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Obstetricians' Attitudes Toward the Treatment of Extremely Preterm Infants in China
Tao Han1,2,3, Dan Wang1,4, Wenyu Xie1,2,3
1Department of Neonatology, Senior Department of Pediatrics, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, China.
Insights
Chinese obstetricians show conservative attitudes towards treating extremely preterm infants (EPIs). Many EPIs are withdrawn from NICU care, with 28 weeks considered the cutoff for full treatment.
Area of Science:
- Neonatal Medicine
- Obstetrics
- Pediatric Policy
Background:
- Extremely preterm infants (EPIs) face high mortality and disability risks.
- Obstetrician attitudes significantly impact EPIs' access to neonatal intensive care units (NICUs).
- Understanding these attitudes is crucial for improving EPI care and pediatric health policies.
Purpose of the Study:
- To investigate the attitudes of Chinese obstetricians regarding the treatment of EPIs.
- To identify the perceived gestational age cutoff for providing full care to preterm infants in China.
Main Methods:
- A cross-sectional, online questionnaire survey was conducted among 2817 obstetricians across China.
- Data collected included participant demographics, EPI delivery experience, and attitudes toward resuscitation and NICU admission.
- Logistic regression analyzed factors associated with attitudes toward the care cutoff.
Main Results:
- Only 19.1% supported resuscitation at 24 weeks, rising to 54.8% at 26 weeks, and 100% at 27 weeks.
- 47.1% reported frequent withdrawal of treatment for EPIs before NICU admission.
- Most (72.8%) obstetricians favored 28 weeks as the cutoff for full care, influenced by professional title, region, and hospital type.
Conclusions:
- Chinese obstetricians generally hold conservative views on treating EPIs.
- Withdrawal from NICU treatment is common for EPIs.
- A 28-week gestational age is widely considered the threshold for full care, with influencing factors identified.
Importance:
Extremely preterm infants (EPIs) are at high risk of mortality and disability, and whether obstetricians are active in treating EPIs is directly related to whether EPIs can get an opportunity to enter the neonatal intensive care unit (NICU) for treatment. A greater understanding of the attitudes of obstetricians toward the treatment of EPIs is needed to improve treatment of this population and optimize pediatric health policies and services.
Objective:
To clarify the attitudes of obstetricians toward the treatment of EPIs in China.
Design, Setting, And Participants:
A cross-sectional, online, questionnaire-based survey was conducted among obstetricians from various provinces and cities in China through the wenjuanxing application (a survey platform) between June and July 2021. The questionnaire included characteristics of the participants, their experiences in delivering EPIs, their attitudes toward EPI resuscitation, and their opinions about the cutoff for providing full care to preterm infants in China. Possible factors associated with their attitudes toward the cutoff for providing full care to preterm infants were analyzed by logistic regression. Data analysis was performed from August 2021 to January 2022.
Main Outcomes And Measures:
The attitudes of obstetricians toward the resuscitation and treatment of EPIs, and the current cutoff for providing full care to premature infants.
Results:
A total of 2817 valid questionnaires were recovered from 30 provinces and cities in mainland China. Of the 2817 obstetricians (mean [SD] age, 41.76 [8.50] years) investigated, 156 (5.5%) were male, 2661 (94.5%) were female, 1339 (47.5%) were deputy chief physicians or chief physicians, 1662 (59.0%) were from tertiary hospitals, and 2048 (72.7%) had experience in delivering EPIs. The proportion of obstetricians who supported resuscitation of preterm infants was 19.1% (539 respondents) at a gestational age 24 weeks, 24.1% (679 respondents) at 25 weeks, 54.8% (1543 respondents) at 26 weeks, and 100.0% (2817 respondents) at 27 weeks. A total of 1326 obstetricians (47.1%) reported that it was common or very common for EPIs to be withdrawn from resuscitation and not to be admitted to the NICU for treatment. Regarding the treatment of EPIs with higher possibility of survival, 1621 obstetricians (57.5%) maintained that appropriate information should be communicated but their parents' wishes should be respected. Most obstetricians (2051 respondents [72.8%]) maintained that 28 weeks was the cutoff for providing full care to preterm infants in China; 766 respondents (27.2%) thought of it as inappropriate, suggesting the cutoff should be less than 28 weeks. Logistic regression analysis showed that these differences were significantly associated with the professional titles of the obstetricians, geographical regions, hospital levels and types, whether they had any experience in delivering EPIs, and the total number of EPIs born yearly in their units.
Conclusions And Relevance:
In this cross-sectional study, most Chinese obstetricians maintained a conservative attitude toward the treatment of EPIs. It was very common for EPIs to be withdrawn from treatment without entering the NICU directly after birth. Most obstetricians maintained that 28 weeks' gestational age should be the cutoff for providing full care to premature infants.
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