Artigo Original/Original Article
Displasia broncopulmonar: Práticas clínicas em cinco unidades de cuidados intensivos neonatais
Bronchopulmonary dysplasia: Clinical practices in five Portuguese neonatal intensive care units
H. Guimarães1,
, G. Rocha1, G. Vasconcellos1, E. Proença2, M.L. Carreira3, M.R. Sossai4, B. Morais4, I. Martins5, T. Rodrigues6, M. Severo6
Corresponding author
herciliaguimaraes@gmail.com
Correspondência/Correspondence to: Hercilia Guimarães, Serviço de Neonatologia/Departamento de Pediatria – Hospital de São João, Alameda Professor Hernâni Monteiro, 4202-451 Porto, Telephone: 00351 225095816, Fax: 225505919,
Correspondência/Correspondence to: Hercilia Guimarães, Serviço de Neonatologia/Departamento de Pediatria – Hospital de São João, Alameda Professor Hernâni Monteiro, 4202-451 Porto, Telephone: 00351 225095816, Fax: 225505919,
1 NICU, Hospital de S. João, Porto
2 Maternidade Júlio Dinis, Porto
3 Hospital de Santo António, Porto
4 Hospital Fernando da Fonseca, Amadora/Sintra
5 Hospital Pedro Hispano, Matosinhos
6 Departamento de Epidemiologia, Faculdade de Medicina da Universidade do Porto, Portugal/Department of Epidemiology, Faculty of Medicine of Porto University, Portugal
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João, Porto" "etiqueta" => "1" "identificador" => "af0005" ] 1 => array:3 [ "entidad" => "Maternidade Júlio Dinis, Porto" "etiqueta" => "2" "identificador" => "af0010" ] 2 => array:3 [ "entidad" => "Hospital de Santo António, Porto" "etiqueta" => "3" "identificador" => "af0015" ] 3 => array:3 [ "entidad" => "Hospital Fernando da Fonseca, Amadora/Sintra" "etiqueta" => "4" "identificador" => "af0020" ] 4 => array:3 [ "entidad" => "Hospital Pedro Hispano, Matosinhos" "etiqueta" => "5" "identificador" => "af0025" ] 5 => array:3 [ "entidad" => "Departamento de Epidemiologia, Faculdade de Medicina da Universidade do Porto, Portugal/Department of Epidemiology, Faculty of Medicine of Porto University, Portugal" "etiqueta" => "6" "identificador" => "af0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cr0005" "etiqueta" => "*" "correspondencia" => "<span class="elsevierStyleBold">Correspondência</span>/<span class="elsevierStyleItalic"><span class="elsevierStyleBold">Correspondence to:</span></span> Hercilia Guimarães, Serviço de Neonatologia/Departamento de Pediatria – Hospital de São João, Alameda Professor Hernâni Monteiro, 4202-451 Porto, Telephone: 00351 225095816, Fax: 225505919," ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Bronchopulmonary dysplasia: Clinical practices in five Portuguese neonatal intensive care units" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2009-06-29" "fechaAceptado" => "2009-09-08" "PalabrasClave" => array:2 [ "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec570129" "palabras" => array:9 [ 0 => "Displasia broncopulmonar" 1 => "cuidados intensivos neonatais" 2 => "recém-nascidos de pré-termo" 3 => "boas práticas" 4 => "ventilação mecânica" 5 => "oxigénio" 6 => "corticosteróides pré-natais" 7 => "sépsis" 8 => "canal arterial patente" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec570128" "palabras" => array:9 [ 0 => "Bronchopulmonary dysplasia" 1 => "neonatal intensive care" 2 => "preterm infants" 3 => "better practices" 4 => "mechanical ventilation" 5 => "oxygen therapy" 6 => "prenatal corticosteroids" 7 => "sepsis" 8 => "patent ductus arteriosus" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Com o advento do surfactante, dos corticosteróides pré-natais e dos avanços na tecnologia, a sobrevida dos recém-nascidos de extremo baixo peso tem melhorado dramaticamente. As taxas de displasia broncopulmonar (DBP) variam amplamente entre unidades, e vários estudos, avaliando resultados de múltiplas intervenções, têm mostrado alguma melhoria na prevalência da DBP. A implementação de potenciais boas práticas na DBP tem sido adoptada por muitos serviços nas últimas décadas. <span class="elsevierStyleBold">Objectivo:</span> Comparar cinco unidades portuguesas de cuidados intensivos neonatais no que se refere as práticas clínicas no