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In 2009, following a report from the Nuffield Council on the ethics of critical care decisions in fetal and neonatal medicine, a BAPM Working Group published guidance on the management of extreme preterm birth at less than 26 weeks of gestation.1 This guidance has been widely cited over the intervening 10 years, but gradually became out of date. Outcomes for all preterm infants have improved significantly, and a plethora of data indicate that UK neonatologists are increasingly likely to offer potentially life-sustaining care to babies born at 23 or even 22 weeks of gestation. In 2016, 88% of babies born alive at 23 weeks of gestation in the UK were offered potentially life-sustaining care at birth, of whom around 30% survived without severe disability.2 Practice in the UK is broadly in keeping with other highly developed countries across the globe, and there is no doubt that both parental and professional expectation has changed.
In 2018, BAPM set up a new Working Group to revise our Framework for Practice, and it was my great privilege to chair a group of experienced professionals …
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.
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