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        "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Introdu&#231;&#227;o&#58;</span> Pretende-se determinar se a utiliza&#231;&#227;o do m&#233;todo INSURE em rec&#233;m-nascidos de muito baixo peso&#44; com idade gestacional &#40;IG&#41;<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>30 semanas se associa a menor morbilidade e mortalidade quando comparado com uso de nCPAP isolado&#46; <span class="elsevierStyleBold">M&#233;todos&#58;</span> Estudo de coorte retrospectiva dos RNMBP nascidos num hospital de apoio perinatal diferenciado entre Janeiro&#47;2002-Agosto&#47;2008&#46; Inclu&#237;ram-se as crian&#231;as registadas na Vermont-Oxford Network com IG &#8804;<span class="elsevierStyleHsp" style=""></span>30semanas e com uso de nCPAP logo ap&#243;s o nascimento &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>96&#41;&#46;</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Estabeleceu-se Grupo nCPAP &#8211; uso de nCPAP isolado &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41; e Grupo INSURE &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>56&#41;&#46; Consideraram-se <span class="elsevierStyleItalic">outcomes</span> precoces&#58; s&#237;ndroma de dificuldade respirat&#243;ria &#40;SDR&#41;&#44; necessidade de administrar surfactante com intuito terap&#234;utico ou recurso a ventila&#231;&#227;o invasiva&#46; Compararam-se igualmente <span class="elsevierStyleItalic">outcomes</span> tardios&#58; doen&#231;a pulmonar cr&#243;nica da prematuridade &#40;DPC&#41;&#44; mortalidade e o <span class="elsevierStyleItalic">outcome</span> composto DPC-mortalidade&#46; <span class="elsevierStyleBold">Resultados&#58;</span> No grupo INSURE verificou-se menor IG&#44; n&#227;o se registando diferen&#231;as relativamente ao peso ao nascer e indu&#231;&#227;o da matura&#231;&#227;o pulmonar&#46; Verificou-se SDR em 21&#47;40 &#40;53&#37;&#41; casos do grupo nCPAP e em 17&#47;56 &#40;30&#37;&#41; casos do grupo INSURE &#40;OR ajustado &#91;IC 95&#37;&#93; &#8211; 0&#44;2 &#91;0&#44;1-0&#44;6&#93;&#41;&#46; No grupo nCPAP todos estes casos realizaram surfactante com intuito terap&#234;utico&#44; n&#227;o tendo sido efectuada nenhuma dose adicional de surfactante no grupo INSURE&#46; Verificou-se maior n&#250;mero de casos com necessidade de VI no grupo nCPAP do que no grupo INSURE &#40;11&#47;40&#44; 28&#37; <span class="elsevierStyleItalic">vs</span> 9&#47;56&#44; 12&#37;&#41;&#46; N&#227;o foram encontradas diferen&#231;as estatisticamente significativas relativamente aos <span class="elsevierStyleItalic">outcomes</span> tardios&#46; <span class="elsevierStyleBold">Conclus&#227;o&#58;</span> Em RNMBP com IG &#8804;<span class="elsevierStyleHsp" style=""></span>30sem&#44; o uso isolado de nCPAP poder&#225; traduzir-se numa ligeira desvantagem em <span class="elsevierStyleItalic">outcomes</span> precoces&#44; sem evidentes repercuss&#245;es em termos de DPC ou mortalidade&#46;</p><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2010&#59; XVI &#40;5&#41;&#58; 779-795</span></p></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Background&#58;</span> Evidence suggests the INSURE strategy &#40;INtubate-SURfactant administration and Extubate to nasal continuous positive airway pressure &#91;nCPAP&#93;&#41; is superior to mechanical ventilation &#40;MV&#41; with rescue surfactant for the management of respiratory distress syndrome &#40;RDS&#41; in very low birth weight &#40;VLBW&#41; neonates&#46; There is limited data&#44; however&#44; to assess whether INSURE is superior to nCPAP alone&#46; We aimed to compare these two strategies regarding early and late outcomes&#46; <span class="elsevierStyleBold">Methods&#58;</span> Retrospective cohort study from Jan&#47;2002 to Aug&#47;2008&#46; We included VLBW neonateswith gestational age &#40;GA&#41;<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>30 weeks registered in the Vermont Oxford Network that used either nCPAP alone &#40;nCPAP group&#44; N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41;&#44; or with INSURE &#40;INSURE group&#44; N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>56&#41;&#46;</p><p id="sp0120" class="elsevierStyleSimplePara elsevierViewall">We assessed early &#40;RDS&#44; need for rescue surfactant&#44; and CPAP failure with MV&#41; and late outcomes &#40;chronic lung disease of prematurity &#40;CLD&#41;&#44; mortality&#44; and composite outcome of mortality and&#47;or CLD&#41;&#46; <span class="elsevierStyleBold">Results&#58;</span> Neonates