The Management of Babies born Extremely Preterm at less than 26 weeks of gestation. A Framework for Clinical Practice at the time of Birth

Andrew R Wilkinson ^1*, Jag Ahluwalia ², Andy Cole ³, Doreen Crawford ⁴, Janet Fyle ⁵, Ann Gordon ⁶, James Moorcraft ⁷, Tina Pollard ⁸ and Tony Roberts ⁹

¹ Neonatal Unit. Women's Centre, United Kingdom
² Addenbrookes Hospital, Cambridge, United Kingdom
³ BLISS, United Kingdom
⁴ Royal College of Nursing, United Kingdom
⁵ Royal College of Midwives, United Kingdom
⁶ Royal College of Paediatrics & Child Health, United Kingdom
⁷ British Association of Perinatal Medicine, United Kingdom
⁸ Neonatal Nurses Association, United Kingdom
⁹ Royal College of Obstetricians & Gyaecologists, United Kingdom

^* To whom correspondence should be addressed. E-mail: andrew.wilkinson{at}paediatrics.ox.ac.uk.

Accepted 9 September 2008

Abstract

Management of the delivery of an extremely preterm baby is one of the most challenging aspects of perinatal medicine. The ethical, social, economic and legal issues have recently been reviewed by the Nuffield Council on Bioethics.1 The professions and advocates for parents were encouraged to consider the pattern of care appropriate for babies born before 26 weeks’ gestation based on the best information currently available. There are limitations to contemporary evidence, particularly in terms of predicting outcome after the shortest of pregnancies. While recognising these limitations, and although every pregnancy is different, some general principles can be described.

This is not a set of instructions, but a framework to highlight the range of evidence and opinion that needs to be considered by staff and parents. Care of the mother, her fetus and the baby, will always need to be individualised and should be led by senior staff in all disciplines. The parents’ hopes and expectations need to be explored with honesty and compassion in a realistic way, drawing upon the available evidence. Communication and agreed plans must be documented in full and signed legibly. These plans may need to be revised frequently.