Table 4.

Levels of care for the extremely preterm infant, based on risks for anticipated mortality or NDD

Risk estimation for anticipated mortality or long-term NDD	Suggested level of care	Clinical examples that usually meet the risk estimation
Extremely high likelihood of mortality or severe NDD*	Palliative care is recommended**	Infant born at 22 weeks GA, irrespective of additional risk factors***
		Infant born at 24 weeks GA, with an estimated weight of 350 g
Moderate-to-high likelihood of mortality or moderate-to-severe NDD	Intensive care or palliative care are both usual care options	Infant born at 23–24 weeks GA, irrespective of most additional risk factors***
		Infant born at 25 weeks GA, with signs of fetal anemia and abnormal placental blood flow
Low likelihood of mortality or moderate-to-severe NDD	Intensive care is recommended**	Infant born at 25 weeks GA, without additional risk factors***
		Infant born late in 24th week of gestation (e.g., 245), well grown with ANCS given, born in a tertiary care centre

*In the clear majority of cases, the risk estimation for neurodevelopmental disability (NDD) does not reach the ‘extremely high likelihood’ category. Most cases where palliative care is recommended usually relate to an ‘extremely high likelihood’ of mortality, even when providing intensive care. **Given the lack of moral authority on the suggested level of care, parents may choose a nonrecommended option. Health care professionals (HCPs) should engage with them to determine their infant’s management plan. ***Additional risk factors include: small for gestational age (GA), absence of antenatal corticosteroids (ANCS), multiple gestation, GA early within week of gestation, birth outside of a tertiary centre, acute chorioamnionitis, major congenital anomalies present on ultrasound.