What is the period of viability in Indian guidelines?

Period of Viability in Indian Guidelines

Indian-specific guidelines do not explicitly define a gestational age threshold for viability; however, Indian medical practice and research align with the World Health Organization's definition of viability at 22 weeks of gestation or 500g birth weight, with practical resuscitation efforts typically beginning at 28 weeks or greater based on available resources and outcomes data.

International Context Applied to Indian Practice

The available evidence does not contain specific Indian national guidelines defining the period of viability. However, Indian medical practice can be understood through:

WHO Standards Adopted in India

• The World Health Organization sets the lower limit of viability at 22 weeks of gestation, 500g birth weight, or 25cm birth length 1
• This definition is variably applied across Indian healthcare settings depending on available neonatal intensive care resources 1

Practical Viability Thresholds in Indian Settings

• At 28 weeks gestation: Indian studies demonstrate this as a practical threshold where survival becomes more feasible with available resources 2
• Infants born at less than 28 weeks of gestation in developing countries without neonatal intensive care have a 95% probability of dying 1
• This contrasts sharply with developed countries where survival of infants between 22-25 weeks can reach 90% with advanced NICU care 1

Survival Data Relevant to Indian Context

Gestational Age-Specific Outcomes

• 23 weeks: Survival rates of 5-6% with 98-100% serious morbidity among survivors 3
• 24 weeks: Survival rates of 42-59% 3
• 25 weeks: Survival rates of 67-76% 3
• 28 weeks and beyond: Represents the threshold where Indian healthcare systems can more reliably provide effective care 2

Critical Factors Affecting Viability in India

• Location of delivery: Urban tertiary centers versus rural primary health centers significantly impact outcomes 2
• Availability of neonatal intensive care: The definition of viability is dependent on social and medical conditions where the infant is born 1
• Resource availability: Even within one country with NICU availability, viability depends on the specific place of birth and organization of perinatal care 1

Clinical Decision-Making Framework

When Resuscitation Should Be Considered

• ≥28 weeks: Standard resuscitation protocols should be implemented based on Indian outcome data 2
• 25-27 weeks: Consider resuscitation if tertiary NICU care is immediately available
• 23-24 weeks: Resuscitation remains ethically and clinically controversial even in resource-rich settings 4
• <23 weeks: Compassionate care is generally appropriate given survival rates of 5-6% 3

Resource-Dependent Considerations

• The universal definition of viability is not possible due to variability from one setting to another and from one community to another 1
• In settings without advanced NICU capabilities, the practical threshold for viability shifts toward later gestational ages 1

Important Caveats

• Gestational age accuracy: Precise dating is crucial, as outcomes at the extremes of each gestational week may be closer to those of the adjacent week 5
• Individual factors: Birth weight, fetal growth, multiple gestations, and congenital anomalies all affect viability beyond gestational age alone 3
• Parental counseling: Discussions must include accurate information about both short-term survival and long-term neurodevelopmental outcomes specific to available resources 5

The absence of uniform Indian national guidelines reflects the reality that viability is not solely a biological threshold but depends critically on the technological and medical infrastructure available at the specific delivery location 6, 1.