Extremely preterm infant viability and periviable counselling — viva

Stem

Examiner-led viva on periviable counselling and management at 23+3 weeks gestation. [8]

Examiner: This infant is at 23+3 weeks. Walk me through your management framework at this gestational age. [8]

Strong answer: At 23+3 weeks, the infant is squarely within the periviable grey zone (22+0 to 24+6 weeks). My framework has two parallel tracks. First, I optimise antenatally: complete the corticosteroid course, administer magnesium sulfate for neuroprotection, arrange tertiary transfer, and mobilise the neonatal team. Second, I conduct a formal antenatal consultation with both parents, presenting honest outcome data and engaging in shared decision-making about active resuscitation versus comfort care. The parents' values are central and decisive at this gestational age. [8] [9]

Examiner: What survival and impairment figures would you quote the parents? [1] [4]

Strong answer: At 23+3 weeks with active treatment, survival is approximately 30 to 50 per cent, based on NICHD Neonatal Research Network data. Among survivors, approximately 40 to 60 per cent will have moderate-to-severe neurodevelopmental impairment, including cerebral palsy (10 to 15 per cent), cognitive impairment with IQ below 70 (40 to 50 per cent), and visual or hearing impairment (5 to 10 per cent). I would present local institutional data where available, because outcomes vary widely between centres. I would emphasise that survival does not equate to intact survival. [1] [4]

Examiner: How do the prognostic factors modify your estimate for this particular infant? [2]