Delivery room practices for extremely preterm infants: the harms of the gestational age label

Interventions for extremely preterm infants bring up many ethical questions. To answer these questions, data are needed. The investigators of the Epipage-2 study have conducted a rigorous investigation: they report outcomes for all 2145 neonates born between 22 and 26 weeks of gestational age (GA) in France in 2011.1 Their primary outcome measure was the provision of life sustaining interventions in the delivery room and survival statistics. They show that, over a year in France, only one baby born before 24 weeks GA survived to neonatal intensive care unit (NICU) discharge. NICU admission was withheld for 96%, 91%, 38% and 8% of neonates at 22, 23, 24 and 25 weeks of GA. This data is not surprising, as the French policy recommends non-intervention for the smallest babies and practices conform to the policy.

Six other European countries have similar non-treatment policies.2 National policies generally based their recommendations on local or national outcome data. But policies do not just reflect outcomes, they shape them. There is an iterative relationship between policies, guidelines and facts. Most other industrialised countries offer interventions at 23 weeks and, in those countries, many more such babies survive and most survivors do not have severe impairments.

Generally, paediatricians and policy makers favour treatments that improve survival rates. Treatment for extremely preterm infants is the exception to this general rule. There are three common arguments …