Managing births at the limit of viability: the Danish experience

The issue of how to treat extremely premature infants has been debated several times in Denmark, and the option of withholding intensive care has received considerable support. Accordingly, a conservative, minimally invasive approach is used, with selective use of resuscitation in the delivery room, early nasal continuous positive airway pressure, and elective use of mechanical ventilation. Parents are actively involved, and the clinical process is gradual with the risks and benefits considered at each step. The risks include causing pain, suffering and loss of dignity in the short and long term for both the baby and the family. Few babies delivered before 25 completed weeks' gestation are considered to be alive at birth, and only a minority of those admitted for neonatal care do survive. Now, however, parents seem increasingly prepared to accept the suffering and uncertainty of intensive life support for the most immature babies when it becomes necessary.