Estimation of neonatal outcome and perinatal therapy use

Objectives. To learn whether US obstetricians and pediatricians accurately estimate rates of survival and freedom from handicap in preterm infants and to learn whether their knowledge and attitudes influence their choice of i nterventions that may enhance survival. Methods. A cross-sectional survey of obstetricians and pediatricians practi cing in the United States was performed using a pretested questionnaire des igned to identify their knowledge regarding survival and handicap-free rate s of infants born at 23 to 36 weeks of gestation. At each week of gestation , they were asked whether they would provide specific therapeutic intervent ions to either the expectant mother or infant. Survival and handicap-free r ates were compared with published national rates. Obstetricians and pediatr icians were divided into an optimists group and a pessimists group, based o n their estimates of survival. The rates at which each group used therapeut ic interventions were compared. Results. Both obstetricians and pediatricians underestimated survival rates from 24 through 35 weeks of gestation and freedom from serious handicap fr om 23 through 36 weeks of gestation. On the average, optimists accurately p redicted neonatal survival. Obstetricians who underestimated neonatal survi val would less often administer antenatal corticosteroids, perform a cesare an section for fetal distress, and transfer a mother to a tertiary center. Pediatricians who underestimated neonatal survival would less often use mec hanical ventilation, cardiopulmonary resuscitation, inotropes, intravenous fluids, thermal support, and oxygen supplementation. Conclusion. Physicians underestimate survival and freedom from handicap in preterm infants. Underestimation of outcome is associated with restriction in the use of appropriate interventions.