Premature Babies Do Better than Many Doctors Believe
May 8, 2000 -- While medical advances have dramatically raised the survival
rate for premature babies and lowered their risks of developing serious
handicaps, many pediatricians and obstetricians may not be knowledgeable about
the current statistics, a new study suggests. And researchers are concerned
that this could mean they aren't treating these babies as aggressively as they
Premature births occur in 6% to 10% of all pregnancies, and prematurity is
the most common cause of sickness and death among newborn babies. If they
survive, these babies are at risk for serious handicaps such as cerebral palsy,
mental retardation, and developmental delay.
A survey by researchers from the University of Alabama found that
obstetricians and pediatricians underestimated premature infants' odds of
survival and overestimated their chances of developing a serious handicap. For
example, the researchers say, the actual survival rate for a baby delivered at
28 weeks is 84 percent, but the pediatricians who were surveyed put the rate at
68 percent, while the obstetricians estimated 58 percent.
"It?s difficult to say whether or not these misconceptions have affected
care," study investigator James Haywood, MD, tells WebMD. "From our
data, we can see that obstetricians tend to refer women to centers that have
intensive-care nurseries, even if they have misconceptions about the baby?s
outcome." Haywood is a neonatologist and associate professor of pediatrics
at the University of Alabama School of Medicine in Birmingham.
Problems may occur in a hospital without a neonatologist (a pediatrician who
specializes in newborn babies), he says: "A pediatrician or family doctor
may be the one who will counsel a parent with a pessimistic outcome
expectation." While the researchers don?t have nationwide data, says
Haywood, local data from Alabama shows that when women in preterm labor or
their premature babies are not referred to a medical center with appropriate
facilities, the death rate is higher.
Steven Morse, MD, and colleagues from the University of Alabama at
Birmingham sent out more than 1,850 questionnaires to randomly selected general
practice obstetricians and pediatricians.
"Since most babies are born in centers without a neonatologist,
pediatricians are going to be called upon to make decisions, whether they
attend a delivery or counsel a woman in labor," Haywood says. "We
wanted to survey the people who would most likely be faced with making these
It?s not surprising that many general practice obstetricians and
pediatricians underestimated the survival rates, says Michael Speer, MD, who
reviewed the study for WebMD. "Typically, the learning curve of the general
obstetrician and general pediatrician - -as far as survival and intact
survival, and degree of handicap - -will lag behind that of fetal maternal
obstetricians and neonatologists," he says. "And that?s not
unreasonable, because most pediatricians and obstetricians do not take care of
that many small babies." Speer is a neonatologist and an associate
professor of pediatrics at Baylor College of Medicine in Houston.