ESTIMATION OF OUTCOME AND RESTRICTION OF INTERVENTIONS IN NEONATES

Objective. To learn whether pediatricians accurately estimate rates of survival and freedom from handicap in preterm infants and to learn wh ether their knowledge and attitude influence their choice of intervent ions that may enhance survival of extremely preterm infants. Methods. Pediatricians practicing in Alabama were surveyed using a pretested qu estionnaire designed to identify pediatricians' knowledge regarding su rvival and handicap-free rates of infants born. at gestational ages be tween 21 and 36 weeks. For infants born at each week of gestation, the y were asked if they would provide specific therapeutic interventions. Survival and handicap-free rates were compared with published nationa l rates. Pediatricians were divided into an optimist group and a pessi mist group based on how their estimates of survival compared with nati onal published data. The rates at which each group used therapeutic in terventions were compared. Results. The 159 (57%) responding pediatric ians 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 unde restimated neonatal outcome. Those pediatricians who underestimated ne onatal outcome would intervene less often with invasive therapies, inc luding mechanical ventilation, cardiopulmonary resuscitation, inotrope s, and intravenous fluids, compared with those who accurately predicte d outcome from 23 through 27 weeks' gestation. Conclusion. Pediatricia ns often underestimate neonatal outcome of preterm infants. Appropriat e neonatal practice may be affected by this underestimation of the sur vival potential of preterm infants.