Recommendations for the care of extremely premature infants at the border of viability: Joint recommendations of the Working Group Neonatology and Pediatric Intensive Care (AG NPI) of the Austrian Society for Pediatrics and Adolescent Medicine (ÖGKJ) and the Institute for Ethics and Law in Medicine of the University of Vienna (IERM) updated 2024

The Austrian recommendations for the management of extremely preterm infants at the border of viability were last updated in 2017 and initially recommended a primarily palliative approach in gestational week 220-6 due to extremely low survival rates. Since then data from various countries and institutions have shown significantly improved survival rates in this gestational week of over 50% in specialized centers. The updated recommendations reflect these new findings and the advances in neonatal intensive care. The most significant change from the previous version is the expansion of the "gray zone" from week 230-6 to weeks 22+0-23+6, based on the recent literature. The importance of antenatal transfer to only few specialized centers and the practice of shared decision making, where parents are involved in the decision process, is emphasized. The recommendations address ethical, legal and medical aspects and offer individual guidance for the postnatal management of extremely preterm infants born at 220-6, 230-6, and 240-6 weeks of gestation. The goal is to provide a framework for responsible decision-making that considers the best interests of the child, while incorporating the latest medical data, and ensuring that parents are fully involved in the process.