815 - From Weaklings to Peri-viable: A historical perspective on neonates at the edge of viability

Publication Number: 815.5009

Melissa B. Alberts, University of Florida College of Medicine, Gainesville, FL, United States; Ariel Pomputius, University of Florida, Gainesville, FL, United States; Meredith C. Joseph, University of Florida College of Medicine, Gainesville, FL, United States; Marie T. Berg, University of Florida, Gainesville, FL, United States

Background: Neonatology as a field has seen a change in the population it serves with the improvements in research and medical technology. As a result, the limit of what neonate is “viable” has changed along with it. Historically, discussions about life at the edge of viability are complicated by physician perceptions, the goals and wishes of the patients’ families, and what is medically feasible. As the definition of what determines the edge of viability has changed, so too have discussions amongst Neonatologists regarding their role in these patient’s care.

Objective: Examine neonatology literature to track changes in the way the neonates born at the edges of viability are described and classified in the context of changing medical knowledge and technology.

Design/Methods: The shift was be tracked by searching biomedical literature for relevant terms to describe the viability of early preterm neonates, beginning with “peri-viability”. As new terms were discussed in the literature, new search strategies were created and systematically translated across four databases –Embase, PubMed/MEDLINE, Scopus, and Web of Science—in order to reduce database bias.

Results: With advancing technology and medical capabilities, not only has the vernacular regarding this population changed, but the population itself as described has also changed. Medical literature regarding the care of neonates can be seen as far back as the late 1890s with medical texts describing their special care. At that time, weight played the major deciding factor in the viability of the neonate, going so far as to label neonates less than 1000 grams “weaklings” who were not expected to survive. Neonatology as a field came into existence over 50 years later, but considerations regarding viability did not change by much, as weight still played a pivotal role in determining survivability as obtaining accurate gestational ages was problematic with contemporary medical technology. As technology advanced, smaller and smaller neonates were being resuscitated although their prognosis and outcomes were poor. In the 1990s, medical discussions were focused on determining what was medically futile. At the start of the 21st century, talks of futility waned as the terms “pre-viable” and later “peri-viable” came into use in the literature.

Conclusion(s): Over time, the way in which we speak about neonates at the edge of viability have become more grounded in medical terminology as opposed to descriptive terminology. Such a change in vernacular highlights the change in neonatology regarding the role of medicine in these patients and how families perceive them.