Artigo Original/Original Article
Factores de risco de displasia broncopulmonar em cinco unidades portuguesas de cuidados intensivos neonatais
Risk factors for bronchopulmonary dysplasia in five Portuguese neonatal intensive care units
Hercília Guimarães1,
, Gustavo Rocha1, Gabriela Vasconcellos1, Elisa Proença2, Maria Luísa Carreira3, Maria do Rosário Sossai4, Benvinda Morais4, Isabel Martins5, Teresa Rodrigues5, Milton Severo5
Corresponding author
herciliaguimaraes@gmail.com
Hospital de S. João (Director: Professora Doutora Hercília Guimarães), Porto.
Hospital de S. João (Director: Professora Doutora Hercília Guimarães), Porto.
1 Maternidade Júlio Dinis (Director: Dr. José Pombeiro), Porto
2 Hospital de Santo António (Director Drª. Paula Cristina Fernandes), Porto
3 Hospital Fernando Fonseca (Director Drª Rosalina Barrosos), Lisboa
4 Hospital Pedro Hispano (Drª Agostinha Souto), Porto
5 Serviço de Epidemiologia (Director Professor Henrique de Barros), Faculty of Medicine of Porto University, Portugal
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Paula Cristina Fernandes), Porto" "etiqueta" => "2" "identificador" => "af0010" ] 2 => array:3 [ "entidad" => "Hospital Fernando Fonseca (Director Drª Rosalina Barrosos), Lisboa" "etiqueta" => "3" "identificador" => "af0015" ] 3 => array:3 [ "entidad" => "Hospital Pedro Hispano (Drª Agostinha Souto), Porto" "etiqueta" => "4" "identificador" => "af0020" ] 4 => array:3 [ "entidad" => "Serviço de Epidemiologia (Director Professor Henrique de Barros), Faculty of Medicine of Porto University, Portugal" "etiqueta" => "5" "identificador" => "af0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cr0005" "etiqueta" => "*" "correspondencia" => "Hospital de S. João (Director: Professora Doutora Hercília Guimarães), Porto." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Risk factors for bronchopulmonary dysplasia in five Portuguese neonatal intensive care units" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2009-04-23" "fechaAceptado" => "2009-11-05" "PalabrasClave" => array:2 [ "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec570162" "palabras" => array:8 [ 0 => "Displasia broncopulmonar" 1 => "recém-nas-cidos pré-termo" 2 => "unidades de cuidados intensivos neonatais" 3 => "doença da membrana hialina" 4 => "ventilação mecânica" 5 => "oxigenoterapia" 6 => "factores de risco" 7 => "boas práticas" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec570163" "palabras" => array:9 [ 0 => "Bronchopulmonary dysplasia" 1 => "preterm infants" 2 => "neonatal intensive care" 3 => "prematurity" 4 => "hyaline membrane disease" 5 => "mechanical ventilation" 6 => "oxygen therapy" 7 => "risk factors" 8 => "better practices" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">A displasia broncopulmonar (DBP) é multifactorial. Prematuridade, doença da membrana hialina, oxigénio, ventilação mecânica, inflamação e canal arterial são alguns dos factores na sua patogénese</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Objectivo</span>: Avaliar a prevalência da DBP e seus factores de risco em cinco unidades portuguesas, para implementar boas práticas no tratamento deste doentes.</p><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Material e métodos</span>: 256 recém-nascidos (RN) com idade gestacional (IG) <<span class="elsevierStyleHsp" style=""></span>30 semanas e/ou peso <<span class="elsevierStyleHsp" style=""></span>1250<span class="elsevierStyleHsp" style=""></span>g internados em cinco unidades portuguesas, entre 2004 e 2006, foram estudados. Foi recolhida a informação clínica dos processos. A DBP foi definida como a necessidade de oxigénio às 36 semanas de idade pós-conceptional.</p><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Resultados</span>: A prevalência da DBP foi de 12,9%. O seu risco diminuiu de 46% por semana de IG e de 39% por 100g de peso. O risco de DBP foi maior entre os RN com baixo peso (OR adj = 0,73, 95% CI=0,57-0,95), doença da membrane hialina grave (OR adj = 9,85, 95% CI=1,05-92,35), com sépsis (OR adj = 6,22, 95% CI=1,68-23,02), com maior duração de ventilação (42 <span class="elsevierStyleItalic">vs</span> 3 dias, respectivamente nos RN com e sem DBP, p<0,001) e maior duração de FiO<span class="elsevierStyleInf">2</span>>;0,30 (85 <span class="elsevierStyleItalic">vs</span> 5 dias, respectivamente nos doentes com e sem DBP, p<0,001).