Journal of perinatology : official journal of the California Perinatal Association · 2012
Proactive management of extreme prematurity: disagreement between obstetricians and neonatologists.
СтатьяМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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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, Brazilian Network on Neonatal Research
Аннотация
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.
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.
Предметные рубрики MeSH
Adrenal Cortex HormonesAnalysis of VarianceBrazilCardiopulmonary ResuscitationCesarean SectionCohort StudiesConfidence IntervalsDelivery, ObstetricFemaleFetal ViabilityGestational AgeHumansInfant MortalityInfant, NewbornInfant, PrematureInfant, Very Low Birth WeightIntensive Care Units, NeonatalInterprofessional RelationsLife Support CareLogistic ModelsMaleNeonatologyObstetricsOdds RatioPractice Patterns, Physicians'PregnancyPrognosisProspective StudiesTreatment Outcome