• Wafaa Alrawi, Taisser Atrak, Ashraf Abuobayda, Nabil Elmansoury, Omar Elnakeib, and Abhijeet Lonikar.
• Department of Pediatrics, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates.
• Medicine (Baltimore). 2023 Jan 13; 102 (2): e32571e32571.

RationaleA gestational age of 22 to 23 weeks is the lower threshold for selective active intervention. Few infants delivered at a gestational age of 22 to 23 weeks survive if resuscitated. Among those who survive, most develop severe complications, especially in cases of multiple births at the limit of viability.Patient ConcernsWe report the intact survival of extremely preterm twins, a girl (Twin A) and a boy (Twin B), weighing 504g and 475g, respectively, born at the edge of viability at 22 2/7 weeks gestation without significant morbidity.Diagnosesextremely preterm twins born at the edge of viability at 22 2/7 weeks.InterventionsTwin A required 6 weeks of mechanical ventilation. She received conventional and high-frequency oscillation ventilation. She was extubated to noninvasive positive airway pressure ventilation at 28 weeks and 2 days post conception. Twin B required longer duration of invasive ventilation lasting 11 weeks. Moreover, he had several episodes of feeding intolerance and abdominal distension. However, his serial abdominal radiographs showed nonspecific findings. The gastric tubes were eventually removed from both twins. Full oral feeding was successful on discharge.OutcomesBoth infants are presently in good condition.They were discharged home with a full oral feeding, and without any respiratory support. Now they are 18-month-old with unimpaired development.LessonsThis report would support healthcare providers in decision-making. It highlights the importance of perinatal and neonatal management optimization to improve survival rates and clinical outcomes of periviable birth. In addition it emphasize the individuality of each case and the need to consider the parents' wishes in the management decision.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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