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Guidelines on life or death strategies in extremely preterm infants have been formulated in various countries worldwide.1,2,3,4,5,6,7,8,9,10,11,12,13,14,15 The general agreement is not to initiate resuscitation in neonates when gestational age is less than or equal to 22 weeks, and intensive care is assured for infants of 25 weeks and over; in the middle there is a sort of “grey zone”. To provide helpful suggestions for initial management of threatened birth in infants at a gestational age of 25 completed weeks or less, a working group in Florence recently reviewed existing studies on survival and morbidity rates, international guidelines and practice recommendations. A consensus document was drawn up, and this was evaluated by several scientific societies (Italian Paediatric Society (SIP), Italian societies of obstetricians and gynaecologists (AGUI, AOGOI), Italian Society of Legal Medicine (SIMLA), Italian Society of Perinatal Medicine (SIMP), Italian Society of Anaesthesiologists (SIARTI), and the Italian Society of Paediatric Anaesthesia (SARNePI), and is currently being examined by the Italian National Bioethical Committee. The issues addressed include:
Our document offers an overview of different positions that may be helpful for clinicians and parents. It also provides the basis for a debate—which is necessary in Italy, where any discussion about end‐of‐life decisions, particularly in infancy and childhood, is still controversial.
We thank Francesca Ceroni, Judge of the Juvenile Court, Florence, Roberta Filippi, Attorney of the Court of Florence, and Patrizia Pompei, Judge of the Civil Court of Florence for their work in addressing and reviewing the document.
Competing interests: None.