• ethics
• mortality
• neonatology
• palliative care

The BAPM Framework, published in October 2019,1 has provided the first UK-wide guidance on the perinatal management of extreme preterm birth since the Nuffield Council on Bioethics, Royal College of Obstetricians and Gynaecologists and BAPM statements of 2006–2014. Over recent years, survival and neurodevelopmental outcomes after extreme preterm birth have improved steadily and significantly in the UK and other parts of the world. The updated Framework for Practice has acknowledged this, as well as placing a greater emphasis on the role of good communication with parents to facilitate shared informed decision-making around the time of extreme preterm birth. It provides clear guidance for individualised care, relevant to all perinatal healthcare professionals, taking into account practical, ethical and legal issues based on broad-based consensus and consultation as well as the most up-to-date evidence.

The purpose of the new framework is clearly outlined and focused on the need to assist decision-making around the time of extreme preterm birth below 27 completed weeks of gestation. Gestation-based risk assessment has been incorporated, with recent UK data suggesting that survival after birth at 22 weeks of gestation now approaches that of babies born at 23 weeks.2 Survival at 22 weeks may …