Document Detail


Approaching NIH guideline recommended care for maternal-infant health: clinical failures to use recommended antenatal corticosteroids.
MedLine Citation:
PMID:  19495946     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
To assess the use of antenatal corticosteroids in clinical circumstances for which both the NIH Guideline and local experts recommend their use and to describe characteristics associated with failure to use recommended antenatal steroids. We convened local experts to adapt the NIH statement by identifying clinical circumstances for which they agree antenatal steroids should always be used. We conducted a retrospective chart review on a cohort study of mothers who delivered premature (24-34 weeks) infants between 2000 and 2002 at three New York City hospitals and investigated the association of failure to treat with antenatal steroids with characteristics of the mother, pregnancy, delivery, and hospital. Twenty percent (101/515) of eligible mothers failed to receive indicated antenatal corticosteroid therapy. Of these, 43% delivered more than 2 h after admission, and 33% delivered more than 4 h after admission, indicating sufficient time to have treated them. Lack of prenatal care, longer gestation, advanced cervical exam, and intact membranes at admission were associated with failure to receive the recommended therapy. Antenatal steroids were under-utilized in our sample. If our results our generalizable, opportunities for quality improvement in the antenatal management of mothers in preterm labor exist.
Authors:
Elizabeth A Howell; Joanne Stone; Lawrence C Kleinman; Sarla Inamdar; Stephen Matseoane; Mark R Chassin
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2009-06-04
Journal Detail:
Title:  Maternal and child health journal     Volume:  14     ISSN:  1573-6628     ISO Abbreviation:  Matern Child Health J     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-03     Completed Date:  2010-07-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9715672     Medline TA:  Matern Child Health J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  430-6     Citation Subset:  IM    
Affiliation:
Department of Health Policy, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York City, Box 1077, NY, USA. elizabeth.howell@msnyuhealth.org
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MeSH Terms
Descriptor/Qualifier:
Adrenal Cortex Hormones / therapeutic use*
Adult
Chi-Square Distribution
Consensus Development Conferences, NIH as Topic
Female
Guideline Adherence / organization & administration*
Health Planning Guidelines
Humans
Logistic Models
Medical Audit
Multivariate Analysis
National Institutes of Health (U.S.)
New York City / epidemiology
Obstetric Labor, Premature / drug therapy*,  epidemiology
Patient Selection
Physician's Practice Patterns / organization & administration*
Practice Guidelines as Topic*
Pregnancy
Prenatal Care / organization & administration*
Retrospective Studies
United States
Grant Support
ID/Acronym/Agency:
P01 HS10859/HS/AHRQ HHS; P60 MD00270/MD/NCMHD NIH HHS
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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