title: Proactive management of extreme prematurity: disagreement between obstetricians and neonatologists.
abstract: OBJECTIVE
  To verify, in extremely preterm infants, if disagreement between obstetricians and neonatologists regarding proactive management is associated with early death.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil. ruthgbr@netpoint.com.br
authors.forename: R
authors.initials: R
authors.lastname: Guinsburg
authors.forename: M F
authors.initials: MF
authors.lastname: Branco de Almeida
authors.forename: L
authors.initials: L
authors.lastname: Dos Santos Rodrigues Sadeck
authors.forename: S T M
authors.initials: ST
authors.lastname: Marba
authors.forename: L M
authors.initials: LM
authors.lastname: Suppo de Souza Rugolo
authors.forename: J H
authors.initials: JH
authors.lastname: Luz
authors.forename: J M
authors.initials: JM
authors.lastname: de Andrade Lopes
authors.forename: F E
authors.initials: FE
authors.lastname: Martinez
authors.forename: R S
authors.initials: RS
authors.lastname: Procianoy
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000704:Analysis of Variance; D001938:Brazil; D016887:Cardiopulmonary Resuscitation / Q000592:standards / Q000639:trends; D002585:Cesarean Section; D015331:Cohort Studies; D016001:Confidence Intervals; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D005328:Fetal Viability; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D007400:Interprofessional Relations; D008020:Life Support Care / Q000379:methods; D016015:Logistic Models; D008297:Male; D009359:Neonatology / Q000592:standards* / Q000639:trends; D009774:Obstetrics / Q000592:standards* / Q000639:trends; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends; D011247:Pregnancy; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones