Abstract
BackgroundMultidisciplinary study groups have produced documents in an attempt to support decisions regarding whether to resuscitate "at risk" newborns or not. Moreover, there has been an increasingly insistent request for juridical regulation of neonatal resuscitation practices as well as for clarification of the role of parents in decisions regarding this kind of assistance. The crux of the matter is whether strict guidelines, reference standards based on the parameter of gestational age and authority rules are necessary.DiscussionThe Italian scenario reflects the current animated debate, illustrating the difficulty intrinsic in rigid guidelines on the subject, especially when gestational age is taken as a reference parameter for the medical decision.SummaryConcerning the decision to interrupt or not to initiate resuscitation procedures on low gestational age newborns, physicians do not need rigid rules based on inflexible gestational age and birth weight guidelines. Guidance in addressing the difficult and trying issues associated with infants born at the margins of viability with a realistic assessment of the infant's clinical condition must be based on the infant's best interests, with clinicians and parents entering into what has been described as a "partnership of care".
Highlights
Multidisciplinary study groups have produced documents in an attempt to support decisions regarding whether to resuscitate "at risk" newborns or not
Summary: Concerning the decision to interrupt or not to initiate resuscitation procedures on low gestational age newborns, physicians do not need rigid rules based on inflexible gestational age and birth weight guidelines
Guidance in addressing the difficult and trying issues associated with infants born at the margins of viability with a realistic assessment of the infant's clinical condition must be based on the infant's best interests, with clinicians and parents entering into what has been described as a "partnership of care"
Summary
From this scenario that reflects the current animated debate in Italy, derives the intrinsic difficulty of laying down any rigid guidelines on the subject, especially when gestational age is taken as a reference parameter for medical decisions. There is a fair margin of error in the estimation of gestational age, so that in dubious cases, the Carta di Firenze for example specifies the "fundamental importance of clinical evaluation of the newborn by a neonatologist, who should take into account the newborn's conditions at birth, obstetric history and response to resuscitation procedures". Even in critical situations burdened by high mortality or morbidity (for example adult patients with cardiac arrest after trauma; cardiac arrest in children following severe trauma; adult patients with a primary haemorrhagic stroke) [22], the low percentages of survival or even the prevision of long term significant and disabling sequelae certainly do not lead to abstention from the resuscitation procedures laid down in rigorous protocols or guidelines [23,24]
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