in the INSURE group had lower mean GA&#44; while other baseline variables were comparable&#46; The proportion of RDS was significantly superior in the nCPAP group &#40;53&#37; vs&#46; 30&#37;&#59; adjusted OR &#91;95&#37; CI&#93; &#8211; 0&#46;2 &#91;0&#46;1-0&#46;6&#93;&#41;&#46; Therapeutic surfactant was administered to all cases with RDS in the nCPAP group&#44; but to none from the INSURE group&#46; MV was more frequently required in the nCPAP group &#40;11&#47; 40&#44; 28&#37; <span class="elsevierStyleItalic">vs</span>&#46; 9&#47; 56&#44; 12&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#46; No statistically significant differences were found in either of the late outcomes&#46; <span class="elsevierStyleBold">Conclusion&#58;</span> The use of nCPAP alone in VLBW neonates with GA<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>30 weeks may be associated with slightly poorer early outcomes than the INSURE strategy&#44; but there were no significant differences in CLD or mortality&#46;</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2010&#59; XVI &#40;5&#41;&#58; 779-795</span></p></span>"
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Artigo Original/Original Article
Uso do método INSURE versus CPAP nasal isolado em recém-nascidos de muito baixo peso com 30 ou menos semanas de gestação
Early nasal continuous positive airway pressure versus INSURE in VLBW neonates
Ana Saianda1,
Corresponding author
asaianda@gmail.pt

Correspondência/Correspondence to: Ana Saianda, Departamento de Pediatria. Hospital de Santa Maria, Av. Professor. Egas Moniz, 1649-035 Lisboa
, Ricardo M. Fernandes1, Joana Saldanha2
1 Interno do Complementar. Departamento da Criança e da Família. Hospital de Santa Maria – Lisboa/Resident. Child and Family Health Service. Hospital de Santa Maria – Lisboa
2 Assistente graduada. Departamento da Criança e da Família. Unidade de Neonatologia. Hospital de Santa Maria – Lisboa/Consultant. Child and Family Health Service. Neonatal Unit. Hospital de Santa Maria – Lisboa
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    "titulo" => "Uso do m&#233;todo INSURE <span class="elsevierStyleItalic">versus</span> CPAP nasal isolado em rec&#233;m-nascidos de muito baixo peso com 30 ou menos semanas de gesta&#231;&#227;o"
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            "correspondencia" => "<span class="elsevierStyleBold">Correspond&#234;ncia&#47;<span class="elsevierStyleItalic">Correspondence to&#58;</span></span> Ana Saianda&#44; Departamento de Pediatria&#46; Hospital de Santa Maria&#44; Av&#46; Professor&#46; Egas Moniz&#44; 1649-035 Lisboa"
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      "en" => array:1 [
        "titulo" => "Early nasal continuous positive airway pressure versus INSURE in VLBW neonates"
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    "fechaRecibido" => "2009-10-19"
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            2 => "INSURE"
            3 => "sindroma de dificuldade respirat&#243;ria neonatal"
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            0 => "Very low birth weight"
            1 => "nCPAP ventilation"
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        "titulo" => "Resumo"
        "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Introdu&#231;&#227;o&#58;</span> Pretende-se determinar se a utiliza&#231;&#227;o do m&#233;todo INSURE em rec&#233;m-nascidos de muito baixo peso&#44; com idade gestacional &#40;IG&#41;<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>30 semanas se associa a menor morbilidade e mortalidade quando comparado com uso de nCPAP isolado&#46; <span class="elsevierStyleBold">M&#233;todos&#58;</span> Estudo de coorte retrospectiva dos RNMBP nascidos num hospital de apoio perinatal diferenciado entre Janeiro&#47;2002-Agosto&#47;2008&#46; Inclu&#237;ram-se as crian&#231;as registadas na Vermont-Oxford Network com IG &#8804;<span class="elsevierStyleHsp" style=""></span>30semanas e com uso de nCPAP logo ap&#243;s o nascimento &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>96&#41;&#46;</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Estabeleceu-se Grupo nCPAP &#8211; uso de nCPAP isolado &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41; e Grupo INSURE &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>56&#41;&#46; Consideraram-se <span class="elsevierStyleItalic">outcomes</span> precoces&#58; s&#237;ndroma de dificuldade respirat&#243;ria &#40;SDR&#41;&#44; necessidade de