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Aust N Z J Obstet Gynaecol. 2016 Jun;56(3):274-81. doi: 10.1111/ajo.12448. Epub 2016 Feb 24.

What are we telling the parents of extremely preterm babies?

Boland RA1,2,3, Davis PG1,2,4, Dawson JA1,2,4, Doyle LW1,2.

Author information

1
Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
2
Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia.
3
Paediatric Infant Perinatal Emergency Retrieval, Royal Children's Hospital, Parkville, Victoria, Australia.
4
Newborn Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia.

Abstract

BACKGROUND:

Parent counselling and decision-making regarding the management of preterm labour and birth are influenced by information provided by healthcare professionals regarding potential infant outcomes.

AIM:

The aim of this study was to determine whether perinatal healthcare providers had accurate perceptions of survival and major neurosensory disability rates of very preterm infants born in non-tertiary hospitals ('outborn') and tertiary perinatal centres ('inborn').

MATERIALS AND METHODS:

A web-based survey was distributed to midwives, nurses, obstetricians and neonatologists working in non-tertiary and tertiary maternity hospitals, and the perinatal/neonatal emergency transport services in Victoria, Australia.

MAIN OUTCOME MEASURES:

Estimates of survival rates at 24 and 28-weeks' gestation were compared with actual survival rates of a population-based cohort of 24 and 28-weeks' gestation infants, born free of lethal anomalies in Victoria in 2001-2009. Estimates of major neurosensory disability rates in 24 and 28-week survivors were compared with actual disability rates in 24 and 28-week children born in Victoria averaged over three eras: 1991-1992, 1997 and 2005.

RESULTS:

Response rates varied as follows: 83% of non-tertiary midwives, 4% of obstetricians, 55% of tertiary centre staff and 68% of transport team staff responded (total of 30%). Overall, respondents underestimated survival and overestimated major neurosensory disability rates in both outborn and inborn 24 and 28-week infants. Outborn infants were perceived to have much worse prospects for survival and for survival with major disability compared with inborn peers.

CONCLUSION:

Many clinicians overestimated rates of adverse outcomes. These clinicians may be misinforming parents about their child's potential for a favourable outcome.

KEYWORDS:

counselling; extremely preterm infant; mortality; neurodevelopmental disability; outcomes

PMID:
26914811
DOI:
10.1111/ajo.12448
[Indexed for MEDLINE]

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