The Ethics and Practice of Periviability Care

Authors

Alex C Vidaeff
Joseph W Kaempf

Publication Date

3-23-2024

Journal

Children

DOI

10.3390/children11040386

PMID

38671603

PMCID

PMC11049503

PubMedCentral® Posted Date

3-23-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Abstract

Since the 1960s, the gestational age at which premature infants typically survive has decreased by approximately one week per decade [1]. Survival is now reported at remarkably early gestational ages. In 2022, the Vermont Oxford Network reported neonatal intensive care unit (NICU) survival rates of 21%, 46%, and 63% at 22, 23, and 24 weeks’ gestation [2]. Presently, in industrialized nations, the so-called periviability interval refers to the gestational age period of possible survival that extends from approximately 22 to 25 weeks’ gestation. Newborns born within this period are distinguished by their need for extraordinarily complex technologic and pharmacologic interventions in order to survive. Periviability is a fluid time period of technologically assisted potential survival. Since their viability is defined as a potentiality rather than a fixed attribute, it is difficult to establish precisely either a gestational age below which the probability of survival is near zero, for which palliative comfort would be indicated, or an upper limit, above which NICU care should be universal.