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Estimation of neonatal outcome and perinatal therapy use
S B Morse1, J L Haywood, R L Goldenberg
1Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Insights
US physicians often underestimate survival and handicap-free rates for preterm infants. This underestimation can lead to reduced use of crucial interventions that improve outcomes for premature babies.
Area of Science:
- Neonatal Medicine
- Obstetrics
- Pediatric Critical Care
Background:
- Accurate estimation of preterm infant outcomes is crucial for clinical decision-making.
- Physician knowledge and attitudes may influence the application of life-saving interventions.
Purpose of the Study:
- To assess the accuracy of US obstetricians' and pediatricians' survival and handicap-free rate estimations for preterm infants.
- To determine if physician knowledge and attitudes impact their choice of interventions for premature neonates.
Main Methods:
- Cross-sectional survey of US obstetricians and pediatricians using a pretested questionnaire.
- Assessed knowledge of survival and handicap-free rates for infants born between 23 and 36 weeks gestation.
- Compared physician-reported intervention rates with published national data.
Main Results:
- Both obstetricians and pediatricians underestimated survival and handicap-free rates across multiple gestational ages.
- Physicians underestimating survival were less likely to use key interventions like antenatal corticosteroids, mechanical ventilation, and cesarean sections.
- Optimists group accurately predicted neonatal survival on average.
Conclusions:
- US physicians generally underestimate survival and handicap-free outcomes for preterm infants.
- This underestimation is linked to a reduced utilization of appropriate and potentially life-enhancing interventions.
- Improving physician awareness of accurate preterm infant outcomes is essential for optimizing care.
Objectives:
To learn whether US obstetricians and pediatricians accurately estimate rates of survival and freedom from handicap in preterm infants and to learn whether their knowledge and attitudes influence their choice of interventions that may enhance survival.
Methods:
A cross-sectional survey of obstetricians and pediatricians practicing in the United States was performed using a pretested questionnaire designed to identify their knowledge regarding survival and handicap-free rates of infants born at 23 to 36 weeks of gestation. At each week of gestation, they were asked whether they would provide specific therapeutic interventions to either the expectant mother or infant. Survival and handicap-free rates were compared with published national rates. Obstetricians and pediatricians were divided into an optimists group and a pessimists group, based on their estimates of survival. The rates at which each group used therapeutic interventions were compared.
Results:
Both obstetricians and pediatricians underestimated survival rates from 24 through 35 weeks of gestation and freedom from serious handicap from 23 through 36 weeks of gestation. On the average, optimists accurately predicted neonatal survival. Obstetricians who underestimated neonatal survival would less often administer antenatal corticosteroids, perform a cesarean section for fetal distress, and transfer a mother to a tertiary center. Pediatricians who underestimated neonatal survival would less often use mechanical ventilation, cardiopulmonary resuscitation, inotropes, intravenous fluids, thermal support, and oxygen supplementation.
Conclusion:
Physicians underestimate survival and freedom from handicap in preterm infants. Underestimation of outcome is associated with restriction in the use of appropriate interventions.