The Prenatal Consult (part I)

This is part I of a series of posts which also currently includes part II, and part III.
One of the things that I do quite frequently is counseling parents of babies that will likely require admission to the NICU. By far and away this is most frequently a baby that is at risk to deliver prematurely.
A baby is considered to be "premature" if delivered at less than 37 completed weeks of gestation. However, babies that are greater than 35 completed weeks of gestation frequently do not require intensive care. In our facility, any baby born at less than 35 weeks gestation gets admitted to the NICU.
Most all experts would agree that a baby born before 23 completed weeks of gestation is not viable. The major reason is that the lungs have no ability to exchange gas until they have developed beyond this critical stage. For babies born before 23 weeks we take all measures to make the baby warm and comfortable and to help the parents with the grieving process.
So most of the parents that I speak with have a baby that may deliver between 23 and 35 weeks gestation. I start by explaining the mortality risk based on data collected nationwide. If the baby is less than 25 completed weeks, then I discuss the idea of limiting resuscitation attempts according to the parents' wishes. This decision is based not only on the low survival rate, but also the high incidence of morbidities (complications) which may include neorodevelopmental handicaps such as blindness, deafness, or crippling cerebral palsy. For example, at 24 weeks survival is about 55%, however, the chance of survival without a major handicap is only about 30%. After 25 completed weeks, the improvement in outcomes would raise an ethical dilemma if the parents were to state that they wanted to limit resuscitation. Each discussion is targeted to the specific gestational age and any other coexisting conditions in the pregnancy.
After reviewing the statistics, I move on to discussion of delivery room procedures, a topic that I will save for the next entry in this series of posts (The Prenatal Consult). Stay tuned...