HEC Forum

, Volume 23, Issue 1, pp 31–42 | Cite as

Report of an International Conference on the Medical and Ethical Management of the Neonate at the Edge of Viability: A Review of Approaches from Five Countries

  • William R. SexsonEmail author
  • Deborah K. Cruze
  • Marilyn B. Escobedo
  • Alfred W. Brann


Current United States guidelines for neonatal resuscitation note that there is no mandate to resuscitate infants in all situations. For example, the fetus that at the time of delivery is determined to be so premature as to be non-viable need not be aggressively resuscitated. The hypothetical case of an extremely premature infant was presented to neonatologists from the United States and four other European countries at a September 2006 international meeting sponsored by the World Health Organization Collaborating Center in Reproductive Health of Atlanta (currently, the Global Collaborating Center in Reproductive Health). Responses to the case varied by country, due to differences in legal, ethical and related practice parameters, rather than differences in medical technology, as similar medical technology was available within each country. Variations in approach seemed to stem from physicians’ perceptions of their ability to remove the neonate from life support if this appeared non-beneficial. There appears to be a desire for greater convergence in practice options and more open discussion regarding the practical problems underlying the variability. Specifically, the conference attendees identified four areas that need to be addressed: (1) lack of international consensus guidelines in viability and therapeutic options, (2) lack of bodies capable of generating these guidelines, (3) variation in laws between countries, and (4) the frequent failure of physicians and families to confront death at the beginning of life.


Neonatal resuscitation Ethical treatment of premature infants Neonatology 


  1. American Heart Association. (2005). Part 7: Neonatal resuscitation. Circulation, 112 (22_suppl), III-91-99.Google Scholar
  2. Center for Disease Control, Prevention. (2008). National vital statistics report. Atlanta: Centers for Disease Control and Prevention.Google Scholar
  3. Emory University Office of International Affairs. (2008). Key international accomplishments in 200708: Emory, Europe and Eurasia [On-line] available from: Accessed 8 April 2009.
  4. IndexMundi (2008). Russia Birth Rate. [On-line] available from: Accessed 23 March 2009.
  5. IndexMundi. (2008). Russian life expectancy at birth. [On-line] available from: Accessed 23 March 2009.
  6. Kattwinkel, J. (Ed.). (2006). Textbook of neonatal resuscitation (5th ed.). Elk Grove Village, Il: American Academy of Pediatrics, American Heart Association.Google Scholar
  7. Marquez, P., Suhrcke, M., McKee, M., & Rocco, L. (2007). Adult health in the Russian Federation: More than just a health problem. Health Affairs, Countries Studies, 26(4), 1040–1051.CrossRefGoogle Scholar
  8. Putin, V. (2006). Annual address to the federal assembly. Moscow: The Kremlin.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • William R. Sexson
    • 1
    Email author
  • Deborah K. Cruze
    • 2
  • Marilyn B. Escobedo
    • 3
  • Alfred W. Brann
    • 4
  1. 1.Emory University School of MedicineAtlantaUSA
  2. 2.Health Sciences and Ethics, Center for EthicsEmory UniversityAtlantaUSA
  3. 3.Reba McEntire Endowed Chair in Neonatology, Neonatal Perinatal Medicine, Department of PediatricsUniversity of OklahomaOklahoma CityUSA
  4. 4.Emory University School of Medicine, Global Collaborating Center in Reproductive Health, AtlantaAtlantaUSA

Personalised recommendations