15 - From Fragility to Viability: The Evolution of Preterm Newborn Survival
Saturday, April 25, 2026
3:30pm - 5:45pm ET
Publication Number: 2012.15
Ahmed Bayoumy, Richmond university medical center, Staten Island, NY, United States; Naheed Abedin, Richmond university medical center, Plainsboro, NJ, United States
Pediatric Resident Richmond university medical center Staten Island, New York, United States
Background: Progress in perinatology and medical technology has extended the boundaries of viability to remarkable new levels. The survival rates of infants with extreme prematurity have significantly increased over the past few decades. Objective: The study examines the historical progression of limits of viability and resulting ethical decision making dilemmas. Design/Methods: A systematic search was performed and journal articles reviewed Results: In the early 1800’s the survival rate of premature infants was extremely low. During the 1880’s French obstetrician Stephane Tarnier introduced the first modern incubator for newborns, which greatly improved survival of preterm infants. Dr. Pierre Budin, Tarnier’s student developed gavage feeding for infants, too weak or too immature to suck and swallow. In the early 1900’s hospitals began establishing “Special care baby units”, as incubators and other innovations gained broader acceptance. In the 1950’s and 1960’s modern intensive care units with standardized management protocols were developed. Dr. Virginia Apgar formulated a scoring system for objective assessment of newborns at birth. Mary Ellen Avery discovered that respiratory distress syndrome in premature infants was caused by deficiency in lung surfactant. Mechanical ventilators specially designed for infants appeared between 1960 to 1970, and Maria Delivoria-Papadopoulos established its use for premature infants, hence improving respiratory support and subsequent survival. Synthetic pulmonary surfactant was introduced in the 1980’s and revolutionized the management of respiratory distress syndrome. As medical innovations continued to advance, notably antenatal steroid to mothers introduced by Liggins and Howie (Adopted by NIH consensus panel 1995) the gestational age for viability began to fall. In the 1960’s delivery before 28 weeks completed was considered previable. By the 1970’s the range extended between 24 to 28 weeks. At the start of the 21st century the threshold was 22-23 weeks in some cases.
Conclusion(s): Decision about resuscitation and aggressive life support for infants present significant challenges for both physicians and families. At the limits of viability survival is frequently complicated by short and long term disability with ongoing risk of death. The high morbidity rate inevitably places an additional health burden on the survivors and a financial strain on families and society. Providing intensive care to this high risk population presents a fundamental conflict between sanctity, quality of life and treatment cost effectiveness.
