Impacto do uso de CPAP em sala de parto sobre a incidência de displasia broncopulmonar e óbito em prematuros de muito baixo peso.
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2020-07-31
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Universidade Estadual Paulista (Unesp)
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INTRODUÇÃO: Recém-nascidos prematuros (RN PT) de muito baixo peso (MBP) frequentemente necessitam de assistência respiratória ao nascer. Um suporte ventilatório bem- sucedido nesta fase pode ter impacto positivo no prognóstico e sobrevida desses pacientes. OBJETIVOS: Comparar PT-MBP com ou sem uso de CPAP em sala de parto (SP), em relação ao tipo de assistência ventilatória necessária durante a internação e aos desfechos DBP e/ou óbito. MATERIAL E MÉTODO: Estudo observacional de uma coorte retrospectiva, cujos dados foram coletados de forma prospectiva, realizado no Hospital das Clínicas da Faculdade de Medicina de Botucatu-UNESP (janeiro/2011-dezembro/2019). Incluídos PT menores que 34 semanas de idade gestacional (IG), com peso de nascimento até 1500g, nascidos no serviço. Não foram incluídos os óbitos das primeiras 24 horas de vida e excluídos os RNs com malformações maiores e infecções congênitas. Os PT foram divididos em três grupos de acordo com o suporte ventilatório em SP, sendo: G1:CPAP sim, G2:CPAP não, G3:intubação (IOT); e subdivido em três faixas de IG: < 29; entre 29-32 e ≥ 32 semanas. Avaliadas variáveis maternas, gestacionais e as relacionadas à assistência ventilatória e às morbidades neonatais. Os principais desfechos foram óbito durante a internação, DBP ou a combinação de ambos. Realizada análise descritiva com testes paramétricos e não paramétricos e modelo de regressão logística para análise das variáveis de associação (α=0,05). RESULTADOS: Analisados 362 PT (G1), 83 (G2) e 187 (G3). Os PT intubados em SP foram os de menor peso e IG. Em comparação aos grupos com e sem CPAP em SP (G1 e G2), o grupo intubado (G3) foi o que mais frequentemente utilizou ventilação mecânica (VM) (G1:48%; G2:62%; 98%; p<0,05), mais tempo permaneceu em VM (p<0,05), além de maior tempo sob oxigenoterapia (p<0,05). O grupo intubado apresentou maiores taxas de óbito e de DBP, sem diferença nos desfechos entre G1 e G2. Nos PT < 29 semanas a mortalidade e o desfecho combinado morte ou DBP foram maiores no G3; nos PT entre 29 e 32 sem todos os desfechos foram maiores no G3 e nos PT ≥ 32 semanas todos os grupos foram semelhantes quanto aos desfechos. Na análise multivariada, a intubação em SP aumentou a chance de morte e de DBP de forma independente. O tempo de ventilação mecânica associou-se com maior chance para o óbito e o tempo de oxigênio com maior chance para DBP. A não utilização de ventilação mecânica invasiva foi fator protetor para DBP. CONCLUSÃO: Não houve diferença entre os grupos com e sem CPAP em relação aos desfechos estudados, porém, o grupo intubado em SP, comparado aos demais, apresentou maior mortalidade e maior incidência de DBP e DBP/óbito.
