Limit of viability: The Swiss experience

Area of Science:

• Perinatology
• Neonatal Medicine
• Public Health

Background:

• Significant advancements in perinatology have reduced mortality for extremely low birth weight infants.
• High rates of short-term complications and neurodevelopmental impairment persist among survivors.
• Optimal care strategies for borderline viable infants remain a subject of ongoing debate.

Purpose of the Study:

• To review the evolution and impact of national recommendations for perinatal care at the limit of viability in Switzerland.
• To explore factors contributing to outcome variability in the care of immature infants.

Main Methods:

• Analysis of national guidelines published in 2002 and revised in 2011 for infants born between 22 and 26 weeks of gestation.
• Examination of center-to-center outcome variability in neonatal intensive care units (NICUs).

Main Results:

• Initial Swiss recommendations were developed by a multidisciplinary expert team.
• Despite national guidelines, significant variability in infant outcomes across centers has been observed.
• Local NICU culture appears to be a significant factor influencing care and outcomes.

Conclusions:

• The effectiveness of national guidelines in standardizing care for borderline viable infants is still under evaluation.
• Further research is needed to understand and address the influence of NICU culture on infant outcomes.
• Continued efforts are necessary to improve both evidence-based care and reduce variability in outcomes for the most immature infants.