Provider Awareness, Understanding and Use of NICHD Neonatal Research Network Outcomes Estimator

Abstract

Introduction Our aim was to survey clinicians to assess awareness and utilization of the NICHD Neonatal Research Network outcomes estimator, which allows clinicians to use multiple factors to better estimate the likelihood that intensive care will benefit the delivered neonate.

Study Design The survey tool included a list of questions regarding the estimator. We collected responses from various medical personnel assessing awareness, frequency of use, knowledge of estimator, and information regarding the database.

Results There were a total of 141 participants. Forty-two percent reported awareness of the estimator and of those, 75% had visited the Web site. Eighty-two percent of those visiting the site had actually used the estimator. Maternal–fetal medicine (MFM) physicians versus generalists were more likely to have heard of the estimator (75 vs. 32%). Obstetrics and gynecology residents had similar familiarity with the estimator as attending generalists. Of those having used the tool, 25% knew the correct variables, with only 19% knowing the outcomes. Interestingly, a majority of users misunderstood database components.

Conclusion A majority of clinicians, and a fourth of MFM physicians, who care for patients with threatened preterm birth are either unaware or have limited understanding of the estimator, offering a potential area of improvement in the counseling of such at-risk patients.

Keywords

periviable - preterm birth - patient counseling - infant outcomes

• References

• 1 Martin JA, Hamilton BE, Osterman MJK , et al. Births: Final Data for 2013. National Vital Statistics Reports. Vol 64, No. 1. Hyattsville, MD: National Center for Health Statistics; 2015
• 2 Callaghan WM, MacDorman MF, Rasmussen SA, Qin C, Lackritz EM. The contribution of preterm birth to infant mortality rates in the United States. Pediatrics 2006; 118 (4) 1566-1573
• 3 MacDorman MF, Kirmeyer SE, Wilson EC. Fetal and Perinatal Mortality, United States, 2006. National Vital Statistics Reports. Vol 60, No. 8. Hyattsville, MD: National Center for Health Statistics; 2012
• 4 Raju TN, Mercer BM, Burchfield DJ , et al. Periviable birth: executive summary of a Joint Workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for MaternalFetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists. J Perinatol 2014; 34 (5) 333-342
• 5 Copel JA, Bahtiyar MO. A practical approach to fetal growth restriction. Obstet Gynecol 2014; 123 (5) 1057-1069
• 6 Tyson JE, Parikh NA, Langer J, Green C, Higgins RD. National Institute of Child Health and Human Development Neonatal Research Network Intensive care for extreme prematurity—moving beyond gestational age. N Engl J Med 2008; 358 (16) 1672-1681
• 7 Lee HC, Green C, Hintz SR , et al. Prediction of death for extremely premature infants in a population-based cohort. Pediatrics 2010; 126 (3) e644-e650
• 8 Grobman WA, Kavanaugh K, Moro T, DeRegnier RA, Savage T. Providing advice to parents for women at acutely high risk of periviable delivery. Obstet Gynecol 2010; 115 (5) 904-909
• 9 Dupont-Thibodeau A, Barrington KJ, Farlow B, Janvier A. End-of-life decisions for extremely low-gestational-age infants: why simple rules for complicated decisions should be avoided. Semin Perinatol 2014; 38 (1) 31-37
• 10 Tucker Edmonds B, Krasny S, Srinivas S, Shea J. Obstetric decision-making and counseling at the limits of viability. Am J Obstet Gynecol 2012; 206 (3) 248.e1-248.e5
• 11 Ethridge Jr JK, Louis JM, Mercer BM. Accuracy of fetal weight estimation by ultrasound in periviable deliveries. J Matern Fetal Neonatal Med 2014; 27 (6) 557-560
• 12 Patel RM, Kandefer S, Walsh MC , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Causes and timing of death in extremely premature infants from 2000 through 2011. N Engl J Med 2015; 372 (4) 331-340