Obstetricians’ Attitudes Toward the Treatment of Extremely Preterm Infants in China

Abstract

Extremely preterm infants (EPIs) are at high risk of mortality and disability, and whether obstetricians are active in treating EPIs is directly related to whether EPIs can get an opportunity to enter the neonatal intensive care unit (NICU) for treatment. A greater understanding of the attitudes of obstetricians toward the treatment of EPIs is needed to improve treatment of this population and optimize pediatric health policies and services. To clarify the attitudes of obstetricians toward the treatment of EPIs in China. A cross-sectional, online, questionnaire-based survey was conducted among obstetricians from various provinces and cities in China through the wenjuanxing application (a survey platform) between June and July 2021. The questionnaire included characteristics of the participants, their experiences in delivering EPIs, their attitudes toward EPI resuscitation, and their opinions about the cutoff for providing full care to preterm infants in China. Possible factors associated with their attitudes toward the cutoff for providing full care to preterm infants were analyzed by logistic regression. Data analysis was performed from August 2021 to January 2022. The attitudes of obstetricians toward the resuscitation and treatment of EPIs, and the current cutoff for providing full care to premature infants. A total of 2817 valid questionnaires were recovered from 30 provinces and cities in mainland China. Of the 2817 obstetricians (mean [SD] age, 41.76 [8.50] years) investigated, 156 (5.5%) were male, 2661 (94.5%) were female, 1339 (47.5%) were deputy chief physicians or chief physicians, 1662 (59.0%) were from tertiary hospitals, and 2048 (72.7%) had experience in delivering EPIs. The proportion of obstetricians who supported resuscitation of preterm infants was 19.1% (539 respondents) at a gestational age 24 weeks, 24.1% (679 respondents) at 25 weeks, 54.8% (1543 respondents) at 26 weeks, and 100.0% (2817 respondents) at 27 weeks. A total of 1326 obstetricians (47.1%) reported that it was common or very common for EPIs to be withdrawn from resuscitation and not to be admitted to the NICU for treatment. Regarding the treatment of EPIs with higher possibility of survival, 1621 obstetricians (57.5%) maintained that appropriate information should be communicated but their parents' wishes should be respected. Most obstetricians (2051 respondents [72.8%]) maintained that 28 weeks was the cutoff for providing full care to preterm infants in China; 766 respondents (27.2%) thought of it as inappropriate, suggesting the cutoff should be less than 28 weeks. Logistic regression analysis showed that these differences were significantly associated with the professional titles of the obstetricians, geographical regions, hospital levels and types, whether they had any experience in delivering EPIs, and the total number of EPIs born yearly in their units. In this cross-sectional study, most Chinese obstetricians maintained a conservative attitude toward the treatment of EPIs. It was very common for EPIs to be withdrawn from treatment without entering the NICU directly after birth. Most obstetricians maintained that 28 weeks' gestational age should be the cutoff for providing full care to premature infants.