Patrick Myers1, Naomi Laventhal2, Bree Andrews3, Joanne Lagatta4, William Meadow3. 1. Feinberg School of Medicine, Northwestern University, Chicago, IL. Electronic address: PMyers@luriechildrens.org. 2. C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI. 3. The University of Chicago Comer Children's Hospital, Chicago, IL. 4. Medical College of Wisconsin, Milwaukee, WI.
Abstract
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.
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.
Authors: Matthew A Rysavy; Jeffrey D Horbar; Edward F Bell; Lei Li; Lucy T Greenberg; Jon E Tyson; Ravi M Patel; Waldemar A Carlo; Noelle E Younge; Charles E Green; Erika M Edwards; Susan R Hintz; Michele C Walsh; Jeffrey S Buzas; Abhik Das; Rosemary D Higgins Journal: JAMA Pediatr Date: 2020-05-04 Impact factor: 16.193
Authors: Genevieve L Taylor; Robert M Joseph; Karl C K Kuban; Laurie M Douglass; Jeff Laux; Bree Andrews; Rebecca C Fry; Wayne A Price; Thomas M O'Shea Journal: Pediatrics Date: 2021-04-06 Impact factor: 7.124