Neonatologists And Pediatricians Highlight Progress And Barriers To Preemie Care
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.
About RSV
Each year, up to 125,000 infants in the United States are hospitalized with severe RSV infections, the leading cause of infant hospitalization in the U.S. Approximately one-half of all infants are infected with RSV during the first year of life, and nearly all children have been infected at least once by the time they reach their second birthday. In the United States, RSV causes up to 1.7 million physician office visits; 400,000 emergency room visits and more than 230,000 hospital outpatient emergency room visits per year. RSV is the most common respiratory infection in infancy or childhood. Children born prematurely as well as those with chronic lung disease or congenital heart disease are at highest risk for severe disease and hospitalization due to RSV. In addition, some 25-40% of infants in the first year of life infected with RSV develop lower respiratory tract infections (such as bronchiolitis or pneumonia) which can additionally compromise the hearts and lungs of these high-risk infants (1). The virus may also cause severe illness in populations such as the elderly, those with underlying respiratory or cardiac disease, and those with compromised immune systems (e.g., bone marrow transplant patients).
About MedImmune
MedImmune strives to provide better medicines to patients, new medical options for physicians and rewarding careers to employees. Dedicated to advancing science and medicine to help people live better lives, the company is focused on cardiovascular/gastrointestinal disease, neuroscience, oncology, infection, respiratory disease and inflammation. With approximately 3,000 employees worldwide and headquarters in Maryland, MedImmune is wholly owned by AstraZeneca plc (LSE: AZN.L, NYSE: AZN). For more information, visit MedImmune's website at http://www.medimmune.com.
(1) http://www.cdc.gov/ncidod/dvrd/revb/respiratory/rsvfeat.htm. Viewed February 15, 2008.
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http://www.medimmune.com
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