Morning Becky,
as I said in my previous post, if you find what I plan on writing here too difficult to read, please feel to ask MNHQ to delete this post and I just want reiterate that I can only comment on my own working experience, not what other units may/may not do under similar circumstances.
If a baby is delivered at 24 completed weeks gestation, then they will be automatically resuscitated at delivery. As they are so immature, they will normally be intubated and ventilated and given a drug called surfactant directly into their lungs. Lung immaturity is the biggest initial problem for extreme preterm infants as they have not had the time in the womb for their lungs to mature and start producing their own surfactant. This deficiency can cause long term damage and problems for babies.
If a woman goes into labour at less then 24 weeks but 23-23+6 weeks pregnant, then they will have the opportunity to discuss with a neonatologist/paediatrician, what their wishes are regarding resuscitation.
A team from the neonatal unit would attend the delivery if this is what the parents wished and if the baby was born in good condition and showed signs of life, then they would be resuscitated.
Babies born at 23+ weeks do survive but sadly the greater percentage don't as they really are very immature.
Babies under 23 weeks are extremely unlikely to be offered resuscitation at birth, I have worked in neonates for a very long time and I can only recall 1 22+6 week baby being brought to the unit. Although they were a good weight, their lungs were too small and immature to cope with the work of breathing/ventilation and this baby sadly died at only a few hours of age.
I think what is very very hard for parents, is when a baby is born under 23 weeks and is born alive and they can live for some time and their baby is not offered any help to survive.
In these circumstances, parents are given their baby to hold.
This is because at the moment, the technology just isn't around to help these babies. 30 years ago, babies who were born at 28 weeks gestation were in a similar situation as those babies born today at 23-24 weeks gestation.
Survival rates are improving slowly and maybe in the future, advancements will be made so even more extreme preterm babies will be given a chance of survival.
A baby's birthweight will also have a factor on their chances of survival and again it is rare for a baby of under 400g to survive.
Because of the support extreme preterm babies require in order to survive, this can cause damage/problems that in turn can make them extremely unwell.
Ventilation can cause lung damage and if you are a preterm baby you are more susceptible to lung damage. It then becomes a catch 22 situation as the baby's lungs are damaged by being ventilated and they then become stuck on a ventilator as their lungs are not able to cope with breathing without support.
As an earlier poster mentioned they are at more of a risk of bleeds into the brain, which depending on the severity, can cause a lot of problems in the long term. Inserting lines into small babies can be a problem but most preterm babies who require intensive care will have umbilical lines inserted into their cord, which is an easy way of gaining access to veins/arteries.
There are other problems that preterm babies can have, but the ventilation and haemorrhages are generally the major difficulties in the first week of life.
The smaller and more immature you are at birth, you will normally need an awful lot of support and despite the best efforts, sometimes this isn't enough.
If there is anything else you would like to know, please let me know and I'll try to help.