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Perinatal network consensus guidelines on the resuscitation of extremely preterm infants born at <27 weeks’ gestation


In spite of recent advances in perinatal care and an increase in survival of extremely preterm infants over the last few years, there remains a lack of consensus about practical aspects of resuscitation of extremely preterm infants born before 27 weeks’ gestation. With this in the background, the working group of one of the Perinatal Networks in London, UK, set out to conduct a survey to explore the opinions of the doctors and nurses on resuscitation practices of infants born before 27 weeks’ gestation, with the aim of developing consensus guidelines. The working group emailed a questionnaire to all neonatal units within the Perinatal Network to seek the views of paediatric medical and nursing staff on resuscitation of infants born at <27 weeks’ gestation. The questionnaire was returned anonymously by post. The responses highlighted the difference of opinion that currently exists amongst the clinicians and nurses across the world around the resuscitation practices of extremely preterm infants; yet at the same time, there seemed to be some consensus on certain issues. Based on the survey (questionnaire) results and already existing literature, the working group of the North West London Perinatal Network (NWLPN) produced and implemented specific consensus guidelines on practical aspects of resuscitation for infants born before 27 weeks’ gestation for the network. The network plans to audit these guidelines in future and also produce a parent information leaflet explaining the relevance of these guidelines.

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  1. 1.

    Bell EF (2007) Noninitiation or withdrawal of intensive care for high-risk newborns. Pediatrics 119:401–403

  2. 2.

    Costeloe K, Hennessy E, Gibson AT et al (2000) The EPICure study: outcomes to discharge from hospital for infants born at the threshold of viability. Pediatrics 106:659–671

  3. 3.

    EPICure 2 Perinatal Group (2008) Survival and early morbidity of extremely preterm infants in England: changes since 1995. Arch Dis Child 93(Supp 1):A33–A34

  4. 4.

    Higgins RD, Delivoria-Papadopoulos M, Raju TN (2005) Executive summary of the workshop on the border of viability. Pediatrics 115:1392–1396

  5. 5.

    Kaempf JW, Tomlinson MW, Campbell B et al (2009) Counseling pregnant women who may deliver extremely premature infants: medical care guidelines, family choices, and neonatal outcomes. Pediatrics 123:1509–1515

  6. 6.

    Lantos JD, Meadow WL (2006) Neonatal bioethics: the moral challenges of medical innovation. Johns Hopkins University Press, Baltimore, MD

  7. 7.

    London Perinatal Networks Annual Report (2008). Available

  8. 8.

    Marlow N, Wolke D, Bracewell MA et al (2005) Neurologic and developmental disability at 6 years of age after extremely preterm birth. N Engl J Med 352:9–19

  9. 9.

    Miller G (2007) Extreme prematurity: practices, bioethics, and the law. Cambridge University Press, New York, NY

  10. 10.

    Nuffield Council on Bioethics (2006) Critical care decisions in fetal and neonatal medicine: ethical issues. Nuffield Council on Bioethics. Available at:

  11. 11.

    Pignotti MS, Donzelli G (2008) Perinatal care at the threshold of viability: an international comparison of practical guidelines for the treatment of extremely preterm births. Pediatrics 121:e193–e198

  12. 12.

    Royal College of Paediatrics and Child Health (2004) Withholding or withdrawing life sustaining treatment in children—a framework for practice, 2nd edn. RCPCH, London

  13. 13.

    Sims DG, Heal CA, Bartle SM (1994) Use of adrenaline and atropine in neonatal resuscitation. Arch Dis Child Fetal Neonatal Ed 70:F3–F9

  14. 14.

    Thames Regional Perinatal Group (2000) Guidelines relating to the birth of extremely immature infants (22–26 weeks gestation). Thames Regional Perinatal Group. Available

  15. 15.

    Tyson JE, Stoll BJ (2003) Evidence-based ethics and the care and outcome of extremely premature infants. Clin Perinatol 30:363–387

  16. 16.

    Wilkinson AR, Ahluwalia J, Cole A et al (2009) Management of infants born extremely preterm at less than 26 weeks of gestation: a framework for clinical practice at the time of birth. Arch Dis Child Fetal Neonatal Ed 94:F2–F5

  17. 17.

    Wood NS, Marlow N, Costeloe K et al (2000) Neurologic and developmental disability after extremely preterm birth. EPICure Study Group N Engl J Med 343:378–384

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We would like to thank all the members of the NWLPN for their valuable contributions to this report. A special thanks to all those who participated in the survey and the staff for their valuable feedback on this article.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Correspondence to Sunit Godambe.

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Kariholu, U., Godambe, S., Ajitsaria, R. et al. Perinatal network consensus guidelines on the resuscitation of extremely preterm infants born at <27 weeks’ gestation. Eur J Pediatr 171, 921–926 (2012).

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  • Guidelines
  • Resuscitation
  • Extremely
  • Preterm
  • Infants