Abstract :
There has been changing face in child / neonatal care including the care of preterm babies. It is recommended that all hospitals that provide highrisk obstetric and neonatal intensive care should develop informative, rational, supportive, clear and practical guidelines to assist the women delivering extremely premature infants. One of the main problems after the survival of a preterm baby is impaired neuro-developmental outcome. The societal cost of saving the preterm babies will be enormous. When we are discussing the legal and ethical issues related to care at the edge of viability, almost everyone has a role to play. The multidisciplinary approach should involve team efforts in decision making. The team shall consist of pediatricians, legal or medico-legal expert, social worker, representative from judiciary, government and possibly policy makers. There are no clear cut “Do Not Resuscitate” (DNR) guidelines in India. Almost all NICUs have struggled with decisions about newborns at the threshold of viability and the question of “how small is too small”. Relevant moral considerations include the primacy of the newborn’s best interests, parental autonomy, physicians’ duties of beneficence and non-maleficence, and distributive justice. Thus it is clear that care at the edge of viability is a challenging and responsible task for the perinatologists and the hospital staff attracting the attention of the concerned.
Keyword :
Preterm, Low birth weight, age of viability, NICU, DNR, Euthanasia, Neuro-developmental outcome, ethical issues, Neonatal care