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Minerva Pediatrica 2020 May 15

DOI: 10.23736/S0026-4946.20.05825-9

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Decision-making at the limit of viability: an overview

Ana LEMOS 1 , Henrique SOARES 1, 2, Hercília GUIMARÃES 1, 2, 3

1 Faculty of Medicine, University of Porto, Porto, Portugal; 2 Neonatal Intensive Care Unit, Department of Pediatrics, Centro Hospitalar e Universitário de São João, Porto, Portugal; 3 Cardiovascular R&D Unit of Faculty of Medicine, University of Porto, Porto, Portugal


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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.


KEY WORDS: Premature birth; Fetal viability; Neonatal intensive care; Shared decision-making; Ethics

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