Proactive management of extreme prematurity: Disagreement between obstetricians and neonatologists
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Data
2012-12-01
Autores
Guinsburg, R.
Branco de Almeida, M. F.
Dos Santos Rodrigues Sadeck, L.
Marba, S. T M
Rugolo, Ligia Maria Suppo de Souza [UNESP]
Luz, J. H.
De Andrade Lopes, J. M.
Martinez, F. E.
Procianoy, R. S.
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Resumo
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
Como citar
Journal of Perinatology, v. 32, n. 12, p. 913-919, 2012.