Management of the neonate at the limits of viability : the Dutch viewpoint

Due to ever-improving medical technology over the course of the last century, the limit of viability has been lowered from around 32 weeks of gestation, first to 28 weeks and, in recent decades, to as low as less than 24 weeks. Long-term follow-up studies (Project on Preterm and Small-for-Gestational-Age Infants, Leiden Follow-up Project on Prematurity, Epidemiological Project for ICU Research and Evaluation, Etude Epidemiologique sur les Petits Ages Gestationnels, Extremely Preterm Infants in Belgium), however, have shown high percentages of deaths and/or disabilities at lower gestational ages in surviving children. Many parents and children are burdened with lifelong iatrogenic disabilities. As a result, the Dutch Paediatric Association and the Dutch Society of Obstetrics and Gynaecology have laid down joint rules for the management of expected/threatened preterm delivery.