Proactive management of extreme prematurity: disagreement between obstetricians and neonatologists

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Guinsburg, Ruth [UNIFESP]
Branco de Almeida, M. F. [UNIFESP]
Santos Rodrigues Sadeck, L. dos
Marba, S. T. M.
Suppo de Souza Rugolo, L. M.
Luz, J. H.
Andrade Lopes, J. M. de
Martinez, F. E.
Procianoy, R. S.
Brazilian Network Neonatal Res
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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 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
Journal of Perinatology. New York: Nature Publishing Group, v. 32, n. 12, p. 913-919, 2012.