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Published on: November 20, 2015
[Approach to preterm birth on the threshold of viability (the 22-25 week) of gestation]
Insights
Preterm birth is a significant issue with high societal costs. Parental wishes regarding quality of life may outweigh gestational age in decisions for extremely premature infants.
Area of Science:
- Perinatal Medicine
- Neonatology
- Public Health
Background:
- Preterm birth poses socioeconomic challenges due to the costs associated with caring for disabled premature infants.
- The frequency of preterm births remains stable in the Euro-Atlantic Region despite advancements in perinatal care.
- Preterm birth manifests clinically as premature labor, premature rupture of membranes, or cervical incompetence.
Purpose of the Study:
- To discuss the complexities surrounding preterm birth, viability, and decision-making in neonatal care.
- To highlight the ethical considerations and the importance of parental input in cases of extreme prematurity.
Main Methods:
- Review of current clinical understanding of preterm birth.
- Analysis of viability thresholds and the 'grey zone' of neonatal prognosis.
- Examination of West European recommendations for managing extremely premature infants.
Main Results:
- The threshold for infant viability is currently between 22-23 weeks of gestation.
- The 22-25 weeks gestation period is considered a 'grey zone' with uncertain mortality and morbidity outcomes.
- Individualized approaches and parental informed consent are emphasized for neonates born between 24-25 weeks.
Conclusions:
- Decision-making for extremely premature infants requires a balance between medical prognosis and parental values concerning quality of life.
- Parental wishes regarding the initiation of aid for newborns may be prioritized over strict gestational age criteria.
- Ethical considerations and individualized care are paramount in managing the uncertain outcomes of preterm birth.
Abstract:
Preterm birth represents a serious socioeconomic problem because of costs for the care and integration of some premature children with disabilities into society. It is a syndrome which results from many initiating reasons. It takes three basic forms of the clinical view: premature labour with contractions, premature rupture of the membranes and incompetence of cervix. The frequency of preterm births is stable in most countries of the Euro-Atlantic Region, which does not correspond to still improving perinatal care. Viability is known as an ability to survive, grow and develop in a standard way. The threshold of viability in regard to the possibility to be born alive and survive lies between week 22 and 23 at present. By neonatologists, the 22-25 weeks of gestation is known as the grey zone, during which the prognosis of mortality and morbidity is uncertain. The recommendations of most West European countries emphasize the importance of individual approach to the 24-25 week. The parents must be informed about the prognosis of mortality and morbidity of the foetus. The criterion of quality of life should also be respected. Therefore the wishes of parents not to provide the aid to the newborn baby may be more important than the criterion of maturity.
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