Resuscitation of Neonates at Marginal Viability

This paper discusses the issues and policies of resuscitation of neonates at marginal viability.

This paper explains that the threatened birth of an extremely preterm or anomalous infant presents complex medical, social, and ethical issues for the family and the involved physicians. The author points out that cardiopulmonary resuscitation in the delivery room is a modality that presents clinicians with significant ethical issues because the decision to not resuscitate is made rapidly and most often without the advice of a bioethics committee. The author suggests the importance of facilitating change in the care of pregnant women and marginally viable infants resulting in parents developing an understanding of the risks that their newborn faces if delivered and resuscitated.

Table of Contents
Facilitating Change
“The current and most frequent policy on resuscitating neonates of marginal viability is from the “Textbook of Neonatal Resuscitation”. It suggests the non-initiation of resuscitation for newborns less than 23 weeks gestation and/or 400 grams in birth weight. It consists of resuscitating infants of 23- 24 weeks or greater unless they have a previously diagnosed lethal anomaly. Current practice is to not resuscitate infants with congenital anomalies that are incompatible with life (Bloom, 1993). The fetus of 23 weeks is considered a possible but unlikely survivor. Since there is some evidence of survival of 23 week infants, various hospitals have adopted the policy of resuscitating these fetuses. Very low birth weight (VLBW) infants that survive represent a small percentage of those delivered.”