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Last Updated: Wednesday, 22 September, 2004, 17:37 GMT 18:37 UK
The Dutch policy

A premature baby's feet

While in the UK, each baby is assessed on a case by case basis, it is a different story just a few hundred miles away.

In fact in The Netherlands there is a policy governing what doctors should and should not do in the event of a baby being born extremely prematurely.

The current position was summed up by the Dutch Paediatric Association in 2002 and is followed by the 10 large centres for the intensive care of premature babies in the country.

The policy, which was laid out in their newsletter, said:

At 23/24 weeks' gestation, the chances of a positive prognosis for the premature baby are so slender that, in principle, no intensive [post natal] care is offered.

Upwards of 27 weeks' gestation, the prognosis is sufficiently positive to opt for intensive post-natal care.

Borderline period

We know that they feel pain, something which we'd never realised in the past
Dr Franz Walther, Dutch Neonatologist

25/26 weeks' gestation constitutes a transitional period. In many cases, especially at 26 weeks' gestation, intensive post-natal care is justified, in line with currently held views.

At 25 weeks' gestation, individual factors will frequently be taken into consideration with regard to the question of whether to proceed with or withhold treatment.

In conclusion, the 10 centres for the intensive care of premature babies in the Netherlands are in agreement with regard to the treatment of extremely premature babies.

As of last year, in contrast to most other countries, the Netherlands no longer has a centre which supports full intensive care for babies born at 23/24 weeks' gestation.

As before, the borderline period is 25/26 weeks' gestation, at which point individual factors are frequently decisive, particularly [for babies born] at 25 weeks' gestation.

Dangers

Professor Frans Walther, a leading neonatologist in Holland spoke to Panorama to explain the policy.

He said: "In the nursery you'd be confronted by these very premature infants and at a point of time you see the pain, you see the pain of the child, you see the pain of the parents, and you start to wonder "Are we doing the right stuff for the baby? Are we doing the right stuff for the family.

"Don't think these babies have a fun time in incubators...we know that they feel pain, something which we'd never realised in the past."

However, he does admit that reaching decisions about viability limits are always difficult, adding: "That's one of the dangers of putting up limits - on occassion there is an infant who might have lived, who might have been well, and who dies."



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