Management of Periviable Newborns in the Nordic Countries

Thor      Willy Ruud Hansen; Ola      Didrik Saugstad

Abstract

Perinatal and neonatal health care is quite uniform in the Nordic countries in spite of large differences in population densities and transport distances. For the present study data was collected with a questionnaire sent to neonatologists in the five Nordic countries Denmark, Finland, Iceland, Norway, and Sweden. In these countries there are totally approximately 80 level II and 25 level I NICUs. Care of periviable immature infants is strongly centralized with a few exceptions in Norway due to long transport distances. Iceland with one level III NICU only is the only country with national guidelines for management of prematurity, and only Norway has national guidelines for follow-up. In all countries the lower margin of viability is considered as < 23 weeks, although practical handling of these smallest children may vary between countries and within each country. In parts of Sweden proactive management is recommended while other units, for instance in Denmark, practice palliative care at 23 weeks and life support at 24 weeks. Following a consensus conference organized in Norway in 1998 it became common practice to treat babies with gestational age down to 23 weeks, however parental choice and autonomy should be respected. This seems to be in accordance with recent international guidelines. In summary, ELBWI are offered intensive care treatment in all Nordic countries but with some variation between countries concerning rate of referral and degree of centralization of care. Survival rates for these babies are quite high in all the Nordic countries.

Keywords: Extreme prematurity, ethics, health care practices, resuscitation, end-of-life decisions

« Previous Next »