Proactive management of extreme prematurity: disagreement between obstetricians and neonatologists

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 230/7 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.