Rosane Reis de Mello

Morbidade respiratória no primeiro ano de vida de prematuros egressos de uma unidade pública de tratamento intensivo neonatal

OBJETIVO: Verificar a incidencia de morbidade respiratoria no primeiro ano de vida de prematuros de muito baixo peso e verificar se existe diferenca na incidencia de morbidade respiratoria no primeiro ano de vida segundo os fatores de risco neonatais. METODOS: O desenho foi de coorte prospectivo. Foram estudados neonatos com peso de nascimento inferior a 1.500 g e idade gestacional inferior a 34 semanas nascidos entre 1998 e 2000. As criancas foram acompanhadas mensalmente no Ambulatorio de Seguimento ate os 12 meses de idade corrigida para a prematuridade. A cada consulta, foi verificada a presenca de sindrome obstrutiva de vias aereas e/ou pneumonia e/ou internacao por problemas respiratorios. Foi calculada a taxa de incidencia de morbidade respiratoria ocorrida no primeiro ano de vida. Utilizou-se teste estatistico para a diferenca de proporcoes (qui-quadrado). RESULTADOS: A amostra compreendeu 97 prematuros. As medias do peso de nascimento e da idade gestacional foram 1.113 g e 28 semanas. Durante o acompanhamento, 28% deles apresentaram sindrome obstrutiva de vias aereas, 36% apresentaram pneumonia e 26% necessitaram de internacao. Morbidade respiratoria ocorreu em 53% das criancas. Houve diferenca significativa entre as taxas de morbidade respiratoria nas criancas que fizeram uso prolongado de oxigenio (83%) e nas que nao fizeram (43%). CONCLUSAO: Mais de 50% das criancas acompanhadas apresentaram intercorrencia respiratoria no curso do primeiro ano de vida. A incidencia de pneumonia e de internacao foi elevada. As criancas que fizeram uso prolongado de oxigenio apresentaram significativamente maior taxa de incidencia de morbidade respiratoria do que as criancas que nao usaram oxigenio prolongadamente.

Valores de predição da avaliação neurológica e ultra-sonográfica cerebral neonatal em relação ao desenvolvimento de prematuros de muito baixo peso

OBJETIVO: Verificar os valores de predicao de dois exames (neurologico e ultra-sonografico) realizados no periodo neonatal, em relacao ao desenvolvimento neuromotor e cognitivo de prematuros. METODO: Foram estudados 70 prematuros com peso de nascimento inferior a 1.500g. A media do peso de nascimento e idade gestacional foram, respectivamente, 1.185g (DP:180) e 32,2 semanas (DP:1,4). Foi realizada avaliacao neurologica pelo metodo de Dubowitz e Dubowitz e ultra-sonografia cerebral por volta de 40 semanas de idade corrigida. Apos a alta do bercario estas criancas foram acompanhadas no ambulatorio de seguimento. RESULTADOS: Com idade media de 21 meses (DP: 4,9) corrigidos para a prematuridade, 25,7% das criancas apresentaram comprometimento neuromotor, e 20,3%, alteracao cognitiva. O exame neurologico neonatal foi mais sensivel que especifico em relacao a alteracao neuromotora (sensibilidade:77,7%, especificidade:57,6%), e cognitiva (sensibilidade: 78,5%, especificidade: 56,4%), e apresentou baixo valor de predicao tanto para alteracao neuromotora (38,9%) quanto cognitiva (31,4%). A ultra-sonografia apresentou elevada especificidade tanto para o desenvolvimento neuromotor (92,3%) quanto cognitivo (89,1%). O valor preditivo da ultra-sonografia foi satisfatorio para anormalidades neuromotoras (69,2%), porem baixo para as alteracoes cognitivas (50,0%). CONCLUSAO: A associacao dos dois exames com resultados anormais apresentou valores de predicao mais elevados para as anormalidades nas duas areas do desenvolvimento.

Lung mechanics and high-resolution computed tomography of the chest in very low birth weight premature infants

