More needs to be done for preemie healthcare

Feb 20 2008

A recent survey of 202 neonatologists and pediatricians, which examined current attitudes and practices when caring for the specialized health needs of preterm infants, revealed that most respondents (70 percent) feel the United States' healthcare system does not place enough emphasis on or dedicate enough resources to preventive healthcare for preemies.

The survey was sponsored by MedImmune, Inc.

The incidence of preterm birth, when infants are born at less than 36 weeks gestation, has increased steadily in the United States since the mid-1990s. Because these babies lack the usual complement of antibodies, which are supplied by the mother to babies in late gestation, preterm babies are at high risk of getting a host of infectious diseases, including respiratory syncytial virus (RSV), the leading cause of infant respiratory hospitalization in the United States. That risk can be even greater among infants that have an array of complex health problems including immune deficiencies, chronic lung disease, congenital heart disease and neurological disorders.

“This survey reminds us that, while progress in preemie healthcare has been made, more still needs to be done to ensure that every preemie, regardless of his or her circumstances, receives the care he or she deserves,” said Richard J. Martin, M.D., division chief of neonatology, Rainbow Babies and Children's Hospital, Cleveland, Ohio.

Additional key survey findings shed light on reasons why premature infants may not receive the specialized care they require:

Preemie care practices differ among doctors with varying levels of experience.

• More than half (53 percent) of pediatricians with 10 years of experience or less relied on parents to find out if a patient was born prematurely, compared with just 14 percent of pediatricians with 21 plus years of experience. The more experienced pediatricians favored the hospital discharge summary (43 percent) or communication with the child's neonatologist for this information (36 percent).

• Twenty-one percent of neonatologists with more than 10 years of experience said providing parents with a copy of their child's discharge plan is the most important step when discharging a preemie from the hospital. Only three percent of neonatologists with fewer years of experience named this as the most important step.

• Most pediatricians (56 percent) with 10 years of experience or less said they stop working with a preemie's neonatologist immediately following discharge, whereas most pediatricians (54 percent) with 21 plus years of experience keep working with the neonatologist until their patient is at least three months old.

Late-preterm infants (defined as 34-to-35 weeks gestational age for the purpose of the survey) may not be on their doctors' “radars” because of misconceptions about the risks these babies face.

• Fifty-eight percent of 34-to-35 week infants are perceived, by their surveyed doctors, as healthy (not at high-risk), even though they are premature and at high risk for RSV disease.

Doctors agree that there are a number of reimbursement and managed-care barriers to effective preemie care.

• Most physicians (70 percent) feel that the U.S. healthcare system does not dedicate enough emphasis and resources to preventive healthcare for premature infants.
  • Eighty-four percent of these physicians say they are willing to personally advocate for more preventive health services for preemies.

• Most pediatricians (69 percent) say their office staff spends more time on reimbursement for premature infants than for full-term babies. Seventy-seven percent say they spend more time on reimbursement for premature babies at high risk for serious RSV than for preemies who are not at high risk for serious RSV.

About the Survey

HCD Research, an independent research company, surveyed a random sample of 202 neonatologists and pediatricians from September 5 to 25, 2007. To qualify, respondents had to have spent at least 50 percent of their time in a clinical setting, with neonatologists treating at least three preemies per month and pediatricians treating at least three preemies in the past four months. Respondents with an existing financial relationship with an advertising agency, the U.S. Food and Drug Administration or a market research firm were excluded. No incentive was offered in exchange for respondents' participation.

Ninety-seven neonatologists participated in the survey. Thirty-two neonatologists had 10 years of experience or less, 37 neonatologists had between 11 and 20 years of experience, and 28 neonatologists had at least 21 years of experience. A total of 105 pediatricians participated in the survey. Twelve were pediatric pulmonologists and 15 were pediatric cardiologists. Thirty-two pediatricians had 10 years of experience or less, 45 pediatricians had between 11 and 20 years of experience, and 28 pediatricians had at least 21 years of experience.