Below the threshold of “Viability” - A middle east experience

Abstract

Background: The Corniche Hospital, Abu Dhabi, is the largest and most advanced perinatal center in the United Arab Emirate (UAE), providing care in line with international standards within its 64-cot NICU, serving a mainly Muslim population. We share our experience on outcomes of babies born in our center at 22 weeks' gestation, below the threshold of viability. At this gestation, a senior neonatologist attends each delivery to assess the baby, offer stabilization whilst assessing the baby's response. We then looked simply at the outcomes of these births. Methods: Retrospective data was collected from June 2011 to Dec 2020 using electronic hospital records and our in-house neonatal database – a nine-and-a-half-year period. Information on all babies born between 22 + 0 to 22 + 6 weeks gestation was sought; Gestational age was calculated from last menstrual period (LMP). Results: Over a nearly 10-year period, just over 67,000 live births occurred at our center, of which 134 babies were between 22 + 0- and 22 + 6-week gestation at birth. Complete data was available in 114 babies who were assessed as alive at the onset of labor. Thirty-seven were still born and there were 77 live births, their average weight was 486 gm. Twenty-eight babies were offered comfort care, the other 49 babies were offered stabilization/resuscitation from which 20 babies were admitted to the NICU. Four babies, whose average weight was 536gms, survived to discharge. All four survivors have varying degrees of neuro-disability and chronic lung disease. Conclusion: This information may feed into the development of a framework, that supports parents and clinicians. This framework should reflect cultural, religious, and legal aspects applicable to the Middle East whilst providing direction on the care of babies born below the current definitions of viability within the region.