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Neonatologists’ perceptions of uncertainty: a national survey

Journal of Perinatology (2025)Cite this article

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Clinicians working in the neonatal intensive care unit (NICU) face pervasive uncertainty in practice, however, limited studies have explored neonatologists’ experiences with uncertainty outside of the relationship it has with parent communication [1]. Studies of clinicians in other specialties have correlated more intolerance of uncertainty with burnout [2]. Our goal was to describe neontologists’ reactions to uncertainty in patient care.

We created a survey utilizing the validated revised Physicians’ Reactions to Uncertainty (PRU) scale [3]. The PRU has 4 components: anxiety, concern about bad outcomes, reluctance to disclose to patients and to physicians. Lower scores reflect more tolerance of uncertainty. We added questions to better reflect situations of uncertainty specific to neonatal care. Added survey questions were evaluated through cognitive interviewing which allowed the study team to examine interpretation of questions to refine the final survey before implementation. (Survey tool in Supplemental Materials Figure 1) [4]. We distributed the electronic survey between March and April 2023 via the American Academy of Pediatrics (AAP) Section on Neonatal Perinatal Medicine (SONPM) listserv. This study was approved by the Medical College of Wisconsin IRB. Data were presented as n (%) or median and interquartile range (IQR). Kruskal-Wallis Test was performed to compare the difference in total score and each subscale among Years in Practice. Additionally, linear-by-linear association test was used to examine the association between the scales and Years in Practice while accounting for the natural ordering. P < 0.05 was considered statistically significant. SAS V9.4 (SAS Institute Inc., Cary, NC) and SPSS V29.0 (IBM Corp., Armonk, NY) were used for analysis.

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Fig. 1: Neonatologist discomfort with various types of uncertainty versus years in practice.

References

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Authors and Affiliations

  1. Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA

    Erin Rholl & Steven R. Leuthner

  2. Department of Pediatrics, Brooke Army Medical Center, San Antonio, TX, USA

    Jeanne A. Krick

  3. Department of Pediatrics, Bioinformatics and Quantitative Child Health, Medical College of Wisconsin, Milwaukee, WI, USA

    Amy Y. Pan & Sai Alekha Challa

  4. Bioethics Center and Division of Neonatology, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO, USA

    Stephanie Kukora

  5. University of Missouri Kansas City School of Medicine, Kansas City, MO, USA

    Stephanie Kukora

Authors
  1. Erin Rholl
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  2. Jeanne A. Krick
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  3. Steven R. Leuthner
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  4. Amy Y. Pan
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  5. Sai Alekha Challa
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  6. Stephanie Kukora
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Contributions

ER conceptualized the study, collected and interpreted the data and drafted the initial manuscript. AP and AS performed statistical analysis. JK, SK, and SL assisted in conceptualization of the study, data interpretation and critically reviewed and revised the manuscript. All authors approve the final manuscript as submitted.

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Correspondence to Erin Rholl.

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The authors declare no competing interests.

Ethics approval and consent to participate

This study was approved by the Medical College of Wisconsin Institutional Review Board # PRO00046122. All methods were performed in accordance with relevant guidelines and regulations. Informed consent was obtained from all participants through an informational letter prior to participation.

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Rholl, E., Krick, J.A., Leuthner, S.R. et al. Neonatologists’ perceptions of uncertainty: a national survey. J Perinatol (2025). https://doi.org/10.1038/s41372-025-02292-3

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  • DOI: https://doi.org/10.1038/s41372-025-02292-3

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