Early nasal continuous positive airway pressure versus INSURE in VLBW neonates
Uso do método INSURE versus CPAP nasal isolado em recém-nascidos de muito baixo peso com 30 ou menos semanas de gestação
Ana Saianda1,
, Ricardo M. Fernandes1, Joana Saldanha2
Corresponding author
asaianda@gmail.pt
Correspondence to/Correspondência: Departamento de Pediatria. Hospital de Santa Maria, Av. Professor. Egas Moniz, 1649-035 Lisboa.
Correspondence to/Correspondência: Departamento de Pediatria. Hospital de Santa Maria, Av. Professor. Egas Moniz, 1649-035 Lisboa.
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, Neonatal Unit. 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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Fernandes, Joana Saldanha" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Ana" "apellidos" => "Saianda" "email" => array:1 [ 0 => "asaianda@gmail.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Ricardo M." "apellidos" => "Fernandes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Joana" "apellidos" => "Saldanha" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "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, Neonatal Unit. Hospital de Santa Maria – Lisboa" "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "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" "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondence to/Correspondência: Departamento de Pediatria. Hospital de Santa Maria, Av. Professor. Egas Moniz, 1649-035 Lisboa." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Uso do método INSURE <span class="elsevierStyleItalic">versus</span> CPAP nasal isolado em recém-nascidos de muito baixo peso com 30 ou menos semanas de gestação" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2009-10-19" "fechaAceptado" => "2010-07-05" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec161034" "palabras" => array:6 [ 0 => "Very low birth weight" 1 => "nCPAP ventilation" 2 => "INSURE" 3 => "respiratory distress syndrome (newborn)" 4 => "chronic lung disease of prematurity" 5 => "mortality" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec161035" "palabras" => array:6 [ 0 => "Recém-nascido muito baixo peso" 1 => "nCPAP" 2 => "INSURE" 3 => "sindroma de dificuldade respiratória neonatal" 4 => "doença pulmonar crónica da prematuridade" 5 => "mortalidade" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evidence suggests the INSURE strategy (INtubate-SURfactant administration and Extubate to nasal continuous positive airway pressure [nCPAP]) is superior to mechanical ventilation (MV) with rescue surfactant for the management of respiratory distress syndrome (RDS) in very low birth weight (VLBW) neonates. There is limited data, however, to assess whether INSURE is superior to nCPAP alone. We aimed to compare these two strategies regarding early and late outcomes.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Retrospective cohort study from Jan/2002 to Aug/2008. We included VLBW neonateswith gestational age (GA) ≤ 30 weeks registered in the Vermont Oxford Network that used either nCPAP alone (nCPAP group, N<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>40), or with INSURE (INSURE group, N<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>56). We assessed early (RDS, need for rescue surfactant, and CPAP failure with MV) and late outcomes (chronic lung disease of prematurity (CLD), mortality, and composite outcome of mortality and/or CLD).</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Neonates in the INSURE group had lower mean GA, while other baseline variables were comparable. The proportion of RDS was significantly superior in the nCPAP group (53% vs. 30%; adjusted OR [95% CI] – 0.2 [0.1-0.6]). Therapeutic surfactant was administered to all cases with RDS in the nCPAP group, but to none from the INSURE group. MV was more frequently required in the nCPAP group (11/ 40, 28% <span class="elsevierStyleItalic">vs</span>. 9/ 56, 12%; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.04). No statistically significant differences were found in either of the late outcomes.</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The use of nCPAP alone in VLBW neonates with GA ≤ 30 weeks may be associated with slightly poorer early outcomes than the INSURE strategy, but there were no significant differences in CLD or mortality.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span class="elsevierStyleSectionTitle">Introdução</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pretende-se determinar se a utilização do método INSURE em recém-nascidos de muito baixo peso, com idade gestacional (IG) ≤ 30 semanas se associa a menor morbilidade e mortalidade quando comparado com uso de nCPAP isolado.</p> <span class="elsevierStyleSectionTitle">Métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudo de coorte retrospectiva dos RNMBP nascidos num hospital de apoio perinatal diferenciado entre Janeiro/2002-Agosto/2008. Incluíram-se as crianças registadas na Vermont-Oxford Network com IG ≤30semanas e com uso de nCPAP logo após o nascimento (N<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>96). Estabeleceu-se Grupo nCPAP – uso de nCPAP isolado (N<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>40) e Grupo INSURE (N<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>56). Consideraram-se <span class="elsevierStyleItalic">outcomes</span> precoces: síndroma de dificuldade respiratória (SDR), necessidade de administrar surfactante com intuito terapêutico ou recurso a ventilação invasiva. Compararam-se igualmente <span class="elsevierStyleItalic">outcomes</span> tardios: doença pulmonar crónica da prematuridade (DPC), mortalidade e o <span class="elsevierStyleItalic">outcome</span> composto DPC-mortalidade.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">No grupo INSURE verificou-se menor IG, não se registando diferenças relativamente ao peso ao nascer e indução da maturação pulmonar. Verificou-se SDR em 21/40 (53%) casos do grupo nCPAP e em 17/56 (30%) casos do grupo INSURE (OR ajustado [IC 95%] – 0,2 [0,1-0,6]). No grupo nCPAP todos estes casos realizaram surfactante com intuito terapêutico, não tendo sido efectuada nenhuma dose adicional de surfactante no grupo INSURE. Verificou-se maior número de casos com necessidade de VI no grupo nCPAP do que no grupo INSURE (11/40, 28% <span class="elsevierStyleItalic">vs</span> 9/56, 12%). Não foram encontradas diferenças estatisticamente significativas relativamente aos <span class="elsevierStyleItalic">outcomes</span> tardios.</p> <span class="elsevierStyleSectionTitle">Conclusão</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Em RNMBP com IG ≤30sem, o uso isolado de nCPAP poderá traduzir-se numa ligeira desvantagem em <span class="elsevierStyleItalic">outcomes</span> precoces, sem evidentes repercussões em termos de DPC ou mortalidade.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography/Bibliografia" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neonatal care of very-low-birthweight infants in special-care units and neonatal intensive-care units in Stockholm. 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