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



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.



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.



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.
Feinberg School of Medicine, Northwestern University, Chicago, IL. Electronic address: PMyers@luriechildrens.org.
Patrick
P
Myers
C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI.
Naomi
N
Laventhal
The University of Chicago Comer Children's Hospital, Chicago, IL.
Bree
B
Andrews
Medical College of Wisconsin, Milwaukee, WI.
Joanne
J
Lagatta
The University of Chicago Comer Children's Hospital, Chicago, IL.
William
W
Meadow
D001291:Attitude of Health Personnel; D003376:Counseling / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D000072156:Neonatologists / Q000706:statistics & numerical data*; D009359:Neonatology; D017063:Outcome Assessment, Health Care / Q000379:methods*
ethics; neonate; prematurity; prenatal outcomes