Carla Marques Nicolau

Avaliação da dor em recém-nascidos prematuros durante a fisioterapia respiratória

OBJECTIVES: to assess pain in premature newborns undergoing mechanical ventilation during respiratory physiotherapy. METHODS: prospective study from February 2003 to May 2004, covering premature newborns with a gestational age of <34 weeks and birth weight <1.500 g, undergoing mechanical ventilation, between the 3rd and 7th day of life. The premature newborns underwent the necessary routine respiratory physiotherapy procedures. The Neonatal Infant Pain Scale (NIPS) was used to measure pain. The scale was applied before, immediately after commencing physiotherapy, and immediately following airway aspiration. RESULTS: 30 premature newborns were studied (15 male). The average gestational age was 30.70±2.10 weeks and the average birth weight was 1.010.70±294.60 grams. Each newborn was submitted to an average of 7.33 physioterapy sessions. It was verified that there was no statistically significant difference in the presence of pain before and after respiratory physiotherapy, (p=0.09); although there was a statistically significant difference in the presence of pain before and after airway aspiration (p<0.001). CONCLUSIONS: respiratory physiotherapy does not cause pain, although the aspiration procedure, as it is invasive, is potentially painful.

Influência do tempo de hospitalização sobre o desenvolvimento neuromotor de recém-nascidos pré-termo

O objetivo deste estudo foi avaliar a influencia do tempo de hospitalizacao sobre o desenvolvimento neuromotor de recem-nascidos pre-termo (RNPT). Foi feito um estudo prospectivo com 67 RNPT de idade gestacional ;34 dias. Na analise estatistica considerou-se o nivel de significância p<0,05. Os escores medianos na AIMS (numa faixa possivel de 0 a 21) foram 7 no grupo A, 5 no grupo B; foram encontradas fracas correlacoes significativas nos dois grupos (r=0,32; r=0,34) entre o escore na AIMS e o TH. Os resultados indicam que os RNPT que permaneceram por mais de 34 dias hospitalizados mostraram atraso no desenvolvimento neuromotor, sugerindo que, sem excluir outros fatores, quanto maior o tempo de internacao do RN, maior seu comprometimento motor.

Influência da fisioterapia respiratória sobre a função cardiopulmonar em recém-nascidos de muito baixo peso

OBJETIVO: Avaliar as repercussoes da fisioterapia respiratoria sobre a funcao cardiopulmonar em recem-nascidos pre-termo (RNPT) submetidos a ventilacao mecânica. METODOS: Estudo prospectivo de RNPT com peso de nascimento menor que 1500g, sendo verificados os valores de frequencia cardiaca (FC), saturacao de oxigenio (SatO2), frequencia respiratoria (FR) e pressao arterial sistemica (PA) antes e apos a fisioterapia respiratoria e a aspiracao endotraqueal. Os RNPT incluidos foram avaliados em sessoes sequenciais entre o 3o-7o dias de vida por dois fisioterapeutas da unidade neonatal. Os valores de FC, SatO2 e PA foram coletados por monitorizacao eletronica e a FR, por cronometro. Na analise estatistica, foi utilizado o teste de ANOVA para medidas repetidas, sendo significante p<0,05. RESULTADOS: Foram estudados 42 recem-nascidos, 57% do sexo feminino, com peso de nascimento medio de 1024g e idade gestacional media de 29,5 semanas. Somente 3 RNPT apresentaram Apgar de 5o minuto menor que 5 e a Doenca das Membranas Hialinas foi o principal diagnostico respiratorio (88%). Foram realizadas 252 sessoes de fisioterapia. A FC, FR, SatO2 e PA atingiram valores considerados fisiologicos apos os procedimentos fisioterapeuticos e a aspiracao endotraqueal. CONCLUSOES: Os procedimentos de fisioterapia respiratoria e de aspiracao endotraqueal nao apresentaram influencias significativas na funcao cardiopulmonar, sugerindo que, quando bem indicados e realizados, nao comprometem a estabilidade clinica de RNPT.

