Journal List > Hanyang Med Rev > v.29(4) > 1044026

Kim: Guidelines for Care of Fetal Infants at the Limit of Viability

Abstract

Viability of the fetal infant is its capability of living. It usually implies a fetus that has reached 500g in weight and 20 gestational weeks. Lower limit of viability is between 23 and 25 weeks' gestation in developed countries at present. Trends toward intervention at an earlier gestational age may be continuing. However, the term of viability does not simply mean the ability to be born alive, but the capability to grow and to develop normally in the extrauterine environment. There are concerns on what is the best management for fetal infants on the edge of viability. Decisions regarding all aspects of management of the birth and subsequent care of the fetal infant should be based on the fetal and infant's condition and prognosis and be made jointly by the parents and the physicians. This article will discuss medical, legal, socioeconomic and ethical issues to find the best way in the management of the fetal infants.

References

1. Kim CR. The Limit of Viability in Fetal Infants. J Korean Pediatr Soc. 2003; 46:413–417.
2. Muraskas JK, Carlson NJ, Halsey C, Frederiksen MC, Sabbagha RE. Survival of a 280-g infant. N Engl J Med. 1991; (324):1598–1599.
crossref
3. Chang YS, Kim KY, Koo SH, Lee JH, Hwang JH, Choi CW, Shim JW, Kim SS, Ko SY, Lee EK, Park WS. Outcomes and Management of Fetal Infants with Birth Weight Below 500 g at a Tertiary Center. Korean J Pediatr. 2005; 48:939–945.
4. Muraskas J, Hasson A, Besinger RE. A girl with a birth weight of 280 g, now 14 years old. N Engl J Med. 2004; 351:836–837.
crossref
5. Hokuto I, Ikeda K, Tokieda K, Mori K, Sueoka K. An ultra premature baby of 290 g birth weight needed more than 500 mg/kg of calcium and phosphorus daily. Eur J Pediatr. 2001; 160:450–451.
crossref
6. Dunn PM, Stirrat GM. Capable of being born alive? Lancet. 1984; 1:553–555.
crossref
7. Allen MC, Donohue PK, Dusman AE. The limit of viability-neonatal outcome of infants born at 22 to 25 weeks' gestation. N Engl J Med. 1993; 329:1597–1560.
crossref
8. Lemons JA, Bauer CR, Oh W, Korones SB, Papile LA, Stoll BJ, Verter J, Temprosa M, Wright LL, Ehrenkranz RA, Fanaroff AA, Stark A, Carlo W, Tyson JE, Donovan EF, Shankaran S, Stevenson DK. NICHD Neonatal Research Network. Very low birth weight outcomes of the National Institute of Child health and human development neonatal research network, January 1995 through December 1996. Pediatrics. 2001; 107:E1.
crossref
9. El-Metwally D, Vohr B, Tucker R. Survival and neonatal morbidity at the limits of viability in the mid 1990s: 22 to 25 weeks. J Pediatr. 2000; 137:616–622.
crossref
10. Kaempf JW, Tomlinson M, Arduza C, Anderson S, Campbell B, Ferguson LA, Zabari M, Stewart VT. Medical staff guidelines for periviability pregnancy counseling and medical treatment of extremely premature infants. Pediatrics. 2006; 117:22–29.
crossref
11. Kaempf JW, Tomlinson MW, Campbell B, Ferguson L, Stewart VT. Counseling pregnant women who may deliver extremely premature infants: medical care guidelines, family choices, and neonatal outcomes. Pediatrics. 2009; 123:1509–1515.
crossref
12. Wood NS, Marlow N, Costeloe K, Gibson AT, Wilkinson AR. EPICure Study Group. Neurologic and developmental disability after extremely preterm birth. N Engl J Med. 2000; 343:378–384.
crossref
13. Nishida H. Marginally viable, fetal infants - Who is too young or small to live: Japanese experience. In : Hot topics 2002 in Neonatology; 2002. p. 53–58.
14. Rennie JM. Perinatal management at the lower margin of viability. Arch Dis Child Fetal Neonatal Ed. 1996; 74:F214–F218.
crossref
15. McElrath TF, Robinson JN, Ecker JL, Ringer SA, Norwitz ER. Neonatal outcome of infants born at 23 weeks' gestation. Obstet Gynecol. 2001; 97:49–52.
crossref
16. Bae CW, Kim MH, Chun CS, Lee C, Moon SJ, Yoo BH, Lim BK, Lee SG, Choi YY, Byun SH, Choi AH, Pi SY, Han DG, Yun CK. Neonatal Statistics of Korea in 1996: Collective Results of Live - Births, Neonatal Mortality, and Incidence of Dischage Against Medical Advice at 64 Hospitals. J Korean Soc Neonatol. 1997; 4:153–169.
