Viability cut-off in other countries?

jennylee321 · Jun 10, 2017

Unless the guideline has changed I believe in Canada the age of viability was 23 weeks. But that for infants 23-25 there should be conversation with parents about intensive care and outcomes of extremely premature babies prior to the birth. There's been a push for some about resuscitating 22 weekers. But the over arching theme seems to be that it needs to be decided on a case by case basis rather than using a blanket rule. Especially when there are questions/concerns about moms dates.

Semper_Gumby · Jun 10, 2017

This is an interesting topic for me as a new NICU nurse (and one who's had an interest in NICU for many years). I have "heard" that in many European countries, for example, the cut-off is not as early as in the U.S. I think sometimes we're overly aggressive with resuscitation here, but there's so many stories of miracle babies that people want that to be the story for their baby too, which I totally understand. I definitely agree that it should be a conversation rather than a hard-and-fast rule.

jennylee321 · Jun 11, 2017

This is an interesting topic for me as a new NICU nurse (and one who's had an interest in NICU for many years). I have "heard" that in many European countries, for example, the cut-off is not as early as in the U.S. I think sometimes we're overly aggressive with resuscitation here, but there's so many stories of miracle babies that people want that to be the story for their baby too, which I totally understand. I definitely agree that it should be a conversation rather than a hard-and-fast rule.

There's a book called "Preemie Voices" that's a great read if you can get your hands on a copy. They did a study where they actually followed prems and extreme prems until they were in their 30s and then interviewed them. It's quite interesting to here all their stories especially since it comes directly from the people rather than just hearing a bunch of statistics.

adventure_rn, MSN, NP · Jun 11, 2017

This is an interesting topic for me as a new NICU nurse (and one who's had an interest in NICU for many years). I have "heard" that in many European countries, for example, the cut-off is not as early as in the U.S.

I've heard that too, which is part of what stemmed my curiosity.

Having worked in global health before nursing, I've also found it interesting how many resources we in the US devote to micros when even late pre-term kids may not survive in lower income countries. I worked in rural Peru, and sometimes little effort was made to resuscitate IUGR and late-preterm kids under the assumption that they'd die from failure to thrive (FTT). These are the kind of kids who in our US NICUs might only require NG feeds for a couple of weeks and a bit of breast milk fortification to be 100% healthy newborns. The FTT kids were always the hardest to see come into the clinic for newborn follow-up appointments, since there really wasn't much we could do for them.

In my first unit, we had a very large population of Hispanic migrant workers who would (legally) come to the US for a few months a year to take seasonal migrant farm work. These families would occasionally have babies in our unit who would require lifelong medical attention, and it was very hard to plan for discharge when they had such inconsistent access to medical care. For instance, we had one craniosynastosis baby who wouldn't eat. We were trying to plan a g-tube insertion, neuro follow-ups and cranial/maxillofacial surgeries; unfortunately, the family had to move from state to state every few weeks during the summer to find farm work, then return to rural Mexico once their work visa expired. In reality, if this baby had been born during the winter months while his family was home in Mexico, he probably would have passed away from dehydration/starvation in his first few days due to poor feeding. It ended up being a very challenging, sad case, and it highlighted the vast disparity in access to newborn care.

Man, this is really making me want to study global neonatal health; it's too bad there are so many obstacles to do so.

meanmaryjean, DNP, RN · Jun 11, 2017

I've heard that too, which is part of what stemmed my curiosity.
Having worked in global health before nursing, I've also found it interesting how many resources we in the US devote to micros when even late pre-term kids may not survive in lower income countries. I worked in rural Peru, and sometimes little effort was made to resuscitate IUGR and late-preterm kids under the assumption that they'd die from failure to thrive (FTT). These are the kind of kids who in our US NICUs might only require NG feeds for a couple of weeks and a bit of breast milk fortification to be 100% healthy newborns. The FTT kids were always the hardest to see come into the clinic for newborn follow-up appointments, since there really wasn't much we could do for them.
In my first unit, we had a very large population of Hispanic migrant workers who would (legally) come to the US for a few months a year to take seasonal migrant farm work. These families would occasionally have babies in our unit who would require lifelong medical attention, and it was very hard to plan for discharge when they had such inconsistent access to medical care. For instance, we had one craniosynastosis baby who wouldn't eat. We were trying to plan a g-tube insertion, neuro follow-ups and cranial/maxillofacial surgeries; unfortunately, the family had to move from state to state every few weeks during the summer to find farm work, then return to rural Mexico once their work visa expired. In reality, if this baby had been born during the winter months while his family was home in Mexico, he probably would have passed away from dehydration/starvation in his first few days due to poor feeding. It ended up being a very challenging, sad case, and it highlighted the vast disparity in access to newborn care.
Man, this is really making me want to study global neonatal health; it's too bad there are so many obstacles to do so.

