Babies born after 23 weeks of pregnancy require "complex decisions," experts say today.
A new paper on the management of extremely premature babies has been published by the Royal College of Obstetricians and Gynaecologists.
In the Scientific Impact Paper, experts state that the care of infants born spontaneously between 23 and 24 weeks of gestation "involves complex decisions and requires shared decision making between healthcare professionals and parents."
There has been a marked improvement in the survival rate for extremely premature babies, now at 52%. But there has been no associated drop in major complications such as brain haemorrhage and chronic lung disease.
It is vital that extremely preterm infants are delivered in settings with an appropriate level neonatal unit, says the paper.
There is also a review of the methods for delaying preterm birth, suitable methods of induction, delivery interventions, foetal monitoring during labour, cord clamping, and resuscitation.
Lead author, Dr Anna David of University College London, UK, said: "Delivery at the threshold of viability can be extremely difficult for all involved. Medical decision making is very complex and needs to carefully consider a number of factors.
"It is vital that comprehensive information is exchanged with the parents early so that where possible, they are able to make informed choices before the birth. These discussions need to be undertaken with kindness and sensitivity."
She added: "Given the importance of reducing the morbidity associated with extreme prematurity, it is essential that healthcare professionals discuss with the families the likely outcomes for the baby, possible transfer to an appropriate perinatal unit and mode of delivery."
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