tratamento dos recém-nascidos de muito baixo peso, para desenvolver e melhorar as boas práticas na prevenção da DBP. <span class="elsevierStyleBold">População e métodos:</span> Foram estudados 256 recém-nascidos com a idade gestacional inferior a 30 semanas e/ou peso ao nascer inferior a 1250<span class="elsevierStyleHsp" style=""></span>g, admitidos nas cinco unidades portuguesas (centros 1 a 5) entre 1 de Janeiro de 2004 e 31 de Dezembro de 2006. Foram excluídos os recém-nascidos com malformações <span class="elsevierStyleItalic">major</span>, hemorragia intraventricular grau IV na primeira semana de vida e com doença metabólica ou neuromuscular. Definimos DBP como a dependência do oxigénio às 36 semanas de idade pósconcepcional. A necessidade de melhorar determinada prática foi considerada significativa sempre que se verificava uma melhoria superior a 10% na prevalência da DBP ajustada para a prática, idade gestacional e peso ao nascer, comparada com a prevalência ajustada só para a idade gestacional e peso ao nascer. <span class="elsevierStyleBold">Resultados:</span> A prevalência global da DBP foi de 12,9%. Os resultados mostram que o uso de corticosteróides pré-natais deve ser melhorado nos centros 4 e 5; a política de fluidos deve ser melhorada no centro 4; o uso de oxigénio e a prevenção da sépsis deve ser melhorada nos centros 1 e 2. O tratamento do canal arterial patente deve ser melhorado no centro 2. <span class="elsevierStyleBold">Conclusão:</span> Neste estudo, a implementação de boas práticas para reduzir a lesão pulmonar nos recém-nascidos, de acordo com cada unidade, deve ser dirigida ao aumento da prescrição de corticosteróides pré-natais, ao uso de menor FiO<span class="elsevierStyleInf">2</span>, ao uso criterioso de líquidos na primeiras semanas de vida, à prevenção do canal arterial patente e da sépsis. <span class="elsevierStyleItalic">Guidelines</span>, recomendações ou protocolos são necessários na melhoria da qualidade na prevenção da DBP.</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2010; XVI (2): 273-286</span></p></span>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">With the advent of surfactant, prenatal corticosteroids (PNC) and advances in technology, the survival rate of extremely low birth weight (ELBW) infants has improved dramatically. Rates of bronchopulmonary dysplasia (BPD) vary widely among neonatal intensive care units (NICUs) and many studies using multiple interventions have shown some improvement in BPD rates. Implementing potentially better practices to reduce BPD has been an effort made over the last few decades. <span class="elsevierStyleBold">Aim</span>: To compare five Portuguese NICUs in terms of clinical practices in very low birth weight (VLBW) infants, in order to develop better practices to prevent BPD. <span class="elsevierStyleBold">Patients and methods</span>: 256 preterm neonates, gestational age (GA) <<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>weeks and/or birthweight (BW) <<span class="elsevierStyleHsp" style=""></span>1250<span class="elsevierStyleHsp" style=""></span>g admitted to five Portuguese NICUs (centers 1 to 5) between 1<span class="elsevierStyleSup">st</span> January 2004 and 31<span class="elsevierStyleSup">st</span> December 2006, were studied. VLBW infants with major malformations, grade IV intraventricular haemorrhage in the first week of life and metabolic or neuromuscular disease were excluded. BPD was defined as oxygen dependency at 36 weeks of postconceptional age. We considered a practice to be improved as clinically significant whenever a decrease greater than 10% in the prevalence of BPD adjusted for the practice, GA and BW was achieved compared to BPD prevalence adjusted only for GA and BW. <span class="elsevierStyleBold">Results:</span> The overall prevalence of BPD was 12.9%. Our results revealed that PNC use should be improved in centers 4 and 5; fluid policy in center 4; oxygen therapy and sepsis prevention in centers 1 and 2. Patent ductus arteriosus (PDA) treatment should be improved in center 2. <span class="elsevierStyleBold">Conclusion:</span> The implementation of potentially better practices to reduce lung injury in neonates in Portuguese NICUs, according to each NICU, must be addressed to increase the prescription of PNC, to use a lower FiO<span class="elsevierStyleInf">2</span>, to be careful with fluid administration in the first weeks of life and to prevent PDA and sepsis. It is necessary to follow guidelines, recommendations or protocols to improve quality in the prevention of BPD.