Advocating for neonatology presence at births between 20 and 25 weeks of gestation.

Extreme preterm births between 20 and 25 weeks' gestation present significant challenges in neonatal care and ethics. This manuscript advocates for neonatology presence from 20 weeks onwards to optimize outcomes. Neonatology attendance ensures accurate gestational age assessment, immediate intervention, and informed decision-making. Survival rates for extremely preterm infants have improved significantly, ranging from 0 to 37 % at 22 weeks to 31-78 % at 24 weeks. However, outcomes vary widely based on factors such as healthcare access and socioeconomic conditions. We propose using "preterm birth between 20 and 25 weeks" instead of "periviability" for clarity in clinical protocols and parental counseling. Ethical considerations, including potential overtreatment and parental autonomy, are addressed through clear guidelines. While challenges exist in implementing this approach, particularly in smaller or rural hospitals, solutions such as strengthening regional networks and telemedicine can address these issues. Despite concerns about resource allocation, we argue that the benefits of neonatologist attendance outweigh the challenges, providing the best opportunity for survival and optimal outcomes in these ethically complex situations.