A 354-gram infant: 48 month follow-up.

Extreme prematurity (birth weight less than 500 g) with intact survival is very uncommon. This paper describes a preterm infant with birth weight of 354 g who is now 4 years old and developmentally normal. Intervention and management decisions in such a low birth weight group produce an ethical enigma. Survival of newborns with a birth weight less than 400 g is unusual. Decisions regarding intervention and care for extremely low birth weight infants impact on financial, emotional, and medical responsibilities of family members and health care professionals. It has been increasingly difficult to set guidelines or policies regarding resuscitation of "micropremies" based on weight and gestational age.