Proactive management of extreme prematurity: disagreement between obstetricians and neonatologists

Proactive management of extreme prematurity: disagreement between obstetricians and neonatologists

Author Guinsburg, Ruth Autor UNIFESP Google Scholar
Branco de Almeida, M. F. Autor UNIFESP Google Scholar
Santos Rodrigues Sadeck, L. dos Google Scholar
Marba, S. T. M. Google Scholar
Suppo de Souza Rugolo, L. M. Google Scholar
Luz, J. H. Google Scholar
Andrade Lopes, J. M. de Google Scholar
Martinez, F. E. Google Scholar
Procianoy, R. S. Google Scholar
Brazilian Network Neonatal Res Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Universidade de São Paulo (USP)
Universidade Estadual de Campinas (UNICAMP)
Pontificia Univ Catolica Rio Grande do Sul
Fundaco Oswaldo Cruz
Univ Fed Rio Grande do Sul
Abstract 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. Journal of Perinatology (2012) 32, 913-919; doi:10.1038/jp.2012.28; published online 29 March 2012
Keywords fetal viability
steroids
cesarean section
cardiopulmonary resuscitation
infant newborn
neonatal mortality
Language English
Sponsor Ministry of Health of Brazil
Grant number Ministry of Health of Brazil: MS/VIGISUS 1755/2000
Ministry of Health of Brazil: MS/FNS 274
Ministry of Health of Brazil: FIOCRUZ/PDTSP
Date 2012-12-01
Published in Journal of Perinatology. New York: Nature Publishing Group, v. 32, n. 12, p. 913-919, 2012.
ISSN 0743-8346 (Sherpa/Romeo, impact factor)
Publisher Nature Publishing Group
Extent 913-919
Origin http://dx.doi.org/10.1038/jp.2012.28
Access rights Closed access
Type Article
Web of Science ID WOS:000311831700003
URI http://repositorio.unifesp.br/handle/11600/35579

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