Gestation-Based Viability–Difficult Decisions with Far-Reaching Consequences
Most clinicians rely on outcome data based on completed weeks of gestational of fetal maturity for antenatal and postnatal counseling, especially for preterm infants born at the margins of viability. Contemporary estimation of gestational maturity, based on ultrasounds, relies on the use of first-tr...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-07-01
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| Series: | Children |
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| Online Access: | https://www.mdpi.com/2227-9067/8/7/593 |
| _version_ | 1797527398093160448 |
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| author | Sumesh Thomas Elizabeth Asztalos |
| author_facet | Sumesh Thomas Elizabeth Asztalos |
| author_sort | Sumesh Thomas |
| collection | DOAJ |
| description | Most clinicians rely on outcome data based on completed weeks of gestational of fetal maturity for antenatal and postnatal counseling, especially for preterm infants born at the margins of viability. Contemporary estimation of gestational maturity, based on ultrasounds, relies on the use of first-trimester scans, which offer an accuracy of ±3–7 days, and depend on the timing of the scans and the measurements used in the calculations. Most published literature on the outcomes of babies born prematurely have reported on short- and long-term outcomes based on completed gestational weeks of fetal maturity at birth. These outcome data change significantly from one week to the next, especially around the margin of gestational viability. With a change in approach solely from decisions based on survival, to disability-free survival and long-term functional outcomes, the complexity of the parental and care provider’s decision-making in the perinatal and postnatal period for babies born at less than 25 weeks gestation remains challenging. While sustaining life following birth at the margins of viability remains our priority—identifying and mitigating risks associated with extremely preterm birth begins in the perinatal period. The challenge of supporting the normal maturation of these babies postnatally has far-reaching consequences and depends on our ability to sustain life while optimizing growth, nutrition, and the repair of organs compromised by the consequences of preterm birth. This article aims to explore the ethical and medical complexities of contemporary decision-making in the perinatal and postnatal periods. We identify gaps in our current knowledge of this topic and suggest areas for future research, while offering a perspective for future collaborative decision-making and care for babies born at the margins of viability. |
| first_indexed | 2024-03-10T09:42:17Z |
| format | Article |
| id | doaj.art-a13554e066c448a79b0b28206f409cf2 |
| institution | Directory Open Access Journal |
| issn | 2227-9067 |
| language | English |
| last_indexed | 2024-03-10T09:42:17Z |
| publishDate | 2021-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Children |
| spelling | doaj.art-a13554e066c448a79b0b28206f409cf22023-11-22T03:31:54ZengMDPI AGChildren2227-90672021-07-018759310.3390/children8070593Gestation-Based Viability–Difficult Decisions with Far-Reaching ConsequencesSumesh Thomas0Elizabeth Asztalos1Department of Pediatrics, Section of Neonatology, University of Calgary, C536-1403 29St Nw, Calgary, AB T2N 2T9, CanadaDepartment of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, University of Toronto, M4-230, 2075 Bayview Ave., Toronto, ON M4N 3M5, CanadaMost clinicians rely on outcome data based on completed weeks of gestational of fetal maturity for antenatal and postnatal counseling, especially for preterm infants born at the margins of viability. Contemporary estimation of gestational maturity, based on ultrasounds, relies on the use of first-trimester scans, which offer an accuracy of ±3–7 days, and depend on the timing of the scans and the measurements used in the calculations. Most published literature on the outcomes of babies born prematurely have reported on short- and long-term outcomes based on completed gestational weeks of fetal maturity at birth. These outcome data change significantly from one week to the next, especially around the margin of gestational viability. With a change in approach solely from decisions based on survival, to disability-free survival and long-term functional outcomes, the complexity of the parental and care provider’s decision-making in the perinatal and postnatal period for babies born at less than 25 weeks gestation remains challenging. While sustaining life following birth at the margins of viability remains our priority—identifying and mitigating risks associated with extremely preterm birth begins in the perinatal period. The challenge of supporting the normal maturation of these babies postnatally has far-reaching consequences and depends on our ability to sustain life while optimizing growth, nutrition, and the repair of organs compromised by the consequences of preterm birth. This article aims to explore the ethical and medical complexities of contemporary decision-making in the perinatal and postnatal periods. We identify gaps in our current knowledge of this topic and suggest areas for future research, while offering a perspective for future collaborative decision-making and care for babies born at the margins of viability.https://www.mdpi.com/2227-9067/8/7/593viabilityprematuritygestational maturitycounseling |
| spellingShingle | Sumesh Thomas Elizabeth Asztalos Gestation-Based Viability–Difficult Decisions with Far-Reaching Consequences Children viability prematurity gestational maturity counseling |
| title | Gestation-Based Viability–Difficult Decisions with Far-Reaching Consequences |
| title_full | Gestation-Based Viability–Difficult Decisions with Far-Reaching Consequences |
| title_fullStr | Gestation-Based Viability–Difficult Decisions with Far-Reaching Consequences |
| title_full_unstemmed | Gestation-Based Viability–Difficult Decisions with Far-Reaching Consequences |
| title_short | Gestation-Based Viability–Difficult Decisions with Far-Reaching Consequences |
| title_sort | gestation based viability difficult decisions with far reaching consequences |
| topic | viability prematurity gestational maturity counseling |
| url | https://www.mdpi.com/2227-9067/8/7/593 |
| work_keys_str_mv | AT sumeshthomas gestationbasedviabilitydifficultdecisionswithfarreachingconsequences AT elizabethasztalos gestationbasedviabilitydifficultdecisionswithfarreachingconsequences |