From the Guidelines
It is reasonable to consider a partial code status for a baby born at 23 5/7 weeks gestation when parents and healthcare providers engage in shared decision-making that accounts for the infant's specific clinical circumstances and prognosis. At this gestational age, survival rates range from 23% to 27% 1, with significant risk of severe neurodevelopmental impairment among survivors. A partial code status might include providing respiratory support, IV fluids, and antibiotics, but limiting more aggressive interventions like chest compressions, epinephrine administration, or prolonged mechanical ventilation if the infant's condition deteriorates significantly.
This approach should be based on thorough prenatal counseling that includes discussion of potential outcomes, quality of life considerations, and the family's values and preferences, as recommended by the American College of Obstetricians and Gynecologists 1. The decision should be documented clearly in the medical record and revisited regularly as the infant's condition evolves. Partial code decisions at this borderline viability stage acknowledge both the potential for survival with good outcomes and the reality that some infants may experience prolonged suffering with poor long-term prognosis.
Some key factors to consider in this decision include:
- Gestational age: 23 5/7 weeks falls within the periviable period, as defined by the Society for Maternal-Fetal Medicine 1
- Estimated fetal weight and potential for survival: neonatal survival rates to discharge range from 23% to 27% for births at 23 weeks of gestation 1
- Fetal anomalies or genetic diseases: these may impact the potential for survival and quality of life
- Parental values and preferences: these should be taken into account when making decisions about resuscitation and intensive care, as recommended by the American College of Obstetricians and Gynecologists 1
Medical teams should provide compassionate support regardless of the chosen care path, ensuring comfort measures and family support are prioritized throughout the process. The most recent guidelines from the Society for Maternal-Fetal Medicine 1 and the American College of Obstetricians and Gynecologists 1 emphasize the importance of individualized decision-making and shared decision-making between parents and healthcare providers.
From the Research
Gestational Age and Partial Code Status
There are no research papers provided that directly address the question of at what gestational age a partial code status is reasonable for a neonate born at 23 5/7 weeks of gestation.
Relevant Studies
- The studies provided compare the effectiveness of different respiratory support methods for preterm infants, including high-flow nasal cannula (HFNC) and nasal continuous positive airway pressure (nCPAP) 2, 3, 4, 5, 6.
- These studies focus on preterm infants with gestational ages of 28 weeks or more, and do not provide information on the specific gestational age of 23 5/7 weeks.
- The studies suggest that HFNC and nCPAP have similar efficacy and safety for preterm infants, but do not address the issue of partial code status.
Key Findings
- HFNC and nCPAP are commonly used noninvasive respiratory support methods for preterm infants 2, 3, 4, 5, 6.
- The studies provided do not address the question of partial code status for neonates born at 23 5/7 weeks of gestation.
- There is a lack of data on the use of HFNC and nCPAP in neonates with gestational ages less than 28 weeks 4, 5.