Ethical concerns about treatment of infants at the limit of viability prompted the Canadian Pediatric Society (CPS, 1994) and the American Academy of Pediatrics (1995) to issue guidelines on their management. To examine the impact of changing trends in the management and outcome of these infants, we compared resuscitation and outcomes data from 2 periods (Period 1:1983-89; Period 2:1991-93) at Children's and Women's (C&W) Health Centre of B.C.. C&W has 7,500 births/year. Families at risk of premature delivery are counselled prior to delivery, and treatment decisions jointly made. Survival of 23 week infants decreased in Period 2 vs Period 1, but increased for infants >25 week (Fig 1). There was a corresponding increase in delivery room deaths of ≤25 week infants in Period 2 vs Period 1, but an decrease in infants >25 weeks (Fig 2). Between Period 1 vs Period 2, the incidence of major handicaps (35% vs 36%) and multiple handicaps (38% vs 38%) for ≤25 week infants (assessed at 18 mths CGA) did not change. The results suggest a shift towards less aggressive management of infants at the limit of viability. However, the lack of an accompanying improvement in long term outcomes among survivors suggests that current methods for making treatment decisions may be inadequate, and represents an ethical dilemna. Draft management guidelines published by CPS in 1992 may have influenced management philosophies.

Fig 1
figure 1

Survival by gestational age

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Fig 2
figure 2

Delivery room deaths by gest

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