Assessing risks at 22-24 weeks gestation

Area of Science:

• Neonatal Medicine
• Perinatal Care
• Medical Ethics

Background:

• The British Association of Perinatal Medicine (BAPM) issued new guidance in 2019.
• This guidance permits considering resuscitation for extremely premature infants (EPI) between 22-24 weeks gestational age (GA) on a case-by-case basis in the UK.
• This has created significant discussion and uncertainty within UK neonatal units.

Purpose of the Study:

• To explore the implications of the 2019 BAPM guidance on neonatal care decisions.
• To address the challenges in determining fetal viability and best interests for infants under 24 weeks GA.
• To examine the ethical considerations surrounding survival-focused care (SFC) versus comfort-focused care (CFC).

Main Methods:

• Qualitative analysis of the BAPM guidance framework.
• Review of ethical considerations in neonatal resuscitation.
• Discussion of clinical decision-making processes for extremely premature infants.

Main Results:

• The BAPM guidance introduces a new framework for managing extremely premature infants.
• Decisions regarding viability and the provision of SFC or CFC are complex.
• Despite the framework, persistent uncertainty remains in clinical practice.

Conclusions:

• The 2019 BAPM guidance marks a shift in managing extremely premature infants.
• Ethical dilemmas persist regarding the balance between survival and comfort in neonatal care.
• Further clarification and support are needed for clinicians navigating these complex decisions.