Indian Pediatrics

, Volume 56, Issue 1, pp 13–17 | Cite as

Periviable Birth – The Ethical Conundrum

  • Somashekhar M. Nimbalkar
  • Satvik C. BansalEmail author


When delivery is anticipated near the limit of viability, both the family and the caregiver are faced with many complex and ethically challenging decisions. It must be remembered that the decisions that are made are going to impact the entire life of the baby and the family. Such decisions should be based on the best available evidence about the prognosis for the infant. If the chance of mortality and serious morbidity for an infant is high (but not too high), parental discretion around provision of life-sustaining treatment is appropriate. In this article, we discuss issues on survival and outcomes of extremely premature infants, and the available guidelines.


Ethics Extreme prematurity Survival Viability 


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  1. 1.
    Raju TN, Mercer BM, Burchfield DJ, Joseph GF Jr. Periviable birth: executive summary of a joint workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal–Fetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists. Obstet Gynecol. 2014;123:1083–96.CrossRefGoogle Scholar
  2. 2.
    Lubchenco LO, Searls DT, Brazie JV. Neonatal mortality rate: relationship to birth weight and gestational age. J Pediatr. 1972;81:814–22.CrossRefGoogle Scholar
  3. 3.
    Koops BL, Morgan LJ, Battaglia FC. Neonatal mortality risk in relation to birth weight and gestational age: update. J Pediatr. 1982;101:969–77.CrossRefGoogle Scholar
  4. 4.
    Stoll BJ, Hansen NI, Bell EF, Shankaran S, Laptook AR, Walsh MC, et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics. 2010;126:443–56.Google Scholar
  5. 5.
    Costeloe KL, Hennessy EM, Haider S, Stacey F, Marlow N, Draper ES. Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies). BMJ. 2012;345:e7976.CrossRefGoogle Scholar
  6. 6.
    Moore GP, Lemyre B, Barrowman N, Daboval T. Neurodevelopmental outcomes at 4 to 8 years of children born at 22 to 25 weeks’ gestational age: A meta-analysis. JAMA Pediatr. 2013;167:967–74.CrossRefGoogle Scholar
  7. 7.
    Bolisetty S, Legge N, Bajuk B, Lui K. Preterm infant outcomes in New South Wales and the Australian Capital Territory. New South Wales and the Australian Capital Territory Neonatal Intensive Care Units’ Data Collection. J Paediatr Child Health. 2015;51:713–21.Google Scholar
  8. 8.
    Moore T, Hennessy EM, Myles J, Johnson SJ, Draper ES, Costeloe KL, et al. Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies. BMJ. 2012;345:e7961.CrossRefGoogle Scholar
  9. 9.
    Younge N, Goldstein RF, Bann CM, Hintz SR, Patel RM, Smith PB, et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Survival and neurodevelopmental outcomes among periviable infants. N Engl J Med. 2017; 376:617–28.Google Scholar
  10. 10.
    Lee SK, Penner PL, Cox M. Comparison of the attitudes of healthcare professionals and parents toward active treatment of very low birth weight infants. Pediatrics. 1991;88:110–4.Google Scholar
  11. 11.
    President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Deciding to Forego Life-Sustaining Treatment: A Report on the Ethical, Medical, and Legal Issues in Treatment Decisions. Washington, DC: Government Printing Office; 1983.Google Scholar
  12. 12.
    Singh J, Fanaroff J, Andrews B, et al. Resuscitation in the “gray zone” of viability: Determining physician preferences and predicting infant outcomes. Pediatrics. 2007;120:519–26.CrossRefGoogle Scholar
  13. 13.
    Gillam L. The zone of parental discretion: An ethical tool for dealing with disagreement between parents and doctors about medical treatment for a child. Clin Ethics. 2016; 11:1–8.CrossRefGoogle Scholar
  14. 14.
    Petteys AR, Goebel JR, Wallace JD, Singh-Carlson S. Palliative care in neonatal intensive care, effects on parent stress and satisfaction: a feasibility study. Am J Hosp Palliat Care. 2015;32:869–75.CrossRefGoogle Scholar
  15. 15.
    Mercurio MR. The ethics of newborn resuscitation. Semin Perinatol. 2009;33:354–63.CrossRefGoogle Scholar
  16. 16.
    Wyllie J, Bruinenberg J, Roehr CC, Rüdiger M, Trevisanuto D, Urlesberger B. European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation. 2015;95:249–63.CrossRefGoogle Scholar
  17. 17.
    Wyckoff MH, Aziz K, Escobedo MB, Kapadia VS, Kattwinkel J, Perlman JM, et al. Part 13: Neonatal Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132:S543–60.CrossRefGoogle Scholar
  18. 18.
    American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine. Obstetric care consensus No. 6: Periviable Birth. Obstet Gynecol. 2017;130:e187–e99.CrossRefGoogle Scholar
  19. 19.
    Tyson JE, Parikh NA, Langer J, Green C, Higgins RD. Intensive care for extreme prematurity-moving beyond gestational age. N Engl J Med. 2008;358:1672e8.CrossRefGoogle Scholar
  20. 20.
    Devpura B, Bhadesia P, Nimbalkar S, Desai S, Phatak A. Discharge against medical advice at neonatal intensive care unit in Gujarat, India. Int J Pediatr. 2016;2016:1897039.CrossRefGoogle Scholar

Copyright information

© Indian Academy of Pediatrics 2019

Authors and Affiliations

  1. 1.Department of PediatricsPramukhswami Medical CollegeKaramsadIndia

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