Treatment of preterm infants at the lower margin of viability--a comparison of guidelines in German speaking countries.

INTRODUCTION The treatment of preterm infants at the lower margin of viability is carried out amid growing tension between increasing survival rates, uncertain clinical outcomes, and financial and ethical considerations. The three German speaking countries have released guidelines on this issue, based on a previous common guideline. That is why the differences in national guidelines between the three countries is of peculiar interest in respect of medical ethics. METHODS Current guidelines from Germany, Switzerland, and Austria were compared and similarities and differences discussed. RESULTS The three countries' guidelines follow broadly similar principles, with almost identical intellectual underpinnings and formulations. Some national differences are apparent, nevertheless. DISCUSSION All three guidelines call for a pragmatic approach. National guidelines can only predetermine the framework, with long-term collection of sound local data on morbidity and mortality forming a prerequisite for decision-making, and also in discussions with parents.