Bronchopulmonary dysplasia: Clinical practices in five Portuguese neonatal intensive care units

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Guimarães, G. Rocha, G. Vasconcellos, E. Proença, M.L. Carreira, M.R. Sossai, B. Morais, I. Martins, T. Rodrigues, M. Severo" "autores" => array:10 [ 0 => array:4 [ "nombre" => "H." "apellidos" => "Guimarães" "email" => array:1 [ 0 => "herciliaguimaraes@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "1" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "G." "apellidos" => "Rocha" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "1" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "G." "apellidos" => "Vasconcellos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "1" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "E." "apellidos" => "Proença" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "2" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "M.L." "apellidos" => "Carreira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "3" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "M.R." "apellidos" => "Sossai" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "4" "identificador" => "aff0020" ] ] ] 6 => array:3 [ "nombre" => "B." "apellidos" => "Morais" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "4" "identificador" => "aff0020" ] ] ] 7 => array:3 [ "nombre" => "I." "apellidos" => "Martins" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "5" "identificador" => "aff0025" ] ] ] 8 => array:3 [ "nombre" => "T." "apellidos" => "Rodrigues" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "6" "identificador" => "aff0030" ] ] ] 9 => array:3 [ "nombre" => "M." "apellidos" => "Severo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "6" "identificador" => "aff0030" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "NICU, Hospital de S. João, Porto" "etiqueta" => "1" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Maternidade Júlio Dinis, Porto" "etiqueta" => "2" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hospital de Santo António, Porto" "etiqueta" => "3" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Hospital Fernando da Fonseca, Amadora/Sintra" "etiqueta" => "4" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Hospital Pedro Hispano, Matosinhos" "etiqueta" => "5" "identificador" => "aff0025" ] 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" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondence to/Correspondência: 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 [ "pt" => array:1 [ "titulo" => "Displasia broncopulmonar: Práticas clínicas em cinco unidades de cuidados intensivos neonatais" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2009-06-29" "fechaAceptado" => "2009-09-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec160695" "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" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec160694" "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" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "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. AimTo 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. Patients and methods256 preterm neonates, gestational age (GA)<30 weeks and/or birthweight (BW)<1250g admitted to five Portuguese NICUs (centers 1 to 5) between 1st January 2004 and 31st 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. ResultsThe 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. ConclusionThe 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 FiO2, 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." ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "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. ObjectivoComparar 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. População e métodosForam estudados 256 recém-nascidos com a idade gestacional inferior a 30 semanas e/ou peso ao nascer inferior a 1250g, 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 major, 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. ResultadosA 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. ConclusãoNeste 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 FiO2, ao uso criterioso de líquidos na primeiras semanas de vida, à prevenção do canal arterial patente e da sépsis. Guidelines, recomendações ou protocolos são necessários na melhoria da qualidade na prevenção da DBP." ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:59 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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Displasia broncopulmonar: Práticas clínicas em cinco unidades de cuidados intensivos neonatais

H. Guimarães1,

Corresponding author

herciliaguimaraes@gmail.com

Correspondence to/Correspondência: Serviço de Neonatologia/Departamento de Pediatria – Hospital de São João, Alameda Professor Hernâni Monteiro, 4202-451 Porto. Telephone: 00351 225095816, Fax: +225505919.

, G. Rocha1, G. Vasconcellos1, E. Proença2, M.L. Carreira3, M.R. Sossai4, B. Morais4, I. Martins5, T. Rodrigues6, M. Severo6

