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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Journal of Perinatology, v. 32, n. 12, p. 913-919, 2012.