I've often wondered if this very issue is the reason for the seemingly counterintuitive disparity of perinatal mortality rates in developed and developing countries.

Semper_Gumby · Jun 11, 2017

There's a book called "Preemie Voices" that's a great read if you can get your hands on a copy. They did a study where they actually followed prems and extreme prems until they were in their 30s and then interviewed them. It's quite interesting to here all their stories especially since it comes directly from the people rather than just hearing a bunch of statistics.

Thanks for the recommendation! It would definitely be interesting to read about. And that's part of what raises all these questions about do we or don't we resuscitate, what's too early, etc. because you don't want to give up on the one who'd be the one to make it!

I've heard that too, which is part of what stemmed my curiosity.
Having worked in global health before nursing, I've also found it interesting how many resources we in the US devote to micros when even late pre-term kids may not survive in lower income countries. I worked in rural Peru, and sometimes little effort was made to resuscitate IUGR and late-preterm kids under the assumption that they'd die from failure to thrive (FTT). These are the kind of kids who in our US NICUs might only require NG feeds for a couple of weeks and a bit of breast milk fortification to be 100% healthy newborns. The FTT kids were always the hardest to see come into the clinic for newborn follow-up appointments, since there really wasn't much we could do for them.
In my first unit, we had a very large population of Hispanic migrant workers who would (legally) come to the US for a few months a year to take seasonal migrant farm work. These families would occasionally have babies in our unit who would require lifelong medical attention, and it was very hard to plan for discharge when they had such inconsistent access to medical care. For instance, we had one craniosynastosis baby who wouldn't eat. We were trying to plan a g-tube insertion, neuro follow-ups and cranial/maxillofacial surgeries; unfortunately, the family had to move from state to state every few weeks during the summer to find farm work, then return to rural Mexico once their work visa expired. In reality, if this baby had been born during the winter months while his family was home in Mexico, he probably would have passed away from dehydration/starvation in his first few days due to poor feeding. It ended up being a very challenging, sad case, and it highlighted the vast disparity in access to newborn care.
Man, this is really making me want to study global neonatal health; it's too bad there are so many obstacles to do so.

I'm interested in doing some humanitarian work like that overseas eventually and can only imagine what it's like in places without the kind of access we have to care here in the U.S. That case sounds very sad, especially knowing they wouldn't have had the resources (whether from finances or accessibility) to provide the care the baby needed once they went home. I know I'd always wonder what had happened to that baby!

**LibraSunCNM, BSN, MSN, CNM** · Jun 12, 2017

I've often wondered if this very issue is the reason for the seemingly counterintuitive disparity of perinatal mortality rates in developed and developing countries.

It accounts for some of it, but not as much as you'd think. When you adjust for those differing cutoffs for viability, the U.S. still lags behind all the other industrialized nations in perinatal mortality (I actually got to go to a very interesting presentation about this a couple of years ago).

Leedeedee · Jun 12, 2017

In the UK it's 24 weeks to automatically provide treatment, but at 23 weeks, if the parents request it and the doctors feel it's appropriate,then they can make the individual clinical decision to provide treatment.

adventure_rn, MSN, NP · Jun 12, 2017

In the UK it's 24 weeks to automatically provide treatment, but at 23 weeks, if the parents request it and the doctors feel it's appropriate,then they can make the individual clinical decision to provide treatment.

Thank you for sharing, that's really helpful!

Elvish, BSN, DNP, RN, NP · Jun 14, 2017

Several years ago during another AN debate on infant mortality around the world I asked my Finnish friend the surgeon what their guidelines are and she says they usually do 23 weeks/500g as the cutoff for resuscitation. If you look at where a goodly proportion of research on LBW/ELBWs comes from, you'll find that it's from Scandinavia, which corroborates that.