Decision-making at start of treatment for extremely premature infants: a clinical-ethical study

Extremely Premature Infants (EPIs) born in the so called grey zone are babies born between 23 and 25 weeks compared with the 40 weeks of full gestational period. These babies are extremely vulnerable: they face a high risk of premature death and survivors are likely to face a life with severe disability. At start of treatment the decision to be made is whether to initiate resuscitation and intensive care (i.e. active care). However, this decision is difficult because a clear prediction of outcomes is impossible and indeed no agreement has ever been reached among professional guidelines on what is to be considered as the best practice.
Studies show that ethical considerations are an important element of neonatologists’ reasoning in such a highly sensitive decision-making process. Therefore, the aim of this project is to investigate neonatologists’ ethical reasoning at the start of treatment for EPIs born in the grey zone. In other words, what ethical considerations do neonatologists take into account in deciding whether to initiate active care? We want to use this insight to develop a framework that facilitates an ethicsbased decision-making process. Different steps will be taken to reach our research goal: reviewing the empirical studies and the professional guidelines, interviewing neonatologists in Flanders, searching the clinical-ethical literature and translating the knowledge achieved into an ethical framework valid for clinical practice.