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Estimation of outcome and restriction of interventions in neonates
J L Haywood1, S B Morse, R L Goldenberg
1Department of Pediatrics, School of Medicine,University of Alabama at Birmingham, Birmingham, AL 35213, USA.
Insights
Pediatricians often underestimate survival and healthy outcomes for preterm infants. This underestimation may lead to less frequent use of life-saving interventions for extremely premature babies.
Area of Science:
- Neonatal Medicine
- Pediatric Practice
- Medical Education
Background:
- Accurate estimation of survival and handicap-free rates in preterm infants is crucial for clinical decision-making.
- Pediatricians' knowledge and attitudes may influence interventions for extremely preterm infants.
Purpose of the Study:
- To assess pediatricians' accuracy in estimating preterm infant survival and handicap-free rates.
- To determine if knowledge and attitudes affect intervention choices for extremely preterm infants.
Main Methods:
- Survey of 159 Alabama pediatricians using a questionnaire on gestational age-specific outcomes.
- Comparison of estimated rates with national data, categorizing pediatricians as optimists or pessimists.
- Analysis of intervention rates based on outcome estimation accuracy.
Main Results:
- Pediatricians underestimated survival (23-34 weeks gestation) and handicap-free rates (23-36 weeks gestation).
- Pessimists significantly underestimated neonatal outcomes compared to optimists.
- Underestimators used fewer invasive therapies (e.g., mechanical ventilation, CPR) than those with accurate predictions.
Conclusions:
- Pediatricians frequently underestimate the outcomes for preterm infants.
- Underestimation of survival potential may negatively impact neonatal practice and intervention choices.
Objective:
To learn whether pediatricians accurately estimate rates of survival and freedom from handicap in preterm infants and to learn whether their knowledge and attitude influence their choice of interventions that may enhance survival of extremely preterm infants.
Methods:
Pediatricians practicing in Alabama were surveyed using a pretested questionnaire designed to identify pediatricians' knowledge regarding survival and handicap-free rates of infants born at gestational ages between 21 and 36 weeks. For infants born at each week of gestation, they were asked if they would provide specific therapeutic interventions. Survival and handicap-free rates were compared with published national rates. Pediatricians were divided into an optimist group and a pessimist group based on how their estimates of survival compared with national published data. The rates at which each group used therapeutic interventions were compared.
Results:
The 159 (57%) responding pediatricians underestimated survival rates from 23 through 34 weeks' gestation and freedom from serious handicap from 23 through 36 weeks. Responses of the optimists approximated actual data whereas the pessimists underestimated neonatal outcome. Those pediatricians who underestimated neonatal outcome would intervene less often with invasive therapies, including mechanical ventilation, cardiopulmonary resuscitation, inotropes, and intravenous fluids, compared with those who accurately predicted outcome from 23 through 27 weeks' gestation.
Conclusion:
Pediatricians often underestimate neonatal outcome of preterm infants. Appropriate neonatal practice may be affected by this underestimation of the survival potential of preterm infants.