Abstract
Parents and medical staff usually agree on the management of preterm labour at borderline viability, when there is a relatively high risk of long‐term neurodevelopmental problems in survivors. If delivery is imminent and parents and staff cannot agree on the best management, however, who should decide what will happen when the baby is delivered? Should the baby be resuscitated? Should intensive care be initiated? Three ethicists, one of whom is also a neonatologist, discuss this complex issue.
Highlights
A 30-year-old woman went into threatened labour at 23-week gestation
On a neonatal ward round, the consultant neonatologist said the prognosis for 24-week gestation babies had improved to the extent that he was reluctant to allow the parents the option to withhold neonatal intensive care
Australian and New Zealand Neonatal Network data indicate that, in 1995, 53% of infants born at 24-week gestation who were admitted to neonatal intensive care units survived to be discharged home.[12]
Summary
A 30-year-old woman went into threatened labour at 23-week gestation. She and her husband wanted no active resuscitation and no invasive intervention if the baby was delivered immediately. On a neonatal ward round, the consultant neonatologist said the prognosis for 24-week gestation babies had improved to the extent that he was reluctant to allow the parents the option to withhold neonatal intensive care He stated that if the parents had continued to decline resuscitation he would have acted as the baby’s advocate and over-ruled the parents. Both parents decline invasive neonatal intensive care for a baby at the extremes of viability? In the case example above, clinicians appeared to believe that resuscitation was previously in this grey zone, but a couple of days later had moved into the ‘white zone’, such that non-resuscitation was no longer appropriate
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