Proactive management of extreme prematurity: Disagreement between obstetricians and neonatologists
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Springer Nature
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Objective: To verify, in extremely preterm infants, if disagreement between obstetricians and neonatologists regarding proactive management is associated with early death.Study Design: Prospective cohort of 484 infants with 23 0/7 to 266/7 weeks, without malformations, born from January 2006 to December 2009 in eight Brazilian hospitals. Pro-active management was defined as indication of ≥1 dose of antenatal steroid or cesarean section (obstetrician) and resuscitation at birth according to the international guidelines (neonatologist). Main outcome was neonatal death in the first 24 h of life.Result: Obstetricians and neonatologists disagreed in 115 (24%) patients: only neonatologists were proactive in 107 of them. Disagreement between professionals increased 2.39 times the chance of death in the first day (95% confidence interval 1.40 to 4.09), adjusted for center and maternal/neonatal clinical conditions.Conclusion: In infants with 23 to 26 weeks of gestation, disagreement between obstetricians and neonatologists, translated as lack of antenatal steroids and/or vaginal delivery, despite resuscitation procedures, increases the odds of death in the first day. © 2012 Nature America, Inc.
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Cardiopulmonary resuscitation , Cesarean section , Fetal viability , Infant newborn , Neonatal mortality , Steroids , steroid , cesarean section , cohort analysis , controlled study , female , gestational age , human , major clinical study , male , neonatology , newborn , newborn care , newborn mortality , obstetrics , outcome assessment , perinatal period , physician attitude , practice guideline , prematurity , prospective study , resuscitation , risk assessment , vaginal delivery , Adrenal Cortex Hormones , Analysis of Variance , Brazil , Cardiopulmonary Resuscitation , Cesarean Section , Cohort Studies , Confidence Intervals , Delivery, Obstetric , Female , Fetal Viability , Gestational Age , Humans , Infant Mortality , Infant, Newborn , Infant, Premature , Infant, Very Low Birth Weight , Intensive Care Units, Neonatal , Interprofessional Relations , Life Support Care , Logistic Models , Male , Neonatology , Obstetrics , Odds Ratio , Physician's Practice Patterns , Pregnancy , Prognosis , Prospective Studies , Treatment Outcome
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Inglês
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Journal of Perinatology, v. 32, n. 12, p. 913-919, 2012.
