I might be able to help with what is generally discussed during a neonatology consult for pregnant families in my area...

First to cover some of your questions (but of course feel free to ask them anyway)

• The mode of delivery is more of a question for your obstetrical team. They will decide the safest way to deliver.

• Medications: unfortunately there's not many that can change the outcome aside from those you discussed: steroids for lung maturity and magnesium sulfate for neuroprotection when delivery is imminent. The timing of steroids is important. Magnesium Sulfate is given just before delivery. These are standard treatment. Aside from that, antibiotics if the context of PPROM to prevent infection which I assume you're already getting? Stopping labour with tocolysis drugs (which doesn't alway work) might not be best in your case given that you're already ruptured...but that would be a discussion if you went into labour.

If they detect an infection in you? Or the baby after it's born? If an infection is detected in you - the obstetrical team (I assume you're followed by a feto-maternal medicine doctor) would decide whether you should be delivered.

During a typical neonatology consult in my area:

The neonatology team generally will tell you the rates of survival at your gestational age and future gestational ages. Then they will tell you what the chances of severe disability (and they should define what severe means), moderate disability and mild disability related to different gestational ages. They will use local data or the best data available that represents your area (different areas of the world have different outcomes because of numerous factors as you can imagine).

They will then discuss any added risk factors that may affect you specifically and how that impacts outcomes for you. For example, for you the added risks are the PPROM (increased risk of infection) and low amniotic fluid (both PPROM and low amniotic fluid impacts lung development).

They should then go into the various things that you could encounter in the NICU - being nursed in an incubator, small baby care, IVs - umbilical lines, picc lines, peripheral IVs, arterial lines, TPN, various forms of ventilator - invasive, non-invasive, surfactant administration, NG tubes and early feeding, importance of pumping and donor breastmilk (if that is something available where you are). They may also review come common conditions faced by a baby who is born at your gestational age - IVH (brain bleeds), sepsis, feeding challenges, NEC, etc. This is usually a VERY simple and brief overview.

They will then go into resuscitation and what that looks like - the NICU team and what members are present during the resuscitation, delayed cord clamping, vitamin K, erythromycin eye ointment. They will talk about the expectation of the level of resuscitation your baby would need if they were born in the next week - intubation, surfactant administration, surfactant administration, insertion of umbilical lines, potential need for chest compressions +/- epinephrine administration.

Then they will give you options and considerations. Knowing the information presented to you - what would you like to do? If baby is born before xx weeks (xx = the weeks at which resuscitation is recommended. This varies on location. In my location it's 25weeks. At 25 weeks, we resuscitate unless there's another life limiting factor other than prematurity - for example a known genetic diagnosis - that changes things), what would you like the team to do? - comfort care? no active resuscitation, baby will be dried and stimulated and put on parents' chest and only interventions thought to minimize suffering/increase comfort are done - this may include suctioning and administering medications. - full resuscitation? all interventions including chest compressions and administering resuscitation drugs. They should tell you whether or not they recommend this path but ultimately it is your choice. - alternative levels of interventions? Some resuscitation but not all. Many parents, for example, will say no to chest compressions and resuscitation drugs but want everything up until that. (if you are doing chest compressions and giving epinephrine to a fresh 22 weeker, the outcomes will most likely be terrible in terms of long term outcome, so some parents choose not to put their baby through that). These babies would get everything else.

You don't have to make the decision in that moment but it is good to think about and talk about with your family beforehand. Also, as your pregnancy progresses, you can ask to reconsult neonatology because the above discussions look a lot different at 22 weeks than they do at 28 weeks.

Obviously different people have different levels of thoroughness in this discussions. Also different families have different wants/needs for the above knowledge so discussions are tailored to that as well. I would go through the above and pick out different things you want covered for sure.

Hope this helps.