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Resumo
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
ObjectivoAvaliar a prevalência da DBP e seus factores de risco em cinco unidades portuguesas, para implementar boas práticas no tratamento deste doentes.
Material e métodos256 recém-nascidos (RN) com idade gestacional (IG) <30 semanas e/ou peso <1250g 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.
ResultadosA 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 vs 3 dias, respectivamente nos RN com e sem DBP, p<0,001) e maior duração de FiO2>0,30 (85 vs 5 dias, respectivamente nos doentes com e sem DBP, p<0,001).
ComentáriosOs 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.
Palavras chave:
Displasia broncopulmonar
recém-nascidos pré-termo
unidades de cuidados intensivos neonatais
doença da membrana hialina
ventilação mecânica
oxigenoterapia
factores de risco
boas práticas
Abstract
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.
AimTo 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.
Material and methods256 very low birth weight infants with gestational age (GA) <30 weeks and/or birthweight (BW) <1250g 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.
ResultsBPD 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=0.73, 95% CI=0.57-0.95), severe hyaline membrane disease (adj OR=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>0.30 (85 vs 5 days, respectively in BPD and no BPD patients, p<0.001).
CommentsThe 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.
Key words:
Bronchopulmonary dysplasia
preterm infants
neonatal intensive care
prematurity
hyaline membrane disease
mechanical ventilation
oxygen therapy
risk factors
better practices
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