Proactive management of extreme prematurity: disagreement between obstetricians and neonatologists

J Perinatol. 2012 Dec;32(12):913-9. doi: 10.1038/jp.2012.28. Epub 2012 Mar 29.

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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Analysis of Variance
  • Brazil
  • Cardiopulmonary Resuscitation / standards
  • Cardiopulmonary Resuscitation / trends
  • Cesarean Section
  • Cohort Studies
  • Confidence Intervals
  • Delivery, Obstetric / methods
  • Female
  • Fetal Viability
  • Gestational Age
  • Humans
  • Infant Mortality / trends*
  • Infant, Newborn
  • Infant, Premature*
  • Infant, Very Low Birth Weight*
  • Intensive Care Units, Neonatal
  • Interprofessional Relations
  • Life Support Care / methods
  • Logistic Models
  • Male
  • Neonatology / standards*
  • Neonatology / trends
  • Obstetrics / standards*
  • Obstetrics / trends
  • Odds Ratio
  • Practice Patterns, Physicians' / standards
  • Practice Patterns, Physicians' / trends
  • Pregnancy
  • Prognosis
  • Prospective Studies
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones