Primigravida in 23/24 weeks of twin pregnancy after IVF/ET with chorioamnionitis and visible amniotic membranes of first twin was admitted to our hospital demanding caesarean section. Ethical Committee declined patient’s request, and within 20 minutes vaginal delivery occur. The first twin’s fetal weight was 610g with a 1-minute Apgar score of 3 and a 5-minute score of 4. The neonate was immediately resuscitated, intubated and required mechanical ventilation with Surfactant endotracheal administration. On the first postpartal day an ultrasound examination detected a grade 3 intraventricular haemorrhage (IVH) with clot dissolving and convulsions in clinical status. The newborn was hyperglycaemic with confirmed perinatal infection and a grade 1 necrotic enterocolitis (NEC). Regarding persistent ductus arteriosus indomethacin was administered. During the NICU stay porencephalic cysts and hydrocephalus arose without visible brain tissue. On the 75th postpartal day cardiorespiratory insufficiency occurred with lethal outcome. The second twin’s fetal weight was 680g with a 1-minute Apgar score of 2 and a 5-minute Apgar score of 3. The baby was born with bradycardia and had a few gasps. The neonate was immediately resuscitated, intubated and high-frequency mechanically ventilated. Surfactant was administered endotracheally. An ultrasound detected grade 3 IVH. Lethal outcome appeared on first postpartal day. In the second case there was a premature delivery of neonates of 23 weeks gestational age, BW 749g. The parents were not interested in resuscitation, and the baby showed weak signs of life. The issue of whether or not to intubate arose. Therefore, a dilemma appeared – to reanimate in such conditions, or not? To use an aggressive approach in the NICU, or not? There were ethical dilemmas within the medical personnel regarding resuscitation in such conditions considering the presented clinical and laboratory findings from the first postpartal day. Comfort care is probably the best option, but without medico-legal regulations this is impossible.
Key words: extremely low gestational age infants, ethical dilemmas, resuscitation, delivery room, NICU (Neonatal Intensive Care Unit)