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On the limits of viability: toward an individualized prognosis-based approach

Journal of Perinatology volume 40, pages 1736–1738 (2020)Cite this article

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Consider two fictional cases in The Netherlands: (a) a 41-year-old woman, 233/7 weeks pregnant with a female fetus of estimated 600 g, and (b) a 25-year-old woman, 241/7 weeks pregnant with a male fetus of estimated 500 g. Both women are in imminent labor. Although the chances for survival of the girl might be better compared to the boy, no neonatal intensive care is offered to the parents of the girl because of the GA of 233/7 weeks. Instead, palliative comfort care will be offered. The parents of the boy will be offered full counseling and if desired, after a process of shared decision-making, initiation of neonatal intensive care [1].

Decisions about early intensive or palliative comfort care at the edge of neonatal viability are challenging. Despite international efforts to emphasize the importance of not focusing solely on gestational age (GA) to make these decisions [2,3,4,5], The Netherlands still relies on a GA-based guideline: the earliest GA for offering neonatal intensive care is strictly 240/7 weeks. We, as Dutch professionals, would like to substantiate our criticism of these national guideline as complex decisions about intensive neonatal care should not be based on GA alone [6,7,8,9]. Moreover, we plea for a review of the Dutch, and other strictly GA-based guidelines, on a multidisciplinary basis. In what follows, four arguments will be provided to support this statement.

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Authors and Affiliations

  1. Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, Rotterdam, The Netherlands

    Lien De Proost & Hafez Ismaili M’hamdi

  2. Department of Neonatology, Erasmus MC, Rotterdam, The Netherlands

    Lien De Proost & Irwin Reiss

  3. Department of Obstetrics, Erasmus MC, Rotterdam, The Netherlands

    Lien De Proost & E. J. (Joanne) Verweij

  4. Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    A. A. E. (Eduard) Verhagen

  5. Department of Neonatology, Radboud University Medical Center, Amalia Children’s Hospital, Nijmegen, The Netherlands

    Rosa Geurtzen

  6. Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands

    E. J. (Joanne) Verweij

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  1. Lien De Proost
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  2. Hafez Ismaili M’hamdi
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  6. E. J. (Joanne) Verweij
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Correspondence to E. J. (Joanne) Verweij.

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De Proost, L., Ismaili M’hamdi, H., Verhagen, A.A.E.(. et al. On the limits of viability: toward an individualized prognosis-based approach. J Perinatol 40, 1736–1738 (2020). https://doi.org/10.1038/s41372-020-00793-x

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