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Decision-making at the limit of viability
Ana Lemos1, Henrique Soares2,3, Hercília Guimarães2,3,4
1Faculty of Medicine, University of Porto, Porto, Portugal - anamolemos@hotmail.com.
Insights
Caring for babies born at the limit of viability is challenging. This review highlights interventions and emphasizes individualized care, parental involvement, and support for families facing difficult decisions regarding neonatal intensive care.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Bioethics
Background:
- Babies born at the limit of viability face significant risks of morbidity and mortality.
- Current scientific advancements present challenges in managing these extremely premature infants.
- Varied international recommendations exist for interventions based on gestational age.
Purpose of the Study:
- To review existing literature on the treatment approaches for newborns at the limit of viability.
- To explore interventions aimed at improving survival and minimizing long-term complications.
- To examine ethical considerations and parental involvement in decision-making for extremely premature infants.
Main Methods:
- Literature review of studies concerning the treatment of newborns at the limit of viability.
- Analysis of interventions applied prenatally and postnatally.
- Synthesis of recommendations regarding gestational age thresholds for different treatments.
Main Results:
- Survival rates and survival without morbidity increase with higher gestational age.
- Consensus exists on comfort care for the lowest limit of viability and active care for higher gestational ages.
- Palliative care and parental involvement are crucial considerations.
Conclusions:
- Optimal care for babies at the limit of viability requires a balance of interventions, considering gestational age and individual outcomes.
- Respecting parental wishes and providing comprehensive support, including during bereavement, is essential.
- Continuous evaluation of treatment protocols and ethical guidelines is necessary to improve care for extremely premature infants.
Abstract:
Babies born at the limit of viability have a high risk of morbidity and mortality. Despite great advances in science, the approach to these newborns remains challenging. Thus, this study reviewed the literature regarding the treatment of newborns at the limit of viability. There are several interventions that can be applied before and after birth to increase the baby's survival with the least sequelae possible, but different countries make different recommendations on the gestational age that each treatment should be given. There is more consensus on the extremities of viability, being that, at the lower extremity, comfort care is preferred and active care in newborns with higher gestational age. The higher the gestational age at birth, the higher the survival and survival without morbidity rates. At all gestational ages, it is important to take into account the suffering of these babies and to provide them the best quality of life possible. Sometimes palliative care is the best therapeutic approach. The parents of these babies should be included in the decision-making process, if they wish, always respecting their needs and wishes. Nevertheless, the process of having such an immature child can be very painful for parents, so it is also important to take into account their suffering and provide them with all the necessary support. This support should be maintained even after the death of the newborn.
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