Proactive management of extreme prematurity: disagreement between obstetricians and neonatologists

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 26 6/7 weeks, without malformations, born from January 2006 to De...

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Bibliographic Details
Published in:	Journal of perinatology Vol. 32; no. 12; pp. 913 - 919
Main Authors:	Guinsburg, R, Branco de Almeida, M F, dos Santos Rodrigues Sadeck, L, Marba, S T M, Suppo de Souza Rugolo, L M, Luz, J H, de Andrade Lopes, J M, Martinez, F E, Procianoy, R S
Format:	Journal Article
Language:	English
Published:	New York Nature Publishing Group US 01-12-2012 Nature Publishing Group
Subjects:	692/700/1750/1747 Adrenal Cortex Hormones - therapeutic use Analysis of Variance Beliefs, opinions and attitudes Births Brazil Cardiopulmonary resuscitation Cardiopulmonary Resuscitation - standards Cardiopulmonary Resuscitation - trends Care and treatment Cesarean Section Cohort Studies Confidence Intervals CPR Death Delivery, Obstetric - methods Drug dosages Female Fetal Viability Fetuses Gestational Age Health aspects Humans Infant Mortality - trends Infant, Newborn Infant, Premature Infant, Very Low Birth Weight Infants Infants (Premature) Intensive Care Units, Neonatal Interprofessional Relations Life Support Care - methods Logistic Models Male Medicine Medicine & Public Health Mortality Neonates Neonatologists Neonatology - standards Neonatology - trends Newborn babies Obstetricians Obstetrics - standards Obstetrics - trends Odds Ratio original-article Pediatric Surgery Pediatrics Practice Patterns, Physicians' - standards Practice Patterns, Physicians' - trends Pregnancy Premature babies Professionals Prognosis Prospective Studies Resuscitation Steroid hormones Steroids Steroids (Drugs) Treatment Outcome Vagina Ventilators Brazil Rio Grande do Sul Brazil cesarean section cardiopulmonary resuscitation fetal viability steroids infant newborn neonatal mortality
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Summary:	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 26 6/7 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0743-8346 1476-5543
DOI:	10.1038/jp.2012.28