INTRODUCTION: Very low birth weight (VLBW) premature newborns (PN) often require respiratory assistance at birth. Successful ventilatory support at this stage can have a positive impact on the prognosis and survival of these patients. OBJECTIVES: To compare PN-VLBW with or without the use of CPAP in the delivery room (SP), in relation to the type of ventilatory assistance required during hospitalization and the BPD and / or death outcomes. SUBJECTS AND METHODS: Observational study of a retrospective cohort, which data were collected prospectively, carried out at the “Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP” (January/2011 - December/2019). Including PNs less than 34 weeks of gestational age (GA), with birth weight up to 1500g, born in the service. Deaths in the first 24 hours of life were not included and newborns with major malformations and congenital infections were excluded. PNs were divided into three groups according to the ventilatory support in the DR, being: G1: CPAP yes, G2: CPAP no, G3: TI (Tracheal Intubation); and subdivided into three GI ranges: < 29; between 29-32 and ≥ 32 weeks. Maternal, gestational variables and those related to ventilatory care and neonatal morbidities were evaluated. The main outcomes were death during hospitalization, BPD or a combination of both. Descriptive analysis was performed with parametric and nonparametric tests and a logistic regression model to analyze the association variables (α = 0.05). RESULTS: 362 PNs (G1), 83 (G2) and 187 (G3) were analyzed. PNs intubated in the DR were the ones with the lowest weight and GI. Compared to groups with and without CPAP in the DR (G1 and G2), the intubated group (G3) was the one that most frequently used mechanical ventilation (MV) (G1: 48%; G2: 62%; 98%; p<0,05), longer remained on MV (p < 0.05) and longer remained on oxygen therapy (p < 0.05). The intubated group had higher rates of death and BPD, with no difference in outcomes between G1 and G2. With PNs < 29 weeks, mortality and the combined outcome of death or BPD were higher in G3; in PN between 29 and 32 without all outcomes, they were higher in G3 and in PNs ≥ 32 weeks all groups were similar in terms of outcomes. In the multivariate analysis, intubation in DR increased the chance of death and BPD independently. The time of mechanical ventilation was associated with a greater chance of death and the time of oxygen for BPD. Failure to use invasive mechanical ventilation was a protective factor for BPD. CONCLUSION: There was no difference between the groups with and without CPAP in relation to the studied outcomes, however, the group intubated in DR, compared to the others, had higher mortality and a higher incidence of BPD and BPD/death.
INTRODUCTION: Very low birth weight (VLBW) premature newborns (PN) often require respiratory assistance at birth. Successful ventilatory support at this stage can have a positive impact on the prognosis and survival of these patients. OBJECTIVES: To compare PN-VLBW with or without the use of CPAP in the delivery room (SP), in relation to the type of ventilatory assistance required during hospitalization and the BPD and / or death outcomes. SUBJECTS AND METHODS: Observational study of a retrospective cohort, which data were collected prospectively, carried out at the “Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP” (January/2011 - December/2019). Including PNs less than 34 weeks of gestational age (GA), with birth weight up to 1500g, born in the service. Deaths in the first 24 hours of life were not included and newborns with major malformations and congenital infections were excluded. PNs were divided into three groups according to the ventilatory support in the DR, being: G1: CPAP yes, G2: CPAP no, G3: TI (Tracheal Intubation); and subdivided into three GI ranges: < 29; between 29-32 and ≥ 32 weeks. Maternal, gestational variables and those related to ventilatory care and neonatal morbidities were evaluated. The main outcomes were death during hospitalization, BPD or a combination of both. Descriptive analysis was performed with parametric and nonparametric tests and a logistic regression model to analyze the association variables (α = 0.05). RESULTS: 362 PNs (G1), 83 (G2) and 187 (G3) were analyzed. PNs intubated in the DR were the ones with the lowest weight and GI. Compared to groups with and without CPAP in the DR (G1 and G2), the intubated group (G3) was the one that most frequently used mechanical ventilation (MV) (G1: 48%; G2: 62%; 98%; p<0,05), longer remained on MV (p < 0.05) and longer remained on oxygen therapy (p < 0.05). The intubated group had higher rates of death and BPD, with no difference in outcomes between G1 and G2. With PNs < 29 weeks, mortality and the combined outcome of death or BPD were higher in G3; in PN between 29 and 32 without all outcomes, they were higher in G3 and in PNs ≥ 32 weeks all groups were similar in terms of outcomes. In the multivariate analysis, intubation in DR increased the chance of death and BPD independently. The time of mechanical ventilation was associated with a greater chance of death and the time of oxygen for BPD. Failure to use invasive mechanical ventilation was a protective factor for BPD. CONCLUSION: There was no difference between the groups with and without CPAP in relation to the studied outcomes, however, the group intubated in DR, compared to the others, had higher mortality and a higher incidence of BPD and BPD/death.
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Recém-nascido prematuro, Asfixia ao nascer, CPAP, Óbito neonatal, Displasia Broncopulmonar