Estimation of outcome and restriction of interventions in neonates

被引:29
作者
Haywood, JL
Morse, SB
Goldenberg, RL
Bronstein, J
Nelson, KG
Carlo, WA
机构
[1] Univ Alabama, Sch Med, Dept Pediat, Birmingham, AL 35213 USA
[2] Univ Alabama, Sch Med, Dept Obstet & Gynecol, Birmingham, AL 35213 USA
[3] Univ Alabama, Sch Publ Hlth, Birmingham, AL 35213 USA
关键词
prematurity; survival; knowledge; attitudes; practice;
D O I
10.1542/peds.102.2.e20
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
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.
引用
收藏
页码:art. no. / e20
页数:5
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