Before the First Breath: How Teams Prepare for Birth at the Edge of

A new review in Pediatric Research, led by Kelsi Morgan of Northwestern University and colleagues at Baylor College of Medicine, summarizes how clinicians should prepare for and manage “periviable” births—typically at about 21 to 24 weeks of gestation. It highlights that evidence and outcomes vary widely across hospitals and that guidance differs internationally on when to offer active resuscitation, with some recommending from 22 weeks and others from 23 or 24. The review stresses that before any delivery-room equipment is used, antenatal counseling with families is essential, ideally as a process rather than a single appointment, accounting for what each family values most: survival, quality of life, comfort, or religious considerations. It also notes that national data show survival improvement over time, but outcomes remain highly variable.