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.