Population-Based Outcomes Data for Counseling at the Margin of Gestational Viability

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• 作者：Patrick Myers ; MD¹ ; ^{PMyers@luriechildrens.org} ; Naomi Laventhal ; MD² ; Bree Andrews ; MD ; MPH³ ; Joanne Lagatta ; MD⁴ ; William Meadow ; MD ; PhD³
• 关键词：NICHD ; National Institute of Child Health and Human Development ; NICU ; Neonatal intensive care units
• 刊名：The Journal of Pediatrics
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：181
• 期：Complete
• 页码：208-212.e4
• 全文大小：2045 K
• 卷排序：181

文摘

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 designAn 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.ResultsNinety-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.ConclusionDespite 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.