Population-Based Outcomes Data for Counseling at the Margin of Gestational Viability. J Pediatr 2017 Feb;181:208-212.e4
Date
11/07/2016Pubmed ID
27814911DOI
10.1016/j.jpeds.2016.10.021Scopus ID
2-s2.0-85003846550 (requires institutional sign-in at Scopus site) 15 CitationsAbstract
OBJECTIVE: To survey neonatologists as to how many use population-based outcomes data to counsel families before and after the birth of 22- to 25-week preterm infants.
STUDY DESIGN: An anonymous online survey was distributed to 1022 neonatologists in the US. Questions addressed the use of population-based outcome data in prenatal and postnatal counseling.
RESULTS: Ninety-one percent of neonatologists reported using population-based outcomes data for counseling. The National Institute of Child Health and Human Development Neonatal Research Network Outcomes Data is most commonly used (65%) with institutional databases (14.5%) the second choice. Most participants (89%) reported that these data influence their counseling, but it was less clear whether specific estimates of mortality and morbidity influenced families; 36% of neonatologist felt that these data have little or no impact on families. Seventy-one percent reported that outcomes data estimates confirmed their own predictions, but among those who reported having their assumptions challenged, most had previously been overly pessimistic. Participants place a high value on gestational age and family preference in counseling; however, among neonatologists in high-volume centers, the presence of fetal complications was also reported to be an important factor. A large portion of respondents reported using prenatal population-based outcomes data in the neonatal intensive care unit.
CONCLUSION: Despite uncertainty about their value and impact, neonatologists use population-based outcomes data and provide specific estimates of survival and morbidity in consultation before and after extremely preterm birth. How best to integrate these data into comprehensive, family-centered counseling of infants at the margin of viability is an important area of further study.
Author List
Myers P, Laventhal N, Andrews B, Lagatta J, Meadow WAuthor
Joanne M. Lagatta MD Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Attitude of Health PersonnelCounseling
Female
Gestational Age
Health Surveys
Humans
Infant
Infant, Newborn
Infant, Premature
Male
Neonatologists
Neonatology