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To the Editor Verhagen and Janvier1 have described the processes involved in the medical care of neonates who died. Although their article is highly relevant, we would like to comment on one aspect of it.
They state that “[s]urvival for those born at 24 weeks…is as low as zero in some centers in the Netherlands.”1(p988) It is important to note that, in the Netherlands, views on the medical care of extremely preterm neonates have developed over time. Since September 2010, obstetricians and neonatologists nationwide agreed on offering parents active resuscitation for neonates from a gestational age of 24 weeks onwards. Since then, in the Netherlands, the mortality rate among neonates with a gestational age from 24 weeks and 0 days to 24 weeks and 6 days has decreased to between 45% and 50% in the neonatal intensive care units (data from the Netherlands Perinatal Registry), which is well in accordance with the rates in other European countries actively resuscitating neonates with such a low gestational age.2 Data on long-term morbidity are as yet unavailable but are being collected.3 In addition, data on perinatal deaths are collected to provide insight into the relevant ethical aspects of medical care at the limits of viability raised by Verhagen and Janvier.1
Groenendaal F, Kornelisse R, Hukkelhoven C. Survival at a Gestational Age of 24 Weeks in the Netherlands. JAMA Pediatr. 2014;168(6):582. doi:10.1001/jamapediatrics.2014.26