Swiss Recommendations for the Perinatal Care of Extremely Low Gestational Age Neonates

Aim: To revise the 2011 Swiss recommendations for the perinatal care of extremely low gestational age neonates (ELGANs). Methods: Based on review of recent literature, experts from various medical specialties involved in the perinatal care of ELGANs made suggestions for revisions. Following discussions, changes accepted by the whole working group were incorporated into the revised manuscript. Results: The revised recommendations highlight the importance of individualised risk assessment and emphasise the importance of shared decision-making. While the care of preterm infants with a gestational age below 23 0/7 weeks should be limited to comfort-focused palliative care, risk assessment in preterm infants with a gestational age ≥ 23 0/7 weeks must be individualised by considering additional non-modifiable and modifiable risk factors; decision-making based on gestational age alone must be abandoned. Conclusions: Management options for ELGANs will fall into three different trajectories. First, if survival-focused care is not in the patient's best interest, preference should be given to comfort-focused palliative care. Second, if survival-focused care clearly is in the patient's best interest, survival-focused care will be provided. Third, if the patient's best interest is uncertain, both survival-focused and comfort-focused palliative care can be considered and parental preferences must be explored, respected, and supported.