title: Birth at 22 gestational weeks: case report of cognitive resilience.
abstract: OBJECTIVE
  Children delivered at the edge of viability are at greatest risk of medical and neuropsychological disability, their adverse outcomes overshadowing extremely preterm survivors with more optimal outcomes. We aimed to describe an exceptionally early-born extremely preterm (EEEP) preschooler whose neurobiological, familial, and socioeconomic factors likely influenced her unexpected cognitive resilience.
  
  
  METHODS
  Baby G was a 3-years 10-months-old, English-speaking, Caucasian, singleton girl born weighing 435 g at 225/7weeks' gestation to well-educated married parents. Neonatal complications of extremely premature birth included sepsis, severe respiratory distress syndrome, patent ductus arteriosus requiring ligation, necrotizing enterocolitis not requiring surgical intervention, and retinopathy of prematurity. Intellectual and neuropsychological testing was administered.
  
  
  RESULTS
  Baby G performed age-appropriately in nearly all domains and did not exhibit intellectual deficits. Her general conceptual ability was above average for both her chronological and adjusted ages. She had below average performance on tests of motor function, working memory, and delayed recall of spatial locations. Standardized parental behavioral questionnaires indicated no concern in emotional or attentional functioning except in relation to mental shifting capacity and signs of anxiety.
  
  
  CONCLUSIONS
  Report of persistent adverse neurodevelopmental/neuropsychological disabilities following EEEP birth is a counterpoint to the more optimal outcomes in some vulnerable EEEP survivors. This case emphasizes that decisions about aggressive resuscitation and prognostication for infants born EEEP may be enhanced by consideration of individual variability, and of pertinent medical, socioeconomic, and sociodemographic variables that may be more predictive of neuropsychological outcomes than birth weight and gestational age.
authors.affiliation: a Fairfax Neonatal Associates at Inova Children's Hospital , Falls Church , VA , USA.
authors.forename: Crista A
authors.initials: CA
authors.lastname: Hopp
authors.affiliation: b Independent Private Practice , Potomac , MD , USA.
authors.forename: Ida Sue
authors.initials: IS
authors.lastname: Baron
mesh_terms: D002652:Child Behavior; D002675:Child, Preschool; D003071:Cognition; D004522:Educational Status; D056344:Executive Function; D005260:Female; D006801:Humans; D062071:Infant, Extremely Premature / Q000523:psychology*; D007361:Intelligence Tests; D008570:Memory, Short-Term; D011939:Mental Recall; D009483:Neuropsychological Tests; D010290:Parents; D011247:Pregnancy; D011597:Psychomotor Performance; D055500:Resilience, Psychological; D012151:Resuscitation; D065852:Spatial Memory
keywords: Viability; cognitive assessment; extremely preterm; neurodevelopment; preschool