“Waste not, want not”, or the cost of doing the wrong thing
Journal Title: Jornal de Pediatria - Year 2016, Vol 92, Issue 1
Abstract
In 1995, Sinclair pointed out that it had taken an inordinately long time to understand that we had synthesized adequate evidence on antenatal corticosteroids (ANCS) to prevent respiratory distress syndrome (RDS) and its complications in preterms.1 Secondly, it then took even longer for the knowledge to be disseminated into practice. The dissemination problem was addressed by the NIH in a specific trial to enhance uptake of knowledge on ANCS by the obstetric community over ‘standard’ methods of teaching.2 In that cluster randomized trial, a package of teaching interventions aimed at the high-risk perinatal caregivers improved the uptake of ANCS in target populations of mothers at risk of preterm delivery by 108%. Yet it appears that despite these two seminal ‘wake-up calls’ to the community – and despite the recommendations of key bodies such as ACOG3,4 – the omission of ANCS continues to plague perinatal–neonatal medicine. For example, between 2005 and 2007 in California, Lee found that “of 15,343 eligible neonates, 23.1% did not receive antenatal steroids in 2005–2007.”5 Of these, a higher proportion of Hispanic mothers did not receive ANCS – 25.6%.5 Disseminating this knowledge-based practice into poorly resourced or lower income countries has been even more challenging.6,7
Authors and Affiliations
Haresh Kirpalani
Keywords
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- DOI 10.1016/j.jped.2015.11.001
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