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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            2 => "rec&#233;m-nascidos de pr&#233;-termo"
            3 => "boas pr&#225;ticas"
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        "titulo" => "Abstract"
        "resumen" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">With the advent of surfactant&#44; prenatal corticosteroids &#40;PNC&#41; and advances in technology&#44; the survival rate of extremely low birth weight &#40;ELBW&#41; infants has improved dramatically&#46; Rates of bronchopulmonary dysplasia &#40;BPD&#41; vary widely among neonatal intensive care units &#40;NICUs&#41; and many studies using multiple interventions have shown some improvement in BPD rates&#46; Implementing potentially better practices to reduce BPD has been an effort made over the last few decades&#46;</p> <span class="elsevierStyleSectionTitle">Aim</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To compare five Portuguese NICUs in terms of clinical practices in very low birth weight &#40;VLBW&#41; infants&#44; in order to develop better practices to prevent BPD&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">256 preterm neonates&#44; gestational age &#40;GA&#41;<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30 weeks and&#47;or birthweight &#40;BW&#41;<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1250g admitted to five Portuguese NICUs &#40;centers 1 to 5&#41; between 1st January 2004 and 31<span class="elsevierStyleSup">st</span> December 2006&#44; were studied&#46; VLBW infants with major malformations&#44; grade IV intraventricular haemorrhage in the first week of life and metabolic or neuromuscular disease were excluded&#46; BPD was defined as oxygen dependency at 36 weeks of postconceptional age&#46; We considered a practice to be improved as clinically significant whenever a decrease greater than 10&#37; in the prevalence of BPD adjusted for the practice&#44; GA and BW was achieved compared to BPD prevalence adjusted only for GA and BW&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The overall prevalence of BPD was 12&#46;9&#37;&#46; Our results revealed that PNC use should be improved in centers 4 and 5&#59; fluid policy in center 4&#59; oxygen therapy and sepsis prevention in centers 1 and 2&#46; Patent ductus arteriosus &#40;PDA&#41; treatment should be improved in center 2&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The implementation of potentially better practices to reduce lung injury in neonates in Portuguese NICUs&#44; according to each NICU&#44; must be addressed to increase the prescription of PNC&#44; to use a lower FiO<span class="elsevierStyleInf">2</span>&#44; to be careful with fluid administration in the first weeks of life and to prevent PDA and sepsis&#46; It is necessary to follow guidelines&#44; recommendations or protocols to improve quality in the prevention of BPD&#46;</p>"
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Com o advento do surfactante&#44; dos corticoster&#243;ides pr&#233;-natais e dos avan&#231;os na tecnologia&#44; a sobrevida dos rec&#233;m-nascidos de extremo baixo peso tem melhorado dramaticamente&#46; As taxas de displasia broncopulmonar &#40;DBP&#41; variam amplamente entre unidades&#44; e v&#225;rios estudos&#44; avaliando resultados de m&#250;ltiplas interven&#231;&#245;es&#44; t&#234;m mostrado alguma melhoria na preval&#234;ncia da DBP&#46; A implementa&#231;&#227;o de potenciais boas pr&#225;ticas na DBP tem sido adoptada por muitos servi&#231;os nas &#250;ltimas d&#233;cadas&#46;</p> <span class="elsevierStyleSectionTitle">Objectivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Comparar cinco unidades portuguesas de cuidados intensivos neonatais no que se refere as pr&#225;ticas cl&#237;nicas no tratamento dos rec&#233;m-nascidos de muito baixo peso&#44; para desenvolver e melhorar as boas pr&#225;ticas na preven&#231;&#227;o da DBP&#46;</p> <span class="elsevierStyleSectionTitle">Popula&#231;&#227;o e m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Foram estudados 256 rec&#233;m-nascidos com a idade gestacional inferior a 30 semanas e&#47;ou peso ao nascer inferior a 1250<span class="elsevierStyleHsp" style=""></span>g&#44; admitidos nas cinco unidades portuguesas &#40;centros 1 a 5&#41; entre 1 de Janeiro de 2004 e 31 de Dezembro de 2006&#46; Foram exclu&#237;dos os rec&#233;m-nascidos com malforma&#231;&#245;es <span class="elsevierStyleItalic">major</span>&#44; hemorragia intraventricular grau IV na primeira semana de vida e com doen&#231;a metab&#243;lica ou neuromuscular&#46; Definimos DBP como a depend&#234;ncia do oxig&#233;nio &#224;s 36 semanas de idade p&#243;sconcepcional&#46; A necessidade de melhorar determinada pr&#225;tica foi considerada significativa sempre que se verificava uma melhoria superior a 10&#37; na preval&#234;ncia da DBP ajustada para a pr&#225;tica&#44; idade gestacional e peso ao nascer&#44; comparada com a preval&#234;ncia ajustada s&#243; para a idade gestacional e peso ao nascer&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A preval&#234;ncia global da DBP foi de 12&#44;9&#37;&#46; Os resultados mostram que o uso de corticoster&#243;ides pr&#233;-natais deve ser melhorado nos centros 4 e 5&#59; a pol&#237;tica de fluidos deve ser melhorada no centro 4&#59; o uso de oxig&#233;nio e a preven&#231;&#227;o da s&#233;psis deve ser melhorada nos centros 1 e 2&#46; O tratamento do canal arterial patente deve ser melhorado no centro 2&#46;</p> <span class="elsevierStyleSectionTitle">Conclus&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Neste estudo&#44; a implementa&#231;&#227;o de boas pr&#225;ticas para reduzir a les&#227;o pulmonar nos rec&#233;m-nascidos&#44; de acordo com cada unidade&#44; deve ser dirigida ao aumento da prescri&#231;&#227;o de corticoster&#243;ides pr&#233;-natais&#44; ao uso de menor FiO<span class="elsevierStyleInf">2</span>&#44; ao uso criterioso de l&#237;quidos na primeiras semanas de vida&#44; &#224; preven&#231;&#227;o do canal arterial patente e da s&#233;psis&#46; <span class="elsevierStyleItalic">Guidelines</span>&#44; recomenda&#231;&#245;es ou protocolos s&#227;o necess&#225;rios na melhoria da qualidade na preven&#231;&#227;o da DBP&#46;</p>"
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Article information

ISSN: 21735115
Original language: English

DOI:10.1016/S2173-5115(10)70035-X

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