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

Abstract

We report the case of a preterm small for gestational age male infant born at 24 weeks of gestation with a birth weight of 268 g who was discharged from our hospital without the requirement for home oxygen therapy or tube feeding. He did not experience severe intraventricular hemorrhage, periventricular leukomalacia, hearing disability, or any other serious complications. At that time (February 2019), according to the University of Iowa's Tiniest Babies Registry, he was the tiniest male infant in the world to survive without any serious complications other than severe retinopathy of prematurity that required laser therapy. Although the survival rate of infants with extremely low birth weight is improving worldwide, a high mortality rate and incidence of severe complications remain common for infants weighing <300 g at birth, particularly in male infants. In recent years, there have been frequent discussions regarding the ethical and social issues involved in treating extremely preterm infants weighing <400 g. Despite the challenges, reports of such infants surviving are increasing. Neonatal medicine has already achieved great success in treating infants weighing 400 g or more at birth. However, lack of evidence and experience may make physicians reluctant to treat infants weighing less than this. 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.

Keywords: birth weight of 268 g; extremely low birth weight; family involvement; intact survival; male; marginally viable infant; minimal handling.

Figure 1

The clinical course of respiratory management. The left vertical axis indicates the daily maximum ventilator setting for mean airway pressure and the right vertical axis indicates the daily maximum ventilator setting for FiO₂. The horizontal axis indicates the postnatal day of life. The solid line indicates mean airway pressure, and the dotted line indicates FiO₂. HFO, high-frequency oscillation; SIMV, synchronized intermittent mandatory ventilation.

Figure 2

Patient's growth charts. Our infant's anthropometric measurements are plotted against Japanese neonatal anthropometric charts of male infants delivered by a para 0 mother according to gestational age at birth. Dots indicate the patient's measurements at the given postmenstrual age. The vertical axes indicate (A) body weight, (B) body length, and (C) head circumference. The horizontal axis indicates gestational age for the Japanese neonatal anthropometric charts and postmenstrual age for our patient. The Japanese neonatal anthropometric charts feature five solid lines indicating the distribution of data; in order from top to bottom, they represent the mean +2.0 SD, +1.5 SD, ±0 SD, −1.5 SD, and −2.0 SD.