ETHICAL DECISIONS AT THE LIMIT OF NEONATAL VIABILITY

Abstract

This study aimed to analyze ethical decision-making at the limits of neonatal viability, emphasizing delivery room management, neonatal resuscitation, and key interventions associated with reduced neonatal morbidity and mortality. A systematic review was conducted including open-access human studies published between 2016 and 2026, focused on perinatology. After eligibility assessment and qualitative analysis, ten studies were included in the final sample. Findings demonstrated increased survival among extremely preterm infants, particularly between 23 and 24 weeks of gestation, accompanied by higher rates of chronic morbidity. Effective ventilation during the “golden minute,” strict thermoregulation, delayed cord clamping, therapeutic hypothermia for hypoxic-ischemic encephalopathy, and human milk feeding for necrotizing enterocolitis prevention were identified as major determinants of neonatal outcomes. Decision-making at the threshold of viability requires integration of scientific evidence, bioethical principles, and shared decision-making with families to ensure proportional and humanized care, highlighting the need for flexible institutional protocols to guide individualized care.