Abstract
The current Dutch guideline on care at the edge of perinatal viability advises to consider initiation of active care to infants born from 24 weeks of gestational age on. This, only after extensive counseling of and shared decision-making with the parents of the yet unborn infant. Compared to most other European guidelines on this matter, the Dutch guideline may be thought to stand out for its relatively high age threshold of initiating active care, its gray zone spanning weeks 24 and 25 in which active management is determined by parental discretion, and a slight reluctance to provide active care in case of extreme prematurity. In this article, we explore the Dutch position more thoroughly. First, we briefly look at the previous and current Dutch guidelines. Second, we position them within the Dutch socio-cultural context. We focus on the Dutch prioritization of individual freedom, the abortion law and the perinatal threshold of viability, and a culturally embedded aversion of suffering. Lastly, we explore two possible adaptations of the Dutch guideline; i.e., to only lower the age threshold to consider the initiation of active care, or to change the type of guideline.
Highlights
Guidelines on care at the edge of perinatal viability differ between countries
Our country has a relatively high threshold of providing active care (>24 weeks of gestation), a gray zone between 24 and 26 weeks of gestational age (GA), the initiation of active management in the gray zone determined by parental discretion, and a slight reluctance to initiate active care for extremely premature infants [1,2,3,4]
Until 2005, a Dutch consensus guideline recommended not to provide active care to extremely premature infants born before 260/7 weeks of GA [5]
Summary
Guidelines on care at the edge of perinatal viability differ between countries. Both in terms of such guidelines and the related attitudes of healthcare professionals, the Netherlands can be considered as an outlier. Our country has a relatively high threshold of providing active care (>24 weeks of gestation), a gray zone between 24 and 26 weeks of gestational age (GA), the initiation of active management in the gray zone determined by parental discretion, and a slight reluctance to initiate active care for extremely premature infants [1,2,3,4]. This Dutch position merits reflection, especially in view of the current revision of the guideline on the matter. We will use the outcomes of this analysis to speculate on possible emendations of the current guideline
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