Limits of viability: are we heading in right direction?

Area of Science:

• Neonatal Medicine
• Global Health Equity
• Perinatal Care

Background:

• The definition of limits of viability, based on gestational age and birth weight, has evolved with neonatal care advancements.
• These viability thresholds differ significantly across countries, indicating variations in health system capacity rather than fixed biological limits.
• Global disparities in survival rates at the margins of prematurity are substantial, particularly between high-income (HIC) and low- and middle-income countries (LMIC).

Purpose of the Study:

• To critically examine the definition and context-dependent nature of the limits of viability.
• To analyze global inequities in periviable survival and their relationship with health system capacity.
• To discuss these disparities within the framework of Sustainable Development Goals (SDG) and child health rights.

Main Methods:

• This study is a critical review of the concept of limits of viability.
• It analyzes global disparities in survival at the margins of prematurity.
• The review considers the role of global health governance and emerging challenges.

Main Results:

• The limits of viability are not fixed biological thresholds but are shaped by access to perinatal and neonatal care.
• Persistent disparities in periviable survival remain substantial, with outcomes largely determined by place of birth.
• Current trends show a need to align technological progress in neonatal care with global health equity.

Conclusions:

• Reducing inequities in periviable survival necessitates prioritizing equitable implementation of evidence-based interventions.
• Strengthening health systems and sustaining global collaboration are crucial for improving outcomes for vulnerable newborns.
• Aligning advances in neonatal care with global equity is essential for the highest attainable standard of health for all children.