017-0103\/911453\/peds_20170103.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,11]],"date-time":"2021-12-11T02:43:13Z","timestamp":1639190593000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/140\/6\/e20170103\/38145\/Two-Year-Neurodevelopmental-Outcome-of-an-Infant"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,12,1]]},"references-count":14,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2017,12,1]]},"published-print":{"date-parts":[[2017,12,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2017-0103","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,12,1]]},"article-number":"e20170103"}}