Efeitos da fisioterapia respiratória sobre a pressão arterial em recém-nascidos pré-termo

Oscilacoes na pressao arterial (PA) sistemica sao diretamente proporcionais as oscilacoes do fluxo sanguineo cerebral nos prematuros, mas sao escassos os estudos acerca do efeito dos procedimentos fisioterapeuticos sobre a PA. Este estudo investigou a repercussao desses procedimentos e da aspiracao endotraqueal na pressao arterial em recem-nascidos pre-termo (RNPT) na primeira semana de vida. Foram estudados 42 RNPT com peso de nascimento menor que 1.500 gramas em ventilacao mecânica. A PA foi mensurada em tres momentos: antes da fisioterapia (A), imediatamente apos os procedimentos fisioterapeuticos (B) e imediatamente apos a aspiracao endotraqueal (C). Os dados coletados foram analisados estatisticamente, com nivel de signficância fixado em p<0,05. Os 42 RNPT tinham idade gestacional media de 29,58±2,16 semanas e peso medio ao nascer 1012,68±274,16 g, com predominância do sexo feminino (57,1%) e da doenca das membranas hialinas (90,4%). As medias das variaveis estudadas, respectivamente pressao arterial sistolica, diastolica e (media), em mmHg, foram: momento A, 71,32 x 40,56 (53,04); momento B, 69,93 x 39,41 (51,98); e momento C, 74,29 x 43,75 (54,82). A PA dos recem-nascidos permaneceu dentro dos valores fisiologicos apos os procedimentos fisioterapeuticos e de aspiracao, portanto as intervencoes fisioterapeuticas realizadas nao podem ser consideradas prejudiciais para os RNPT; a aspiracao endotraqueal teve maior influencia nas oscilacoes da PA.

Characterization of the motor performance of newborns in a neonatal unit of tertiary level

Objective: To characterize the motor performance of newborns in a neonatal unit of tertiary level and compare the results to the values recommended by the Test of Infant Motor Performance (TIMP). Method: Newborns between 34 and 416/7 weeks of corrected gestational age, breathing spontaneously and presenting state of consciousness 4 or 5, according to Brazelton, were included. TIMP was used to evaluate the motor performance. Results: The age groups of 34-35 and 36-37 weeks showed on average TIMP scores similar to the reference values (p>0.05), while in the age groups of 38-39 weeks and 40-41 weeks TIMP scores were statistically lower than the reference values (p<0.001 and p=0.018, respectively). The 34-35 and 36-37 week groups were rated as average, while the 38-39 and 40-41 week groups were defined as low average. Classifications below average and very below average were not observed. Conclusion: The newborns showed average scores compared to the TIMP reference values; however, there were two groups whose performances were within the low average. There was no significant difference in motor performance of newborns in the age groups of 38-39 and 40-41 weeks. This behavior suggests that the sample studied has special features that possibly negatively influenced their motor performance. The results showed that the TIMP is a very useful tool and can be used safely in tertiary neonatal units.

Repercussões da hiperinsuflação manual em recém-nascidos pré-termo sob ventilação mecânica.

Objective To assess the effects of manual hyperinflation, performed with a manual resuscitator with and without the positive end-expiratory pressure valve, on the respiratory function of preterm newborns under mechanical ventilation. Methods Cross-sectional study of hemodynamically stable preterm newborns with gestational age of less than 32 weeks, under mechanical ventilation and dependent on it at 28 days of life. Manual hyperinflation was applied randomly, alternating the use or not of the positive end-expiratory pressure valve, followed by tracheal aspiration for ending the maneuver. For nominal data, the two-tailed Wilcoxon test was applied at the 5% significance level and 80% power. Results Twenty-eight preterm newborns, with an average birth weight of 1,005.71 ± 372.16g, an average gestational age of 28.90 ± 1.79 weeks, an average corrected age of 33.26 ± 1.78 weeks, and an average mechanical ventilation time of 29.5 (15 - 53) days, were studied. Increases in inspiratory and expiratory volumes occurred between time-points A5 (before the maneuver) and C1 (immediately after tracheal aspiration) in both the maneuver with the valve (p = 0.001 and p = 0.009) and without the valve (p = 0.026 and p = 0.001), respectively. There was also an increase in expiratory resistance between time-points A5 and C1 (p = 0.044). Conclusion Lung volumes increased when performing the maneuver with and without the valve, with a significant difference in the first minute after aspiration. There was a significant difference in expiratory resistance between the time-points A5 (before the maneuver) and C1 (immediately after tracheal aspiration) in the first minute after aspiration within each maneuver.