Don’t Rush It: Conservative Care in Denmark

Abstract

One of the first European NICUs was established at Rigshospitalet in Copenhagen in 1965, and mechanical ventilation became the standard of care for preterm infants in 1971. After a failed attempt to extend this to the most immature infants in the early 1980s, a policy with minimally invasive support after birth with nasal continuous positive airway pressure was adopted from the neonatal unit in Odense. The conservative approach was consolidated by a national consensus conference; the lay panel concluded that a lower limit of gestation should be installed and priority should be given to parental counseling and support. This was confirmed some years later by the majority of the members of the Danish Council on Ethics, and questionnaire-based research revealed a significant proportion of the general population that would forego life support in extremely preterm infants. Since the year 2002, the treatment of infants <28 weeks’ gestation at birth has been centralized to 4 university-based NICUs, the treatment policies have been rather uniform, and the survival of infants at 23 weeks’ gestation or less has been unusual. Most recently, however, a professional initiative has been undertaken to centralize all births >22 weeks’ gestation to improve parental counseling and neonatal intervention.