Pre-viable Newborns in Saudi Arabia: Where are We Now and What the Future May Hold?

Saleh      Al-Alaiyan; Sameer      Al-Abdi; Jubara      Alallah; Fahad      Al-Hazzani; Khalid      AlFaleh

Abstract

Rates of population growth, total fertility and birth among the Saudi population are increasing, resulting in more than half a million newborns delivered every year. Despite this significant number of deliveries, there is still an existing shortage in NICU (neonatal intensive care unit) beds in tertiary level hospitals. The percentage of pre-viable newborns in Saudi Arabia is similar to most countries worldwide. We agree that the definition of pre-viability is vague rather than distinct. Recently, a religious opinion regarding resuscitation of pre-viable newborns was issued from Saudi Arabia. It states that for infants born at less than 6 lunar months (252/7 weeks), two specialist physicians could assess the infant’s clinical condition at birth and based on their opinion the infant could be offered full resuscitation if it is beneficial to the infant or he or she can be left without intervention to die but should not be deprived of nutrition or fluids. In this review, we compared the outcome of infants less than 1500 grams in three tertiary hospitals in Saudi Arabia with outcome of infants recently published by NICHD. We found that outcomes of these infants born in our tertiary level hospitals are comparable with the outcome of similar groups from NICHD. We strongly believe that clear guidelines are highly needed to support shared decision making to avoid inconsistency in managing ELBW infants at all Saudi hospitals.

Keywords: Health care practices, end-of-life decisions, ethics, extreme prematurity, periviability, resuscitation

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