Perinatal care of extremely premature infants

The guidelines were formed during a workshop involving doctors, nurses, other health professionals and parents from NSW and the ACT, conducted in February 2005 to discuss perinatal care of extremely premature infants.

The workshop produced consensus statements about some of the difficult ethical and practical issues, and to produce accurate and consistent information for doctors and parents.

The consensus statements, produced by the delegates after extensive discussion and reported by Dr Kei Lui of the Royal Hospital for Women (Sydney), University of NSW and colleagues, are published in the latest issue of the Medical Journal of Australia (MJA).

"The debate on management of neonates at the threshold of viability is an emotive and complex issue," say the authors.

Care of extremely premature infants demands a balance between parents' wishes, doctors' responsibilities, and the likelihood that the child will survive and have an acceptable quality of life.

Workshop delegates agreed that there is a 'grey zone' — between 23 weeks and 25 weeks and 6 days gestation — during which it is acceptable medical practice not to initiate intensive care if parents wish.

The consensus statements advised that women at high risk of imminent delivery within the grey zone should receive appropriate and skilled counselling.

The workshop also updated and revised the NSW and ACT parents' information booklet for extremely premature births. The updated booklet is available at www.psn.org.au.

The authors of the consensus statements hope that they will help guide parents and clinicians in making the difficult decisions surrounding care of extremely premature infants.

In an accompanying editorial, Professor Brian Darlow of the Christchurch School of Medicine at the University of Otago congratulates Dr Lui and colleagues on their approach to the issue.

"In their statement, Lui and colleagues have provided valuable guidelines for parents and practitioners dealing with impending extremely preterm delivery," said Professor Darlow.

The Medical Journal of Australia is a publication of the Australian Medical Association.

Both these journal articles can be accessed at www.mja.com.au.