</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Comentários:</span> Os factores de risco de DBP mais relevantes foram o baixo peso, a doença da membrana hialina grave, a duração da ventilação mecânica e da oxigenoterapia e a sépsis. A implementação das boas práticas para reduzir a lesão pulmonar nos RN deve ser dirigida para melhorar as práticas que reduzem estes factores de risco.</p><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2010; XVI (3): 419-430</span></p></span>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall">The pathogenesis of bronchopulmonary dysplasia (BPD) is clearly multifactorial. Specific pathogenic risk factors are prematurity, respiratory distress, oxygen supplementation, mechanical ventilation (MV), inflammation, patent ductus arteriosus (PDA), etc.</p><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Aim:</span> To evaluate BPD prevalence and to identify risk factors for BPD in five Portuguese Neonatal Intensive Care Units in order to develop better practices the management of these newborns.</p><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Material and methods</span>: 256 very low birth weight infants with gestational age (GA) <<span class="elsevierStyleHsp" style=""></span>30 weeks and/or birthweight (BW) <<span class="elsevierStyleHsp" style=""></span>1250<span class="elsevierStyleHsp" style=""></span>g admitted in five Portuguese NICUs, between 2004 and 2006 were studied. A protocol was filled in based on clinical information registered in the hospital charts. BPD was defined as oxygen dependency at 36 weeks of postconceptional age.</p><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Results</span>: BPD prevalence was 12.9% (33/256). BPD risk decreased 46% per GA week and of 39% per 100g BW. BPD risk was significantly higher among newborns with low BW (adj OR<span class="elsevierStyleHsp" style=""></span>= 0.73, 95% CI=0.57-0.95), severe hyaline membrane disease (adj OR<span class="elsevierStyleHsp" style=""></span>= 9.85, 95% CI=1.05-92.35), and those with sepsis (adj OR=6.22, 95% CI=1.68-23.02), those with longer duration on ventilatory support (42 vs 3 days, respectively in BPD and no BPD patients, p<0.001) and longer duration of FiO2<span class="elsevierStyleHsp" style=""></span>>;0.30 (85 vs 5 days, respectively in BPD and no BPD patients, p<0.001).</p><p id="sp0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Comments</span>: The most relevant risk factors were low birth weight, severe hyaline membrane disease, duration of respiratory support and oxygen therapy, and nosocomial sepsis. The implementation of potentially better practices to reduce lung injury in neonates must be addressed to improve practices to decrease these risk factors.</p><p id="sp0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2010; XVI (3): 419-430</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:58 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New developments in the presentation, pathogenesis, epidemiology and prevention of bronchopulmonary dysplasia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "I.R.S. Sosenko" 1 => "E. 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Goldsmith" 6 => "J.H. Carpenter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2006-0913C" "Revista" => array:7 [ "tituloSerie" => "Pediatrics" "fecha" => "2006" "volumen" => "118" "numero" => "Suppl 2" "paginaInicial" => "S73" "paginaFinal" => "S77" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17079626" "web" => "Medline" ] ] ] ] ] ] ] ] 56 => array:3 [ "identificador" => "bb0285" "etiqueta" => "56." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Breathsavers Group. Evaluation and development of potentially better practices to reduce bronchopulmonary dysplasia in very low birth weight infants" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N.R. Payne" 1 => "M. LaCorte" 2 => "S. Sun" 3 => "P. Karna" 4 => "M. LewisHunstiger" 5 => "J.P. 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Article information
ISSN: 08732159Original language: Portuguese
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