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The limits of perinatal viability: grappling with the “grey zone”

Brian A Darlow
Med J Aust 2006; 185 (9): . || doi: 10.5694/j.1326-5377.2006.tb00659.x
Published online: 6 November 2006

On balance, new guidelines for parents and practitioners are helpful and workable

Which infants at the margins of viability should receive neonatal intensive care and how should such decisions be made? These challenging questions are posed in this issue of the Journal by Lui and colleagues.1 Their answers, arrived at by means of a multidisciplinary conference, are presented as a consensus statement that makes several recommendations for practice.


  • Department of Paediatrics, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand.


Correspondence: brian.darlow@chmeds.ac.nz

  • 1. Lui K, Bajuk B, Foster K, et al. Perinatal care at the borderlines of viability: a consensus statement based on a NSW and ACT consensus workshop. Med J Aust 2006; 185: 495-500. <eMJA full text>
  • 2. Tyson JE, Stoll BJ. Evidence-based ethics and the care and outcome of extremely premature infants. Clin Perinatol 2003; 30: 363-387.
  • 3. Doyle LW and the Victorian Infant Collaborative Study Group. Neonatal intensive care at borderline viability — is it worth it? Early Hum Dev 2004; 80: 103-113.
  • 4. Lucey JF. Fetal infants: thoughts about what to do. Pediatrics 2004; 113: 1819.
  • 5. Partridge JC, Martinez AM, Nishida H, et al. International comparison of care for very low birth weight infants: parents’ perceptions of counseling and decision-making. Pediatrics 2005; 116: e263-e271.
  • 6. Paris JJ, Graham N, Schreiber MD, Goodwin M. Approaches to end-of-life decision-making in the NICU: insights from Dostoevsky’s The Grand Inquisitor. J Perinatol 2006; 26: 389-391.
  • 7. National Health and Medical Research Council. Clinical practice guidelines: care around preterm birth. Canberra: AGPS, 1997.
  • 8. Darlow BA, Hutchinson JL, Henderson-Smart DJ, et al. Prenatal risk factors for severe retinopathy of prematurity among very preterm infants of the Australian and New Zealand Neonatal Network. Pediatrics 2005; 115: 990-996.
  • 9. Watts JL, Saigal S. Outcome of extreme prematurity: as information increases so do the dilemmas. Arch Dis Child Fetal Neonatal Ed 2006; 91: F221-F225.
  • 10. Abeywardana S. Report of the Australian and New Zealand Neonatal Network, 2003. Sydney: ANZNN, 2005.
  • 11. Lorenz JM. Ethical dilemmas in the care of the most premature infants: the waters are murkier than ever. Curr Opin Pediatr 2005; 17: 186-190.

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