National Neonatology Forum Clinical Decision-making for Infants Born at the Margin of Viability: A Modified Delphi Consensus Statement
Infants born at the margins of viability represent a gestational-age window characterized by uncertain survival and a high risk of mortality and long-term neurodevelopmental impairment. Evidence to guide management in low- and middle-income countries remains limited, and in India, decision-making is further influenced by heterogeneity in neonatal intensive care infrastructure, availability of trained personnel, access to perinatal services, and socio-economic and cultural disparities. Recognizing these challenges, an expert panel convened under the aegis of the National Neonatology Forum developed consensus-based guidance for clinical decision-making in periviable infants. A structured modified Delphi process was employed to achieve agreement across key domains. The panel reached consensus on 41 statements addressing 11 prioritized clinical questions relevant to periviable care in the Indian context. These recommendations provide an evidence-informed and ethically grounded framework to support clinicians and families in complex decision-making at the limits of viability. The consensus reflects current expert agreement and may evolve with emerging evidence and future research.
Authors
- Giridhar Sethuraman (ORCID: https://orcid.org/0000-0001-7055-9131)
- Arjit Mohapatra (ORCID: https://orcid.org/0000-0002-3970-2742)
- Reeta Bora (ORCID: https://orcid.org/0000-0002-9134-2510)
- Supreet Khurana (ORCID: https://orcid.org/0000-0002-8874-5984)
- Suksham Jain (ORCID: https://orcid.org/0000-0002-1230-2992)
- Thangaraj Abiramalatha (ORCID: https://orcid.org/0000-0001-9125-3510)
- Shalini Tripathi (ORCID: https://orcid.org/0000-0003-0805-7370)
- Anitha Ananthan (ORCID: https://orcid.org/0000-0002-1007-7437)
- Raman Kumar (ORCID: https://orcid.org/0000-0003-4343-0951)
- Srinivas Murki (ORCID: https://orcid.org/0000-0003-1012-1925)
- Shiv Sajan Saini (ORCID: https://orcid.org/0000-0003-0865-8053)
- Lalan Kumar Bharti
- Rhishikesh Thakre
- Suman Rao P. N.
- Ashish Mehta
- Parul Kotdawala
Institutions
- King Edward Memorial Hospital and Seth G.S. Medical College (IN)
- Government of India (IN)
- Chettinad Health City (IN)
- King George's Medical University (IN)
- Jharkhand Rai University (IN)
- Government Medical College and Hospital (IN)
- Samjin Pharm (South Korea) (KR)
- Government Medical College and Hospital (IN)
- Kovai Medical Center and Hospital (IN)
- Advanced Numerical Research and Analysis Group (IN)
- St.John's Medical College Hospital (IN)
- Rainbow Children's Hospital (IN)
- Post Graduate Institute of Medical Education and Research (IN)
- Ganpat University (IN)
- Centurion University of Technology and Management (IN)
- B.J. Medical College (IN)
- Assam Medical College (IN)
- Central Institute of Psychiatry (IN)
Publication Details
- Journal
- Journal of Neonatology
- Published
- 2026-08-21
- DOI
- https://doi.org/10.1177/09732179261472217
- Primary Topic
- Neonatal Respiratory Health Research
- Type
- article
- Field-Weighted Citation Impact
- 0.00