Limits of viability

[axf10]

Dear colleagues,

I am interested to learn the limits of viability at your institution/country. I have worked in several large centers in the US and we tend to resuscitate infants >24 weeks/ >500 grams. The outcomes are relatively poor for the 24-26 weekers, but despite intense counseling, the majority of families express the desire to resuscitate the infant. I sense that the practice varies depending on culture/religion/and level of education of the patient population. Specifically, I hear that in places such as the Netherlands or even University of California, San Francisco, the usual cutoff for resuscitation vs. comfort care is 26-27 weeks. Can you please share your thoughts, practice, or insight on this matter. Again, I am not just talking about the legal limit, but the usual practice in your region. Thank you.

Edited January 23, 2012 by axf10

[nader]

WE HAVE 23 WEEKS BABY , WEIGHT IS 560 GRAMS, OFF ALL BODY SYSTEMS NOT FUNCTIONING WELL, I THINK HE WILL SPEND A LOT OF MONEY AND EXPIRE AT THE END , I THINK WE CAN SPARE THAT MONEY TO TERM BABYS WITH CORRECTABLE CONGENITAL PROBLEMS9 E.G HERAT PROBLEMS) WHICH SOME TIMES DOESN'T FIND PLACE IN HOSPITALS

[surma]

It's not only the gestational age which is important . I think B Wt. , sex of baby, singleton or multiple gest, ANS before delivery is also v Important.

23 wk, 540gm, singleton, ANS , girl has better chance of survival than 25 wk, 495gm, twins, without ANS , boy.

[yalsaba]

This is a difficult question everywhere. To resuscitate or no. I think there is no clear answer for this question. The best is to have your own guidelines according to your facilities and experience and these guidelines should be discussed thoroughly and agreed from all staff and hospital committees.

[JACK]

The biggest problem facing a neonatologist while counselling propspective parents of an extremem preterm during intrapartum and immediate post-natal period is getting the parents to comprehend the whole picture - the mortality, the morbidity.

I think if we all start using a POT (Preterm Outcome Table) made from our local hospital data, then it may help parents understand what they are facing. This may help in counseling and helping parents make an informed decisions.

LINK: http://www.ncbi.nlm.nih.gov/pubmed/16704470

Can also develop computer based tools like the one from NICHD data to better communicate mortality/morbidity data. The stress should always be on local experiences instead of conveying some international figures which will not be achievable with the given resources and expertise in that hospital

LIN: http://www.nichd.nih.gov/about/org/cdbpm/pp/prog_epbo/epbo_case.cfm

[sSnjezana]

That policy (>25 weeks/ >500 grams) is in my Hospital. But I agree with surma, that it depends of more facts, like mother and pregnancy history, inflammation, pPRVP, twins and other and certainly of parents . We don't " agressively" resuscitate extremly premature babies , but it depends also of expectancy of parents and behavior of baby. We had baby of 442 grams, but she was 29 weeks, she moved barely, but she was definitly alive, and we resuscitated her, and after 3 months discharged her without a major complications. We wil see...

[dr mir]

there are no practiced guidlines our hospitals have no written ones basically usu an attempt at cpr is made pts are admitted most decissions are made on emotuonal basis have never seen orders for do not attempt resuscitation.most collegues do understand and agree with the probable outcomesand also there is usu a junior or pg student who needs ti learn about cpr.a pot will be usefull. dear jack please post the preterm outcome table

[JACK]

...dear jack please post the preterm outcome table

http://ebookbrowse.com/bolisetty-2006-preterm-outcome-table-very-preterm-infants-pdf-d229709866

[Deena]

The policy in our country is full resuscitation from week 24. Our results are mixed, but getting better. Below week 24 requires attendance of neonatologist and discussion with the parents. Only if the parents request and there are signs of viability will resuscitation be attempted. Hasn't happened yet.

[selvanr4]

The EBNEO had a talk on last day by prof from karolinska.

Please listen to. Educative and interesting thoughts.