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Development timeline: March to December 2019

New guidance is coming for Victorian healthcare services to help manage extreme prematurity, including:

  • consensus statement on the zone of parental discretion 
  • guidance on managing pregnant women at high risk of giving birth between 22+0 to 24+6 weeks’ gestation
  • guidance on managing an infant born at 22+0 to 24+6 weeks’ gestation, including active management  and palliative care
  • plain language resources and information for parents and families.

To develop this guidance we will:

  • seek feedback on the draft guidance from stakeholders and the sector in November 2019 and
  • get it independently reviewed.

Why are we developing this guidance? 

Recommendations from the 2018 Parliamentary Inquiry into Perinatal Services include developing evidence-based policies and protocols in obstetric and neonatal care, for health services across Victoria.. 

The Neonatal Advisory Group (NAG) identified:

  • inconsistent management of births at 22+0 to 24+6 weeks’ gestation
  • unequal access to tertiary obstetric and neonatal care, and
  • inconsistent access to high-risk counselling for families by experienced clinicians

These differences contributed to variation in outcomes for babies born at 22+0 to 24+6 weeks’ gestation and highlighted a need for statewide guidance. 

The extreme prematurity guidance will provide evidence-based guidance for clinicians throughout Victoria who care for high-risk pregnant women and newborn babies to reduce variation in care, including access to tertiary perinatal care and guidance for immediate management of the baby at birth. 

Scope of guidance

This guidance is being developed for all staff working in perinatal services in Victoria, including medical, nursing, midwifery and allied health care professional staff in regional and metropolitan, tertiary and non-tertiary health services.  

The guidance is also for clinicians working in the statewide perinatal and retrieval services at the Paediatric Infant Perinatal Emergency Retrieval (PIPER). 

Paramedics and clinicians working in Ambulance Victoria (AV) may refer to this guideline, however AV Clinical Practice Guidelines should remain the default for care of the woman and baby in the pre-hospital environment.

Expert working group membership


Dr Stefan Kane


Tertiary Obstetrician

Royal Women’s Hospital
Associate Professor Jeanie Cheong


Tertiary Neonatologist & Convenor, Victorian Infant Collaborative Study  (VICS) & CRE in Newborn Medicine

Royal Women’s Hospital 

Murdoch Children’s Research Institute 
Jane Bailey Clinical Nurse Consultant, NICU Royal Women’s Hospital
Dr Rosemarie Boland Senior Project Officer

Safer Care Victoria

Paediatric Infant Perinatal Emergency Retrieval (PIPER)

Murdoch Children’s Research Institute 

Dr Jim Holberton Tertiary Neonatologist Mercy Hospital for Women
Kathleen Jones Regional Midwife University Hospital Geelong
Dr Isaac Marshall Regional Paediatrician University Hospital Geelong
Dr Antoinette Mowbray Regional GP Obstetrician Bairnsdale
Dr Trisha Prentice Tertiary Neonatologist & Bioethics specialist Royal Children’s Hospital
Dr Calum Roberts Tertiary Neonatologist Monash Children’s Hospital
Associate Professor Michael Stewart Director, Paediatric Infant Perinatal Emergency Retrieval (PIPER) Royal Children’s Hospital
Dr Kae Sheen Wong Regional Specialist Obstetrician Wodonga
Kylie Wood Consumer Consumer


Working group terms of reference

Get in touch

Centre of Clinical Excellence - Women and Children
Safer Care Victoria

Page last updated: 11 Nov 2020

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