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In Reply.—
We thank Drs Janvier and Barrington for their interest in our periviability counseling guidelines.1 Their sentiments highlight precisely why we designed the guidelines—to provide a rational, supportive, and ethical framework for discussion and decision-making that is based on relevant outcomes studies, consensus, and family choice rather than a particular physician's individual experience or opinion. We would respectfully like to address their comments and concerns.
They state that an infant's “best interests” must be the guiding principle for intervention. We agree, and our guidelines clearly recognize that parents are the appropriate surrogate decision-makers for the best interests of the infant, a concept well established in bioethical decision-making.2,3 As neonatologists, Janvier and Barrington surely know that parents of impending extremely premature infants want and deserve clear medical information and guidance that is based on long-term health outcomes. To advocate that we should resuscitate extremely premature infants and then, after the fact, discuss whether NICU care should be continued …
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