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Physicians' prognoses about the quality of life for infants with intraventricular hemorrhage
G N Siperstein1, M L Wolraich, D Reed
1Center for the Study of Social Acceptance, University of Massachusetts, Boston 02125-3393.
Insights
Physicians expect developmental impairments in infants with intraventricular hemorrhage (IVH). Prognoses for severe IVH (grade IV) predict significant disability, influencing treatment recommendations, unlike milder cases (grade I).
Area of Science:
- Pediatric Medicine
- Neonatology
- Neurology
Background:
- Limited data exists on the long-term outcomes for infants with intraventricular hemorrhage (IVH).
- Physicians frequently need to provide prognoses for these children's future quality of life.
Purpose of the Study:
- To investigate pediatricians' and neonatologists' prognoses for infants with grade I and grade IV intraventricular hemorrhage (IVH).
- To assess the impact of these prognoses on treatment recommendations.
- To identify differences in prognoses and recommendations based on physician discipline and training.
Main Methods:
- A national random survey was conducted.
- The survey included 289 pediatricians and 283 neonatologists.
- Participants provided prognoses for infants with grade I and grade IV IVH and their impact on treatment.
Main Results:
- Both pediatricians and neonatologists predicted slight developmental impairments for grade I IVH infants.
- Severe impairments, including moderate to severe mental retardation and institutionalization, were predicted for grade IV IVH infants.
- Physicians recommended treatment for grade I IVH but were neutral or discouraged treatment for grade IV IVH.
- Physicians' prognoses significantly influenced their treatment recommendations.
- Discipline and training affected physicians' prognoses and recommendations.
Conclusions:
- Physician prognoses for intraventricular hemorrhage (IVH) severity significantly shape treatment recommendations.
- The perceived long-term outcomes for infants with severe IVH (grade IV) can lead to recommendations against aggressive medical intervention.
- Further research is needed to establish definitive long-term outcomes for children with IVH.
Abstract:
There is an absence of definitive information concerning the long-term outcome of children born with intraventricular hemorrhage (IVH). Physicians, however, are called on to prognosticate about the future quality of life of these children. Our study examined pediatricians' and neonatologists' prognoses for infants with grade I- and grade-IV IVH and the impact of those prognoses on recommendations for treatment. A national random survey of 289 pediatricians and 283 neonatologists found that both groups expected infants with grade-I IVH to have slight impairments to future development, whereas infants with grade-IV IVH were expected to have severe impairments. Physicians prognosticated that infants with grade-IV IVH would function at a moderate to severe level of mental retardation, incapable of any employment, and residing in an institution. Furthermore, physicians would encourage parents to seek medical treatment of respiratory distress for the infant with grade-I IVH but were neutral or would discourage parents from seeking treatment for the infant with grade-IV IVH. Lastly, physicians' prognoses were significantly related to their recommendations for treatment. Several differences in physicians' prognoses and recommendations were found to be related to their discipline and training.