title: Perinatal care at the borderlines of viability: a consensus statement based on a NSW and ACT consensus workshop.
abstract: Perinatal care at the borderlines of viability demands a delicate balance between parents' wishes and autonomy, biological feasibility, clinicians' responsibilities and expectations, and the prospects of an acceptable long-term outcome - coupled with a tolerable margin of uncertainty. A multi-professional workshop with consumer involvement was held in February 2005 to agree on management of this issue in New South Wales and the Australian Capital Territory. Participants discussed and formulated consensus statements after an extensive consultation process. Consensus was reached that the "grey zone" is between 23 weeks' and 25 weeks and 6 days' gestation. While there is an increasing obligation to treat with increasing length of gestation, it is acceptable medical practice not to initiate intensive care during this period if parents so wish, after appropriate counselling. Poor condition at birth and the presence of serious congenital anomalies have an important influence on any decision not to initiate intensive care within the grey zone. Women at high risk of imminent delivery within the grey zone should receive appropriate and skilled counselling with the most relevant up-to-date outcome information. Management plans can thus be made before birth. Information should be simple, factual and consistent. The consensus statements developed will provide a framework to assist parents and clinicians in communication, decision making and managing these challenging situations.
authors.affiliation: Department of Newborn Care, Royal Hospital for Women, Sydney, NSW, Australia. kei.lui@sesiahs.health.nsw.gov.au
authors.forename: Kei
authors.initials: K
authors.lastname: Lui
authors.forename: Barbara
authors.initials: B
authors.lastname: Bajuk
authors.forename: Kirsty
authors.initials: K
authors.lastname: Foster
authors.forename: Arnolda
authors.initials: A
authors.lastname: Gaston
authors.forename: Alison
authors.initials: A
authors.lastname: Kent
authors.forename: John
authors.initials: J
authors.lastname: Sinn
authors.forename: Kaye
authors.initials: K
authors.lastname: Spence
authors.forename: Wendy
authors.initials: W
authors.lastname: Fischer
authors.forename: David
authors.initials: D
authors.lastname: Henderson-Smart
mesh_terms: D020958:Australian Capital Territory; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D015931:Intensive Care, Neonatal; D009517:New South Wales; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D017410:Practice Guidelines as Topic