Risk Perception and Decision Making about Early-Onset Sepsis among Neonatologists: A National Survey.

OBJECTIVE: Many newborns are investigated and empirically treated for suspected early-onset sepsis (EOS). This study aimed to describe neonatologists' self-identified risk thresholds for investigating and treating EOS and assess the consistency of these thresholds with clinical decisions. STUDY DESIGN: Voluntary online survey, available in two randomized versions, sent to neonatologists from 20 centers of the Brazilian Network on Neonatal Research. The surveys included questions about thresholds for investigating and treating EOS and presented four clinical scenarios with varying calculated risks. In survey version A, only the scenarios were presented, and participants were asked if they would order a blood test or start antibiotics. Survey version B presented the same scenarios and the risk of sepsis. Clinical decisions were compared between survey versions using chi-square tests and agreement between thresholds and clinical decisions were investigated using Kappa coefficients. RESULTS: In total, 293 surveys were completed (145 survey version A and 148 survey version B). The median risk thresholds for blood test and antibiotic treatment were 1:100 and 1:25, respectively. In the high-risk scenario, there was no difference in the proportion choosing antibiotic therapy between the groups. In the moderate-risk scenarios, both tests and antibiotics were chosen more frequently when the calculated risks were included (survey version B). In the low-risk scenario, there was no difference between survey versions. There was poor agreement between the self-described thresholds and clinical decisions. CONCLUSION: Neonatologists overestimate the risk of EOS and underestimate their risk thresholds. Knowledge of calculated risk may increase laboratory investigation and antibiotic use in infants at moderate risk for EOS. KEY POINTS: · Neonatologists overestimate the risk of EOS.. · There is wide variation in diagnostic/treatment thresholds for EOS.. · Clinical decision on EOS is not consistent with risk thresholds.. · Knowledge of risk may increase investigation and treatment of EOS..

[Avoidable causes of infant deaths due to interventions of the Brazilian Unified Health System: a comparison of two birth cohorts]. / Mortes infantis evitáveis por intervenções do Sistema Único de Saúde: comparação de duas coortes de nascimentos.

Avoidable infant mortality was compared in the cohorts of live births in 2000/20001 and 2007/2008 in Londrina in the state of Paraná. Data on live births and infant deaths were matched in a single database and the underlying causes of death were classified according to the Brazilian List of Avoidable Causes of Mortality of the Brazilian Unified Health System. The proportional variations of death rates were calculated and the technique of correspondence analysis was used. The proportions of avoidable deaths were 71.6% in 2000/2001 and 65.5% in 2007/2008. Avoidable mortality rate due to "care of the woman during pregnancy" was the most frequent in the two biennials with an increase of 16.7%. There was a decline in avoidable mortality rates due to other causes. In 2000/2001, correspondence analysis revealed a profile of deaths characterized mainly by causes avoidable by "care of the woman during labor" and "health promotion/care" while, in 2007/2008, by causes avoidable by "care of the woman during pregnancy," particularly among low birth weight newborns and "not clearly avoidable," among those with adequate weight. Despite a reduction in some avoidable causes of deaths, improvements in prenatal care are required.

Mortes infantis evitáveis por intervenções do Sistema Único de Saúde: comparação de duas coortes de nascimentos / Avoidable causes of infant deaths due to interventions of the Brazilian Unified Health System: a comparison of two birth cohorts

Comparou-se a mortalidade infantil evitável nas coortes de nascimentos de 2000/2001 e de 2007/2008, em Londrina-PR. Dados sobre nascidos vivos e óbitos infantis foram vinculados em base de dados única e as causas básicas de morte foram agrupadas conforme a Lista Brasileira de Causas de Mortes Evitáveis por Intervenções do Sistema Único de Saúde. Calculou-se a variação percentual das taxas de mortes entre os biênios e usou-se a técnica de análise de correspondência. As proporções de óbitos evitáveis foram de 71,6% em 2000/2001 e de 65,5% em 2007/2008. A taxa de mortalidade evitável por atenção à mulher na gestação predominou nos dois biênios, com incremento de 16,7%. Houve declínio das taxas de mortalidade evitável pelas demais causas. A análise de correspondência mostrou, em 2000/2001, um perfil de mortes representado principalmente por causas evitáveis por atenção à mulher no parto e por adequada promoção/atenção à saúde, enquanto que, em 2007/2008, por causas evitáveis por adequada atenção à mulher na gestação, especialmente entre os nascidos com baixo peso, e não claramente evitáveis entre os com peso adequado. Apesar da diminuição da mortalidade por algumas causas evitáveis, são necessárias medidas para aumentar a qualificação da atenção durante a gestação.

Avoidable infant mortality was compared in the cohorts of live births in 2000/20001 and 2007/2008 in Londrina in the state of Paraná. Data on live births and infant deaths were matched in a single database and the underlying causes of death were classified according to the Brazilian List of Avoidable Causes of Mortality of the Brazilian Unified Health System. The proportional variations of death rates were calculated and the technique of correspondence analysis was used. The proportions of avoidable deaths were 71.6% in 2000/2001 and 65.5% in 2007/2008. Avoidable mortality rate due to "care of the woman during pregnancy" was the most frequent in the two biennials with an increase of 16.7%. There was a decline in avoidable mortality rates due to other causes. In 2000/2001, correspondence analysis revealed a profile of deaths characterized mainly by causes avoidable by "care of the woman during labor" and "health promotion/care" while, in 2007/2008, by causes avoidable by "care of the woman during pregnancy," particularly among low birth weight newborns and "not clearly avoidable," among those with adequate weight. Despite a reduction in some avoidable causes of deaths, improvements in prenatal care are required.