</p><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2010; XVI (2): 273-286</span></p></span>" ] ] "lecturaRecomendada" => array:1 [ 0 => array:3 [ "vista" => "all" "titulo" => "<span class="elsevierStyleSectionTitle" id="st0025">Bibliography</span>" "seccion" => array:1 [ 0 => array:2 [ "vista" => "all" "bibliografiaReferencia" => array:59 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary disease following respirator therapy of hyaline-membrane disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "W.H. Northway Jr." 1 => "R.C. Rosan" 2 => "D.Y. 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Article information
ISSN: 08732159Original language: Portuguese
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| 2023 July | 44 | 31 | 75 |
| 2023 June | 22 | 20 | 42 |
| 2023 May | 27 | 23 | 50 |
| 2023 April | 17 | 16 | 33 |
| 2023 March | 21 | 26 | 47 |
| 2023 February | 21 | 29 | 50 |
| 2023 January | 25 | 17 | 42 |
| 2022 December | 16 | 26 | 42 |
| 2022 November | 32 | 43 | 75 |
| 2022 October | 36 | 27 | 63 |
| 2022 September | 29 | 34 | 63 |
| 2022 August | 39 | 51 | 90 |
| 2022 July | 26 | 28 | 54 |
| 2022 June | 17 | 26 | 43 |
| 2022 May | 40 | 37 | 77 |
| 2022 April | 22 | 38 | 60 |
| 2022 March | 22 | 33 | 55 |
| 2022 February | 27 | 26 | 53 |
| 2022 January | 30 | 42 | 72 |
| 2021 December | 22 | 36 | 58 |
| 2021 November | 29 | 35 | 64 |
| 2021 October | 30 | 29 | 59 |
| 2021 September | 25 | 36 | 61 |
| 2021 August | 25 | 26 | 51 |
| 2021 July | 28 | 17 | 45 |
| 2021 June | 18 | 25 | 43 |
| 2021 May | 30 | 22 | 52 |
| 2021 April | 43 | 27 | 70 |
| 2021 March | 48 | 15 | 63 |
| 2021 February | 41 | 16 | 57 |
| 2021 January | 27 | 9 | 36 |
| 2020 December | 26 | 9 | 35 |
| 2020 November | 47 | 21 | 68 |
| 2020 October | 17 | 11 | 28 |
| 2020 September | 62 | 15 | 77 |
| 2020 August | 46 | 26 | 72 |
| 2020 July | 42 | 22 | 64 |
| 2020 June | 48 | 12 | 60 |
| 2020 May | 53 | 18 | 71 |
| 2020 April | 63 | 17 | 80 |
| 2020 March | 61 | 8 | 69 |
| 2020 February | 39 | 23 | 62 |
| 2020 January | 48 | 15 | 63 |
| 2019 December | 40 | 14 | 54 |
| 2019 November | 50 | 18 | 68 |
| 2019 October | 36 | 18 | 54 |
| 2019 September | 47 | 24 | 71 |
| 2019 August | 63 | 18 | 81 |
| 2019 July | 46 | 14 | 60 |
| 2019 June | 56 | 9 | 65 |
| 2019 May | 63 | 37 | 100 |
| 2019 April | 50 | 23 | 73 |
| 2019 March | 107 | 21 | 128 |
| 2019 February | 98 | 12 | 110 |
| 2019 January | 98 | 24 | 122 |
| 2018 December | 48 | 12 | 60 |
| 2018 November | 17 | 2 | 19 |
| 2018 October | 4 | 5 | 9 |
| 2018 September | 20 | 5 | 25 |
| 2018 August | 44 | 16 | 60 |
| 2018 July | 41 | 21 | 62 |
| 2018 June | 41 | 21 | 62 |
| 2018 May | 60 | 10 | 70 |
| 2018 April | 52 | 32 | 84 |
| 2018 March | 52 | 40 | 92 |
| 2018 February | 27 | 13 | 40 |
| 2018 January | 42 | 12 | 54 |
| 2017 December | 51 | 16 | 67 |
| 2017 November | 41 | 15 | 56 |
| 2017 October | 24 | 19 | 43 |
| 2017 September | 30 | 15 | 45 |
| 2017 August | 21 | 20 | 41 |
| 2017 July | 13 | 9 | 22 |
| 2017 June | 26 | 13 | 39 |
| 2017 May | 33 | 13 | 46 |
| 2017 April | 6 | 13 | 19 |
| 2017 March | 16 | 23 | 39 |
| 2017 February | 10 | 5 | 15 |
| 2017 January | 12 | 5 | 17 |
| 2016 December | 10 | 10 | 20 |
| 2016 November | 9 | 6 | 15 |
| 2016 October | 10 | 8 | 18 |
| 2016 September | 2 | 3 | 5 |
| 2016 August | 5 | 3 | 8 |
| 2016 July | 3 | 2 | 5 |
| 2016 June | 0 | 1 | 1 |
| 2016 April | 2 | 6 | 8 |
| 2016 March | 4 | 8 | 12 |
| 2016 February | 3 | 8 | 11 |
| 2016 January | 15 | 5 | 20 |
| 2015 December | 8 | 3 | 11 |
| 2015 November | 4 | 3 | 7 |
| 2015 October | 2 | 2 | 4 |
Show all
