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Obstetricians and pediatricians who are pessimistic about the outcomes of premature infants tend to underestimate their actual chances of survival and freedom from serious handicap. Physicians who are most pessimistic about these infants' outcomes are least likely to use potentially lifesaving therapies, concludes a recent study. Improving physicians' knowledge about the actual outcomes of preterm infants may lead to more appropriate use of lifesaving therapies, concludes the Patient Outcomes Research Team on the Prevention of Low Birthweight Among Minority and High Risk Women, led by Robert L. Goldenberg, M.D., of the University of Alabama, Birmingham. The Low Birthweight PORT was supported by the Agency for Healthcare Research and Quality (PORT contract 290-92-0055).
The researchers surveyed U.S. obstetricians and pediatricians about their knowledge of survival and handicap-free rates of infants born at 23 to 36 weeks of gestation and whether they would provide specific therapeutic interventions either to the expectant mother or infant. Pessimists among the 379 responding obstetricians and 362 responding pediatricians significantly underestimated survival and handicap-free rates for the premature infants, while optimists provided more accurate estimates.
Optimism and pessimism significantly influenced physicians' willingness to use certain lifesaving interventions. In contrast to pessimists, optimistic pediatricians were 1.1 to 1.8 times more likely to use mechanical ventilation and 1.1 to 1.6 times more likely to use inotropic support to strengthen cardiac contraction for infants between 23 and 27 weeks of gestation. Optimists were twice as likely to use thermal support, and they were more likely to use oxygen (1.22), cardiopulmonary resuscitation (1.24 to 1.35), and intravenous fluids (1.24 to 1.50) at 24 and 25 weeks of gestation. Among obstetricians, optimists were more apt to perform cesarean section for fetal distress (1.3 to 2.8) at 23 to 25 weeks of gestation, administer steroids to the mother (1.2 to 1.3), and transfer the mother in preterm labor to a tertiary care facility with neonatal intensive care services.
See "Estimation of neonatal outcome and perinatal therapy use," by Steven B. Morse, M.D., M.P.H., James L. Haywood, M.D., Dr. Goldenberg, and others, in the May 2000 Pediatrics 105(5), pp. 1046-1050.
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