Is intensive care for very immature babies justified?

UNLABELLED Neonatal intensive care is generally considered justified in the majority of very premature infants, but there is some concern about the effectiveness of the techniques used at the margins of viability (22-24 wk of gestation). The controversy that exists in this area is largely due to a lack of agreed endpoints for geographically based populations where all live births are considered. Evaluation of outcome must also take the quality of neurological function in surviving infants into consideration, and in reviewing these data the reader is struck by the few reports providing information on a high proportion of survivors. To inform this debate, the "best data" for analysis are reviewed based on a number of criteria of quality for survival and outcome studies. Based on these data sets, < 25% of babies born alive at 24 wk and below survive without major disability. CONCLUSION An objective review of "best data" will provide the basis of an informed debate on whether providing intensive care for all very immature babies is appropriate in developed countries.