As per the ILCOR / AAP / AHA 2015 Neonatal Resuscitation Guidelines Subsection on Withholding Resuscitation we quote:
“There is a no evidence to support the use of any particular delivery room prognostic score presently available over gestational age assessment alone, in preterm infants at less than 25 weeks gestation”.
As per the NRP Guidelines 3rd Edition (India) “Neonatal Resuscitation: India
“Questions about initiation of Resuscitation for extremely premature babies is a grey area. Babies born between 24+ to 28 weeks has been increasing in the developed countries, it may still not be true for most parts of our country. Non initiation of Resuscitation may be considered appropriate in confirmed gestation below 25 weeks (20 weeks to 24 completed weeks), anencephaly, and confirmed lethal genetic malformation disorder”.
The most read textbook of community medicine in India ‘Park’s Textbook of Preventive and Social Medicine’ states that “viability is a stage when foetus becomes capable of living independently, this has been fixed administratively at 28 weeks, when the foetus weighs approximately 1000 g”.
Viability is defined as >28 weeks and more than 1000 grams. Anything less than that level of treatment has to be decided on case to case basis based on chances of intact survival, informed consent taking into consideration social determinants of health. Basic care should not be compromised.
1. Park K. Demography and Family Planning. In: Park K, editor. Park’s Textbook of Preventive and Social Medicine. 24th ed. Jabalpur: Bhanot; 2017.p.539.
Dr KK Aggarwal
National President IMA
Dr Anupam Sachdeva
Dr R N Tandon
Hony Secretary General
Dr Alok Bhandari