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Med Wieku Rozwoj. 2011 Jul-Sep;15(3 Pt 2):356-67.

[Newborn at the limit of viability. Part 2: Recommendations regarding treatment of mother and newborn at the limit of viability considering ethical aspects].

[Article in English, Polish]

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Klinika Neonatologii i Intensywnej Terapii Noworodka, Instytut Matki i Dziecka, ul. Kasprzaka 17a, 01-211 Warszawa,


The first Polish recommendations regarding the treatment of mothers and infants born at the limit of viability are the result of 1,5 years of work by the Team for Ethical Recommendations in Perinatology, consisting not only of gynecologists-obstetricians and neonatologists, but also geneticists, psychologists, ethics specialists, philosophers and lawyers. Their development was based on similar standards already existing in other European countries, as well as in Australia, Canada and the USA. The recommendations were accepted by the National Consultant for Neonatology, Polish Gynecological Society, Polish Perinatal Medicine Society and Polish Pediatric Society. The Recommendations indicate ethical problems and presented transfer of information among the members of the treatment team as well as between the team and the parents of extremely immature newborns. The necessity of informing parents about their infant's chances for survival has been emphasized, as well as the need to hear their opinions and expectations. A Prenatal Consultation Card and Newborn Treatment Card have been attached to the recommendations, as a tool for presenting decisions and parents' opinions. Problems concerning accurate determination of gestational age and biological maturity of the foetus have also been discussed. Furthermore, on the basis of international research, morbidity and mortality data on infants born at the limit of viability have been presented. The paper also presents recommendations concerning: in utero transport, cesarean section and undertaking resuscitation as opposed to palliative care in newborns depending on their gestational age. It has been emphasized that gestational age cannot be the only criteria in the course of making decisions. Individual pre- and post-natal factors influencing the prognosis should also be taken into account. Recommendations allow both for the situation when the gestational age is precisely determined and when it is uncertain. Attention has been drawn to the need of long-term assessment of development in this group of children. The procedure in case of the infants' death has also been discussed.

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