PROGNOSIS IN PREMATURE-INFANTS - THE OPIN ION OF OBSTETRICIANS COMPARED WITH ACTUAL RESULTS IN LAUSANNE

Aim of the study: To assess the views of obstetricians concerning the survival rate in neonates on the basis of gestational age and birthwei ght, rate of severe handicap, and minimum gestational age for preventi ve and curative measures (steroids for foetal lung maturation and caes arean section in the event of acute foetal distress). Then, to compare these results with the outcomes observed in the referral centre for t hese obstetricians. Method: We circulated an anonymous questionnaire ( two mailings between October 1995 and February 1996) to obstetricians in the Lausanne area. The replies were compared with prospective data from the Lausanne obstetric unit (1989-1995) and neonatal intensive ca re unit (1982-1993) backed by the neurodevelopmental outcome assessed by regular follow-up until the age of 81/2 years. Results: We obtained 116 replies from the 270 specialists questioned (43% participation). The mortality rates in Lausanne are described by gestational age and b irthweight, as is the rate of severe handicap. We observed significant overestimation of the mortality rate for premature infants between 25 and 31 weeks and for birthweights over 600 grams. The rate of severe handicap was widely overestimated for a gestational age below 28 weeks at delivery or a birthweight below 1500 g (prognosis 31.2% and 21.5% respectively, compared with actual figures of 7.4% and 6.8%). Moreover , distribution of replies showed marked heterogeneity between 26 and 2 9 weeks and between 600 and 1000 grams. The estimated minimum gestatio nal age was 26 weeks (mean) for starting steroid therapy and 27 weeks for caesarean section for acute foetal distress. Conclusion: Assessmen t of prognosis by obstetricians did not correlate with our results and reflected the disparity of data found in the literature. Nevertheless , the implications of this discrepancy may be slight. The study stress es the efficacy of the regionalisation of perinatal care in the Lausan ne area, where we observed only 6% of outborn weighing less than 1500 grams in the 18 maternity departments covered. The rate of completed a ntenatal steroid therapy (41% for infants below 1500 grams) appears to be favourable in our population compared with the literature. We advo cate permanent information on local results regarding perinatal outcom e, to enable individual obstetricians to consider the desirability of treating, transferring or even counselling or reassuring their patient s.