Treatment decisions at the threshold of viability

The survival rate for infants born preterm has improved over the last two decades. However, the incidence of moderate and severe neurodevelopmental disability amongst the surviving infants is high, and these infants require prolonged intensive care. Many countries have developed guidelines how and when to treat these infants. Usually, these guidelines are based upon the outcome data of large studies, but social, cultural and economical factors have a major impact on these guidelines as well. Some European countries have set guidelines at when to start treatment based upon gestational age alone. However, recent data show that ethnicity, gender and birth weight are important determinants for survival and morbidity as well. Thus, policies for initiating and withdrawing intensive care for those born extremely preterm should not be based upon gestational age, but infants should have a chance of proving themselves.