There are variations among healthcare providers regarding the gestational age considered the threshold of viability. Currently, the World Health Organization sets the lower limit of viability at 22 weeks of gestation, or a birth weight of 500 g, or a birth length of 25 cm. Neonates are not autonomous. The present study aimed to evaluate the factors involved in healthcare professionals’ management decisions in cases of neonates born at the margins of viability. A narrative review was conducted, including articles published between 2005 and 2025. We included 55 manuscripts and used the SANRA quality scale for assessment. The various approaches currently used worldwide raise concerns about their potential impact on the quality of care provided to these infants. We explored survey-based evidence regarding perceptions of the limit of viability and therapeutic decisions that raise ethical issues. The lack of coherent national guidelines and legislation represents an important burden for our healthcare system. Clinicians are faced with a dilemma regarding the correct management of infants at the limit of viability: whether to prolong treatment despite possible neurological impairment or to indicate discontinuation of treatment. Prenatal counseling for parents before delivery, along with a multidisciplinary approach, is required.
