Published online December 31, 2007
PEDIATRICS Vol. 121 No. 1 January 2008, pp. e193-e198 (doi:10.1542/10.1542/peds.2007-0513)
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SPECIAL ARTICLE

Perinatal Care at the Threshold of Viability: An International Comparison of Practical Guidelines for the Treatment of Extremely Preterm Births

Maria Serenella Pignotti, MD and Gianpaolo Donzelli, MD

Neonatal Medicine, A. Meyer Children Hospital, University of Florence, Florence, Italy

Over the last 2 decades, the survival rate of infants born at ≤25 weeks of gestation has increased; however, significant morbidity and disability persist. The commitment for their care gives rise to a variety of complex medical, social, and ethical aspects. Decision-making is a crucial issue that involves the infant, the family, health care providers, and society. In a review of the existing guidelines, we investigated the different approaches in the care of extremely preterm births in various countries. We found that many scientific societies and professional organizations have issued guidelines that address the recommendations for the care of these fetuses/neonates although to varying degrees. In this article we compare different approaches and assess the scientific grounds of the specific recommendations. With current standards, intensive care is generally considered justifiable at ≥25 weeks, compassionate care at ≤22 weeks, and an individual approach at 23 to 24 weeks, consistent with the parents' wishes and the infant's clinical conditions at birth.

Key Words: practice guidelines • newborn • withholding treatment • fetal viability • perinatal care

Accepted Jun 19, 2007.


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