Introduction As clinicians we act in our patient’s best interest. However, this concept is challenging when faced with infants born at the extremes of viability. Their outcomes are guarded and the management of parental expectations is crucial. The aim is to provide care within an ethical framework. The Nuffield Council on Bioethics, published recommendations for resuscitation of infants born at the extremes of viability. An emphasis is given to the views of parents in making a joint decision about the management of these babies.

Aims To review the outcome of the infants born less than 23⁺⁶ weeks gestation. This will provide local information to the parents during counselling with the national standards (EPICure).

Methods We retrospectively reviewed the outcomes of infants born less than 23⁺⁶ weeks gestation between 01/05/2009 and 31/03/2015 in a neonatal intensive care unit (NICU).

Results Forty-eight infants were born less than 23⁺⁶ weeks gestation in the last six years (45 at 23 weeks and three at 22 weeks). From our cohort, 54% were males and 46% females. All the 22 weeks infants died. Of the 45 infants born at 23 weeks gestation, only 13 survived (29%). Eight were delivered at a Level 2 neonatal unit (LNU) of whom five died. Of the seven infants born <500g only one survived. Of those discharged home, seven were reported to have IVH of whom five were grade three and above, 11 had ROP, eight developed NEC and all had chronic lung disease of whom three were discharged on home oxygen. Nine infants had chest compressions, with or without adrenaline, but only one reported to survive. The average length of stay of an infant born at 23 weeks gestational age to discharge was 53 days in NICU, 45 days in HDU and 24 days in SCBU.

Conclusion Despite our greatest effort and advances in neonatology, the survival of babies at extremes of viability remains poor. There is significant morbidity among survivors. We believe that accurate information, parental engagement and an understanding of ethical considerations are essential for decision making of a newborn at the extremes of viability.