Perinatal care at the borderlines of viability: a consensus statement based on a NSW and ACT consensus workshop

Abstract

Perinatal care at the borderlines of viability demands a delicate balance between parents’ wishes and autonomy, biological feasibility, clinicians’ responsibilities and expectations, and the prospects of an acceptable long‐term outcome — coupled with a tolerable margin of uncertainty. A multi‐professional workshop with consumer involvement was held in February 2005 to agree on management of this issue in New South Wales and the Australian Capital Territory. Participants discussed and formulated consensus statements after an extensive consultation process. Consensus was reached that the “grey zone” is between 23 weeks’ and 25 weeks and 6 days’ gestation. While there is an increasing obligation to treat with increasing length of gestation, it is acceptable medical practice not to initiate intensive care during this period if parents so wish, after appropriate counselling. Poor condition at birth and the presence of serious congenital anomalies have an important influence on any decision not to initiate intensive care within the grey zone. Women at high risk of imminent delivery within the grey zone should receive appropriate and skilled counselling with the most relevant up‐to‐date outcome information. Management plans can thus be made before birth. Information should be simple, factual and consistent. The consensus statements developed will provide a framework to assist parents and clinicians in communication, decision making and managing these challenging situations.

Predicting death or major neurodevelopmental disability in extremely preterm infants born in Australia

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Antenatal corticosteroids for neonates born before 25 Weeks—A systematic review and meta-analysis

“…[6] On the other hand the consensus statement from New South Wales, Australia suggests that it is acceptable not to initiate intensive care in neonates born at 22−25 6 weeks’ gestation if parents wish so after appropriate counselling. [7] It is important to note that the evidence supporting ANC at <26 weeks’ gestation is based mainly on laboratory studies and non-RCTs. The only RCT (n = 49) in this field is from the pre-surfactant era.…”

Survival rates of extremely preterm infants (gestational age <26 weeks) in Switzerland: impact of the Swiss guidelines for the care of infants born at the limit of viability

“…However, this success has its price and the burden of intensive care imposed on borderline viable infants who ultimately do not survive, and high rates of neurosensory impairments among survivors have raised serious ethical questions 7 8 9 10 11. Many national paediatric and neonatal societies have responded to these concerns with the publication of guidelines to support ethical decision making in the care of infants born at the limit of viability 12 13 14 15 16 17 18…”