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**DRAFT** Perinatal management of extreme preterm birth before 27 weeks of gestation: A Framework for Practice (2019)

Management of the delivery of an extremely preterm baby is one of the most challenging aspects of perinatal medicine. The ethical, social, economic and legal issues have recently been reviewed by the Nuffield Council on Bioethics. The professions and advocates for parents were encouraged to consider the pattern of care appropriate for babies born before 26 weeks’ gestation based on the best information currently available. There are limitations to contemporary evidence, particularly in terms of predicting outcome after the shortest of pregnancies. While recognising these limitations, and although every pregnancy is different, some general principles can be described. This is not a set of instructions, but a framework to highlight the range of evidence and opinion that needs to be considered by staff and parents.

ÃÀ¼§ÉçÇørecognises that in the ten years since this document was compiled there have been significant improvements in the care of all babies, including those born extremely preterm. These improvements in care have been reflected in improving survival at the earliest gestations, and should be considered when counselling parents experiencing extreme preterm birth. ÃÀ¼§ÉçÇøis in the process of reviewing this document. In the meantime, we recommend that counselling of parents takes account of published literature, bearing in mind the need to work in partnership with parents to individualise care for all babies and their families.