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Disparities between perceived and true outcomes of infants born at 23-25 weeks' gestation
Rosemarie A Boland1,2,3, Jeanie L Y Cheong1,3,4, Michael J Stewart1,2
1Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Insights
Perinatal clinicians often underestimate survival and overestimate major disability for extremely preterm infants (23-25 weeks). This inaccuracy in assessing outcomes for premature babies may lead to overly pessimistic parental counseling.
Area of Science:
- Neonatal Medicine
- Perinatal Care
- Medical Education
Background:
- Accurate counseling on survival and disability risks for infants born at 23-25 weeks gestation is crucial for informed parental decision-making.
- Understanding clinician perceptions of these outcomes is vital for improving the quality of care and support provided to families.
Purpose of the Study:
- To assess the accuracy of perinatal clinicians' perceptions of survival and major neurodevelopmental disability rates in infants born at 23-25 weeks gestation.
- To determine if the accuracy of these perceptions has changed over a decade (2010 vs. 2020).
Main Methods:
- A web-based survey was administered to various perinatal clinicians (midwives, nurses, neonatologists, obstetricians) in Victoria, Australia, in 2020.
- Clinicians' estimates were compared with actual outcomes for actively managed infants, analyzing data by birthplace, gestational age, and professional discipline.
- Results were compared to a similar survey conducted in 2010 to identify changes in accuracy over time.
Main Results:
- Clinicians underestimated survival rates by 14.4% and overestimated major disability rates by 32.7% overall.
- Perceptions were less accurate for outborn infants compared to inborn infants and varied between professional disciplines (nurses/midwives more pessimistic, pediatricians more optimistic).
- The accuracy of clinicians' outcome perceptions was lower in 2020 compared to 2010.
Conclusions:
- Most perinatal clinicians demonstrate inaccurate perceptions regarding the outcomes of infants born at 23-25 weeks gestation.
- These inaccuracies, particularly underestimating survival and overestimating disability, may lead to overly pessimistic counseling for parents of extremely preterm infants.
- There is a need to improve the accuracy of clinician knowledge to ensure parents receive the most precise information for critical care decisions.
Background:
Decision-making for infants born at 23-25 weeks involves counselling parents about survival and major disability risks. Accurate information is needed for parents to make informed decisions about their baby's care.
Aims:
To determine if perinatal clinicians had accurate perceptions of outcomes of infants born at 23-25 weeks' gestation, and if accuracy had changed over a decade.
Materials And Methods:
A web-based survey was sent to midwives, nurses, neonatologists, and obstetricians working in tertiary and non-tertiary hospitals, and the neonatal retrieval service in the state of Victoria in 2020. A similar survey had been completed in 2010. Clinicians' estimates of survival and major neurodevelopmental disability rates were compared with true rates for actively managed infants overall, and by infant birthplace and gestational age, and professional workplace and discipline. Accuracy of outcomes was compared between eras.
Results:
Overall, 165 surveys were received. Participants underestimated survival (absolute mean difference [%] -14.4%; [95% confidence interval (CI) -16.6 to -12.3]; P < 0.001) and overestimated major disability (absolute mean difference 32.7%; [95% CI 29.7 to 35.8]; P < 0.001) rates overall, and at each week of gestation, and were worse for outborn compared with inborn infants. Perceptions of clinicians in tertiary centres were similar to those of non-tertiary clinicians. Nurses/midwives were more pessimistic, and paediatricians were more optimistic. Clinicians' perceptions of outcome were less accurate in 2020 than in 2010.
Conclusions:
Most perinatal clinicians underestimate survival and overestimate major disability of infants born at 23-25 weeks' gestation, which may translate into overly pessimistic counselling of parents.
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