17. Hahn WH, Chang JY, Bae CW. Birth Statistics and Mortality Rates for Neonatal Intensive Care Units in Korea during 2007: Collective Results from 57 Hospitals. J Korean Soc Neonatol. 2009; 16:36–47.
18. Choi CW, Hwang JH, Shim JW, Kim SS, Ko SY, Lee EK, Chang YS, Park WS. Change in the Limit of Viability of Fetal Infants. J Korean Pediatr Soc. 2003; 46:1194–1199.
19. Richardson DK, Gray JE, Gortmaker SL, Goldmann DA, Pursley DM, McCormick MC. Declining severity adjusted mortality: evidence of improving neonatal intensive care. Pediatrics. 1998; 102:893–899.
crossref
20. Horbar JD, Badger GJ, Carpenter JH, Fanaroff AA, Kilpatrick S, LaCorte M, Phibbs R, Soll RF. Trends in mortality and morbidity for very low birth weight infants, 1991-1999. Pediatrics. 2002; 110:143–151.
crossref
21. Morse SB, Haywood JL, Goldenberg RL, Bronstein J, Nelson KG, Carlo WA. Estimation of neonatal outcome and perinatal therapy use. Pediatrics. 2000; 105:1046–1050.
crossref
22. Niermeyer S, Kattwinkel J, Van Reempts P, Nadkarni V, Phillips B, Zideman D, Azzopardi D, Berg R, Boyle D, Boyle R, Burchfield D, Carlo W, Chameides L, Denson S, Fallat M, Gerardi M, Gunn A, Hazinski MF, Keenan W, Knaebel S, Milner A, Perlman J, Saugstad OD, Schleien C, Solimano A, Speer M, Toce S, Wiswell T, Zaritsky A. International Guidelines for Neonatal Resuscitation: An excerpt from the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Contributors and Reviewers for the Neonatal Resuscitation Guidelines. Pediatrics. 2000; 106:E29.
23. Doron MW, Veness-Meehan KA, Margolis LH, Holoman EM, Stiles AD. Delivery room resuscitation decisions for extremely premature infants. Pediatrics. 1998; 102:574–582.
crossref
24. Morrison JJ, Rennie JM. Clinical, scientific and ethical aspects of fetal and neonatal care at extremely preterm periods of gestation. Br J Obstet Gynaecol. 1997; 104:1341–1350.
crossref
25. Vohr BR, Wright LL, Dusick AM, Mele L, Verter J, Steichen JJ, Simon NP, Wilson DC, Broyles S, Bauer CR, Delaney-Black V, Yolton KA, Fleisher BE, Papile LA, Kaplan MD. Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Development Neonatal Research Network, 1993-1994. Pediatrics. 2000; 105:1216–1226.
crossref
26. Saigal S, Rosenbaum PL, Feeny D, Burrows E, Furlong W, Stoskopf BL, Hoult L. Parental perspectives of the health status and health-related quality of life of teen-aged children who were extremely low birth weight and term controls. Pediatrics. 2000; 105:569–574.
crossref
27. Pignotti MS, Donzelli G. Perinatal care at the threshold of viability: an international comparison of practical guidelines for the treatment of extremely preterm births. Pediatrics. 2008; 121:e193–e198.
crossref
28. Fetus and Newborn Committee. Canadian Paediatric Society. Maternal-Fetal Medicine Committee. Society of Obstetricians and Gynaecologists of Canada. Management of the woman with threatened birth of an infant of extremely low gestational age. CMAJ. 1994; 151:547–553.
29. AAP. ACOG. Guidelines for perinatal care. 6th ed. AAP;ACOG;2007. p. 181–185.
30. MacDonald H. American Academy of Pediatrics. Committee on Fetus and Newborn. Perinatal care at the threshold of viability. Pediatrics. 2002; 110:1024–1027.
crossref
31. Paris JJ, Schreiber MD, Elias-Jones A. Resuscitation of the preterm infant against parental wishes. Arch Dis Child Fetal Neonatal Ed. 2005; 90:F208–F210.
crossref
32. Wall SN, Partridge JC. Death in the intensive care nursery: physician practice of withdrawing and withholding life support. Pediatrics. 1997; 99:64–70.
crossref
33. Chervenak FA, McCullough LB. The limits of viability. J Perinat Med. 1997; 25:418–420.
34. Lantos JD, Mokalla M, Meadow W. Resource allocation in neonatal and medical ICUs. Epidemiology and rationing at the extremes of life. Am J Respir Crit Care Med. 1997; 156:185–189.
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