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 Guimarães1,6, Gustavo Rocha1,6, Gabriela Vasconcellos1,6, Elisa Proença2,6, Maria Luísa Carreira3,6, Maria do Rosário Sossai4,6, Benvinda Morais4,6, Isabel Martins5,6, Teresa Rodrigues5,6, Milton Severo5,6
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
6 Hospital de S. João (Director: Professora Doutora Hercília Guimarães), Porto
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Prematuridade, doença da membrana hialina, oxigénio, ventilação mecânica, inflamação e canal arterial são alguns dos factores na sua patogénese</p> <span class="elsevierStyleSectionTitle">Objectivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar a prevalência da DBP e seus factores de risco em cinco unidades portuguesas, para implementar boas práticas no tratamento deste doentes.</p> <span class="elsevierStyleSectionTitle">Material e métodos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">256 recém-nascidos (RN) com idade gestacional (IG) <30 semanas e/ou peso <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> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">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<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,73, 95% CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,57–0,95), doença da membrane hialina grave (OR adj<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9,85, 95% CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1,05–92,35), com sépsis (OR adj<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6,22, 95% CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>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<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001) e maior duração de FiO<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0,30 (85 <span class="elsevierStyleItalic">vs</span> 5 dias, respectivamente nos doentes com e sem DBP, p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001).</p> <span class="elsevierStyleSectionTitle">Comentários</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">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>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0030" 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> <span class="elsevierStyleSectionTitle">Aim</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">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> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">256 very low birth weight infants with gestational age (GA) <30 weeks and/or birthweight (BW) <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 regis- tered in the hospital charts. BPD was defined as oxygen dependency at 36 weeks of postconceptional age.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">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>=<span class="elsevierStyleHsp" style=""></span>0.73, 95% CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.57-0.95), severe hyaline membrane disease (adj OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9.85, 95% CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.05-92.35), and those with sepsis (adj OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6.22, 95% CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.68-23.02), those with longer duration on ventilatory support (42 vs 3 days, respectively in BPD and no BPD patients, p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) and longer duration of FiO2<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.30 (85 vs 5 days, respectively in BPD and no BPD patients, p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001).</p> <span class="elsevierStyleSectionTitle">Comments</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">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>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:58 [ 0 => array:3 [ "identificador" => "bib1" "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. Bancalari" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "The Newborn Lung Eduardo Bancalari" "paginaInicial" => "187" "paginaFinal" => "207" "serieFecha" => "2008" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2." 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Article information
ISSN: 21735115Original language: Portuguese
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