administrar surfactante com intuito terap&#234;utico ou recurso a ventila&#231;&#227;o invasiva&#46; Compararam-se igualmente <span class="elsevierStyleItalic">outcomes</span> tardios&#58; doen&#231;a pulmonar cr&#243;nica da prematuridade &#40;DPC&#41;&#44; mortalidade e o <span class="elsevierStyleItalic">outcome</span> composto DPC-mortalidade&#46; <span class="elsevierStyleBold">Resultados&#58;</span> No grupo INSURE verificou-se menor IG&#44; n&#227;o se registando diferen&#231;as relativamente ao peso ao nascer e indu&#231;&#227;o da matura&#231;&#227;o pulmonar&#46; Verificou-se SDR em 21&#47;40 &#40;53&#37;&#41; casos do grupo nCPAP e em 17&#47;56 &#40;30&#37;&#41; casos do grupo INSURE &#40;OR ajustado &#91;IC 95&#37;&#93; &#8211; 0&#44;2 &#91;0&#44;1-0&#44;6&#93;&#41;&#46; No grupo nCPAP todos estes casos realizaram surfactante com intuito terap&#234;utico&#44; n&#227;o tendo sido efectuada nenhuma dose adicional de surfactante no grupo INSURE&#46; Verificou-se maior n&#250;mero de casos com necessidade de VI no grupo nCPAP do que no grupo INSURE &#40;11&#47;40&#44; 28&#37; <span class="elsevierStyleItalic">vs</span> 9&#47;56&#44; 12&#37;&#41;&#46; N&#227;o foram encontradas diferen&#231;as estatisticamente significativas relativamente aos <span class="elsevierStyleItalic">outcomes</span> tardios&#46; <span class="elsevierStyleBold">Conclus&#227;o&#58;</span> Em RNMBP com IG &#8804;<span class="elsevierStyleHsp" style=""></span>30sem&#44; o uso isolado de nCPAP poder&#225; traduzir-se numa ligeira desvantagem em <span class="elsevierStyleItalic">outcomes</span> precoces&#44; sem evidentes repercuss&#245;es em termos de DPC ou mortalidade&#46;</p><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2010&#59; XVI &#40;5&#41;&#58; 779-795</span></p></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Background&#58;</span> Evidence suggests the INSURE strategy &#40;INtubate-SURfactant administration and Extubate to nasal continuous positive airway pressure &#91;nCPAP&#93;&#41; is superior to mechanical ventilation &#40;MV&#41; with rescue surfactant for the management of respiratory distress syndrome &#40;RDS&#41; in very low birth weight &#40;VLBW&#41; neonates&#46; There is limited data&#44; however&#44; to assess whether INSURE is superior to nCPAP alone&#46; We aimed to compare these two strategies regarding early and late outcomes&#46; <span class="elsevierStyleBold">Methods&#58;</span> Retrospective cohort study from Jan&#47;2002 to Aug&#47;2008&#46; We included VLBW neonateswith gestational age &#40;GA&#41;<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>30 weeks registered in the Vermont Oxford Network that used either nCPAP alone &#40;nCPAP group&#44; N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41;&#44; or with INSURE &#40;INSURE group&#44; N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>56&#41;&#46;</p><p id="sp0120" class="elsevierStyleSimplePara elsevierViewall">We assessed early &#40;RDS&#44; need for rescue surfactant&#44; and CPAP failure with MV&#41; and late outcomes &#40;chronic lung disease of prematurity &#40;CLD&#41;&#44; mortality&#44; and composite outcome of mortality and&#47;or CLD&#41;&#46; <span class="elsevierStyleBold">Results&#58;</span> Neonates in the INSURE group had lower mean GA&#44; while other baseline variables were comparable&#46; The proportion of RDS was significantly superior in the nCPAP group &#40;53&#37; vs&#46; 30&#37;&#59; adjusted OR &#91;95&#37; CI&#93; &#8211; 0&#46;2 &#91;0&#46;1-0&#46;6&#93;&#41;&#46; Therapeutic surfactant was administered to all cases with RDS in the nCPAP group&#44; but to none from the INSURE group&#46; MV was more frequently required in the nCPAP group &#40;11&#47; 40&#44; 28&#37; <span class="elsevierStyleItalic">vs</span>&#46; 9&#47; 56&#44; 12&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#46; No statistically significant differences were found in either of the late outcomes&#46; <span class="elsevierStyleBold">Conclusion&#58;</span> The use of nCPAP alone in VLBW neonates with GA<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>30 weeks may be associated with slightly poorer early outcomes than the INSURE strategy&#44; but there were no significant differences in CLD or mortality&#46;</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2010&#59; XVI &#40;5&#41;&#58; 779-795</span></p></span>"
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Article information
ISSN: 08732159
Original language: Portuguese
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