Evidence-Based Ethics in the Gray Zone of Neonatal Viability: Promises and Limitations

Abstract

The term ‘evidence-based ethics’ was coined by Tyson to describe the use of specific and detailed outcome data to guide decision making surrounding the provision of neonatal intensive care to infants of borderline viability. Recently, developed prognostic models using factors such as birthweight, gender, multiple birth and antenatal corticosteroid exposure, in addition to gestational age may help refine estimates of prognosis. We will argue that such estimates may help refine the boundaries of the gray zone of infant viability, in which the prognosis is uncertain or guarded enough that parental authority should take precedence in decision making regarding neonatal resuscitation. We will also examine the evidence for applying immediate postnatal factors, such as initial infant heart rate, to determine the appropriateness of resuscitation and conclude that there are few postnatal factors that should alter resuscitation decisions made in concert with the parents prior to delivery.