Ambrósio Cristiane Ribeiro, Sanudo Adriana, Almeida Maria Fernanda Branco de, Guinsburg Ruth
Departamento de Pediatria, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil.
Bioestatística, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Clinics (Sao Paulo). 2016 Apr;71(4):210-5. doi: 10.6061/clinics/2016(04)06.
The goal of the present study was to examine the decisions of pediatricians who teach neonatal resuscitation in Brazil, particularly those who start resuscitation in the delivery room for newborns born at 23-26 gestational weeks.
The present study was a cross-sectional study that used electronic questionnaires (Dec/11-Sep/13) sent to instructors of the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics. The primary outcome was the gestational age at which the respondent said that he/she would initiate positive pressure ventilation in the delivery room. Latent class analysis was used to identify the major profiles of these instructors, and logistic regression was used to identify variables associated with belonging to one of the derived classes.
Of 685 instructors, 82% agreed to participate. Two latent classes were identified: 'pro-resuscitation' (instructors with a high probability of performing ventilation on infants born at 23-26 weeks) and 'pro-limitation' (instructors with a high probability of starting ventilation only for infants born at 25-26 weeks). In the multivariate model, compared with the 'pro-limitation' class, 'pro-resuscitation' pediatricians were more likely to be board-certified neonatologists and less likely to base their decision on the probability of the infant's death or on moral/religious considerations.
The pediatricians in the most aggressive group were more likely to be specialists in neonatology and to use less subjective criteria to make delivery room decisions.
本研究的目的是调查在巴西教授新生儿复苏的儿科医生的决策，特别是那些对妊娠23 - 26周出生的新生儿在产房开始进行复苏的医生的决策。
本研究为横断面研究，通过电子问卷（2011年12月 - 2013年9月）向巴西儿科学会新生儿复苏项目的教员发送。主要结果是受访者表示会在产房开始进行正压通气的胎龄。采用潜在类别分析来确定这些教员的主要特征，并使用逻辑回归来确定与属于其中一个派生类相关的变量。
在685名教员中，82%同意参与。确定了两个潜在类别：“支持复苏”（对23 - 26周出生的婴儿进行通气可能性高的教员）和“支持限制”（仅对25 - 26周出生的婴儿开始通气可能性高的教员）。在多变量模型中，与“支持限制”类别相比，“支持复苏”的儿科医生更有可能是获得委员会认证的新生儿科医生，并且基于婴儿死亡概率或道德/宗教考虑做出决策的可能性更小。
最积极的一组儿科医生更有可能是新生儿学专家，并且在产房决策时使用的主观标准更少。
