A baby born at 28 weeks gestation is classified as “very preterm” and has reached the beginning of the third trimester. Modern medicine allows infants delivered this early to survive, though they face substantial challenges due to extreme prematurity. This gestational age represents a point where survival chances significantly improve compared to babies born just weeks earlier, requiring specialized medical intervention and care.
Defining Viability and Survival Rates
Viability refers to the point at which a fetus can survive outside the womb, a threshold that has moved earlier due to advances in neonatal care. For an infant born at 28 weeks, the survival rate in specialized medical centers typically ranges between 80 to 90 percent, with some data showing rates as high as 94 percent.
This prognosis depends heavily on several factors, including the administration of prenatal steroids to the mother before delivery. The outcome also relies on immediate, expert resuscitation at birth and the availability of a high-level Neonatal Intensive Care Unit (NICU).
Immediate Health Concerns for the Extremely Preterm Infant
The primary difficulties for a 28-week-old infant stem from the immaturity of their organ systems. The respiratory system is a major concern because the lungs lack sufficient surfactant, a fatty substance that helps the air sacs remain open. This deficiency leads to Respiratory Distress Syndrome (RDS), which requires medical support to ensure the lungs can properly exchange oxygen and carbon dioxide.
The neurological system faces the risk of Intraventricular Hemorrhage (IVH), which is bleeding into the fluid-filled spaces of the brain. The blood vessels in the brain of a very preterm infant are fragile and susceptible to rupture from fluctuations in blood pressure. This condition is a serious complication, as it can lead to long-term neurological impairment.
The gastrointestinal tract is also underdeveloped, making feeding difficult and increasing the risk of Necrotizing Enterocolitis (NEC). NEC is an inflammatory disease that can damage or destroy tissue in the bowel wall, and it is most common in infants born before 32 weeks gestation. Since the baby cannot coordinate the suck, swallow, and breathe reflex, they cannot feed orally and require alternative methods of nutrition.
The NICU Experience and Specialized Medical Care
The 28-week-old baby is immediately transferred to the Neonatal Intensive Care Unit (NICU) where specialized equipment supports survival and growth. Incubators provide a precisely controlled thermal environment, necessary because the premature infant lacks the body fat to regulate their own temperature. This warm, humidified space minimizes the energy the baby must expend on thermoregulation.
Respiratory support is provided through mechanical ventilation or Continuous Positive Airway Pressure (CPAP) to help keep the underdeveloped air sacs open. Surfactant replacement therapy, administered directly into the lungs, is a common treatment for RDS. Nutrition is delivered through intravenous lines, often as Total Parenteral Nutrition (TPN), which provides all necessary proteins, fats, and sugars directly into the bloodstream.
The NICU stay for a baby born at 28 weeks is prolonged, with discharge typically occurring close to the original due date, around 36 to 40 weeks of corrected gestational age. Before going home, the infant must demonstrate the ability to maintain a stable body temperature, breathe independently without significant pauses (apnea), and feed adequately by breast or bottle.
Long-Term Developmental Expectations
The long-term outlook for infants born at 28 weeks is generally positive, with a large majority having no or only minimal long-term health problems. However, the increased risk of developmental challenges compared to full-term infants remains. These children may face a higher likelihood of learning disabilities, attention deficit-hyperactivity disorder (ADHD), and sensory processing issues.
Developmental milestones are tracked using “corrected age,” calculated by subtracting the number of weeks the baby was born early from their chronological age. This allows healthcare providers to track development based on when the baby should have been born, providing a more accurate assessment of progress. Follow-up care is standard practice after NICU discharge, involving specialized clinics that monitor growth, hearing, vision, and neurological development. Early intervention programs provide tailored therapy and support, which can significantly improve outcomes for children who show signs of developmental delay.