Following the controversy over Delhi's Max Hospital, where a pre-term baby declared dead by the hospital was found alive later, a clutch of doctors' bodies said on Friday that a foetus of below 24 weeks was not "viable". Quoting standard medical literature, doctors said that "viability" could be defined as a "stage when a foetus becomes capable of living independently". In the Max hospital case, a pre-term baby of 22 weeks was declared dead by the hospital, but was found alive by the parents on their way to the cremation ground.
Even as they steered clear of commenting on this case that led to the cancellation of the hospital's license, representatives of the Indian Medical Association, Indian Academy of Pediatrics and the National Neonatology Forum of India, said that they had felt a need to issue guidelines for standard practice to handle similar cases.
"Our guidelines define that a foetus is considered viable when it is of 28 weeks, and weighs more than a kilogram. At that point, doctors must make all efforts to save that life. Between 24-28 weeks, doctors should decide the issue of viability on a case to case basis, depending on the facilities available, chances of intact survival and informed consent of the family. Basic care must not be compromised, " said Dr K.K. Aggarwal, president, Indian Medical Association.
For a baby born within 20-24 weeks, though signs of life might be visible—there might be breathing, some movement— that doesn't mean that it is viable. Putting the foetus on ventilator in such a case is not an option as that will only increase the costs for the family, he said. The guidelines would be issued to around 3.5 lakh doctors across the country, and also to various state health departments.
Among babies born within the "grey zone" of 24-28 weeks—doctors consider them as cases that can be "salvaged"—about 30-50 per cent will have some neurological defect that will affect their hearing or sight, said Dr Anupam Sachdeva, national president, IAP. "Families must be counselled on these issues before doctors resuscitate [correcting physiological disorders] the pre-term babies in these cases.
It may be noted that earlier this year, a similar case had occurred at Delhi's Safdarjung Hospital where a woman had "aborted spontaneously" a foetus of 20 weeks, and 410 grams. The foetus was declared dead, but later, the parents had found signs of life. In that case, the hospital had said that the movements were a possibility because "abortuses below 22 weeks of gestation often have prolonged periods of cessation of respiration and feeble heart which may lead to difficulty in appreciating clinical signs of life".
