Otro
Proactive management of extreme prematurity: Disagreement between obstetricians and neonatologists
Registro en:
Journal of Perinatology, v. 32, n. 12, p. 913-919, 2012.
0743-8346
1476-5543
10.1038/jp.2012.28
2-s2.0-84870567842
Autor
Guinsburg, R.
Branco de Almeida, M. F.
Dos Santos Rodrigues Sadeck, L.
Marba, S. T M
Rugolo, Ligia Maria Suppo de Souza
Luz, J. H.
De Andrade Lopes, J. M.
Martinez, F. E.
Procianoy, R. S.
Resumen
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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