CONTEXT Premature infant lung development may be affected by lung injuries during the first few weeks of life. Lung injuries have been associated with changes in lung mechanics. OBJECTIVE To evaluate an association between lung mechanics and lung structural alterations in very low birth weight infants (birth weight less than 1500 g). DESIGN A cross-sectional evaluation of pulmonary mechanics (lung compliance and lung resistance) and high resolution computed tomography of the chest at the time of discharge, in 86 very low birth weight infants born at Instituto Fernandes Figueira, a tertiary public healthcare institution in Rio de Janeiro, Brazil. Lung compliance and resistance were measured during quiet sleep. High resolution computed tomography was performed using Pro Speed-S equipment. MAIN MEASUREMENTS Statistical analysis was performed by means of variance analysis (ANOVA/Kruskal Wallis). The significance level was set at 0.05. RESULTS Abnormal values for both lung compliance and lung resistance were found in 34 babies (43%), whereas 20 (23.3%) had normal values for both lung compliance and lung resistance. The mean lung compliance and lung resistance for the group were respectively 1.30 ml/cm H2O/kg and 63.7 cm H2O/l/s. Lung alterations were found via high-resolution computed tomography in 62 (72%) infants. Most infants showed more than one abnormality, and these were described as ground glass opacity, parenchymal bands, atelectasis and bubble/cyst. The mean compliance values for infants with normal (1.49 ml/cm H2O/kg) high resolution computed tomography, 1 or 2 abnormalities (1.31 ml/cm H2O/kg) and 3 or more abnormalities (1.16 ml/cm H2O/kg) were significantly different (p=0.015). Our data were insufficient to find any association between lung resistance and the number of alterations via high-resolution computed tomography. CONCLUSION The results show high prevalence of lung functional and tomographic abnormalities in asymptomatic very low birth weight infants at the time of discharge. They also show an association between lung morphological and functional abnormalities.

Neonatal sepsis as a risk factor for neurodevelopmental changes in preterm infants with very low birth weight

OBJECTIVE to evaluate neonatal sepsis as a risk factor for abnormal neuromotor and cognitive development in very low birth weight preterm infants at 12 months of corrected age. METHODS this was a prospective cohort study that followed the neuromotor and cognitive development of 194 very low birth weight preterm infants discharged from a public neonatal intensive care unit. The Bayley Scale of Infant Development (second edition) at 12 months of corrected age was used. The outcomes were the results of the clinical/neurological evaluation and the scores of the psychomotor development index (PDI) and mental development index (MDI) of the Bayley Scale of Infant Development II. The association between neonatal sepsis and neuromotor development and between neonatal sepsis and cognitive development was verified by logistic regression analysis. RESULTS mean birth weight was 1,119g (SD: 247) and mean gestational age was 29 weeks and 6 days (SD: 2). Approximately 44.3%(n=86) of the infants had neonatal sepsis and 40.7% (n=79) had abnormal neuromotor development and/or abnormal psychomotor development index (PDI < 85) at 12 months of corrected age. On the mental scale, 76 (39.1%) children presented abnormal cognitive development (MDI<85). Children with neonatal sepsis were 2.5 times more likely to develop changes in neuromotor development (OR: 2.50; CI: 1.23-5.10). There was no association between neonatal sepsis and cognitive development impairment. CONCLUSION neonatal sepsis was an independent risk factor for neuromotor development impairment at 12 months of corrected age, but not for mental development impairment.

Fatores associados à morbidade respiratória entre 12 e 36 meses de vida de crianças nascidas de muito baixo peso oriundas de uma UTI neonatal pública

The aim of this paper was to estimate respiratory morbidity and its determinants for premature infants aged 12 to 36 months. The population comprised 84 infants from a cohort of very low birth weight premature infants. The outcome was the respiratory morbidity incidence rate. The relationship between the independent variables and respiratory morbidity was estimated using a Poisson regression model. From 12 to 24 months of age, 56.3% of children had experienced at least one episode of respiratory disease. >From 24 to 36 months, 38.1% of children were affected. Variables significantly associated with respiratory morbidity were bronchopulmonary dysplasia (RR = 1.9; 95%CI: 1.2-2.9), abnormal lung compliance (RR = 1.6; 95%CI: 1.1-2.3), neonatal pneumonia (RR = 2.8; 95%CI: 1.9-4.0), patent ductus arteriosus (RR = 1.6; 95%CI: 1.1-2.5), and respiratory morbidity in the first year of life (RR = 1.7; 95%CI: 1.2-2.5). The incidence of respiratory morbidity remains high in this group of high-risk infants, which calls for regular follow-up and effective interventions to prevent respiratory disease and to improve the quality of life of these children and their families.

Neonatal risk factors for respiratory morbidity during the first year of life among premature infants

CONTEXT AND OBJECTIVE There have been dramatic increases in very low birth weight infant survival. However, respiratory morbidity remains problematic. The aim here was to verify associations between pulmonary mechanics, pulmonary structural abnormalities and respiratory morbidity during the first year of life. DESIGN AND SETTING Prospective cohort study at Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro. METHODS Premature infants with birth weight < 1500 g were studied. Lung function tests and high-resolution chest tomography were performed before discharge. During the first year, infants were assessed for respiratory morbidity (obstructive airways, pneumonia or hospitalization). Neonatal lung tests and chest tomography and covariables potentially associated with respiratory morbidity were independently assessed using relative risk (RR). RR was subsequently adjusted via logistic regression. RESULTS Ninety-seven newborn infants (mean birth weight: 1113 g; mean gestational age: 28 weeks) were assessed. Lung compliance and lung resistance were abnormal in 40% and 59%. Tomography abnormalities were found in 72%; respiratory morbidity in 53%. Bivariate analysis showed respiratory morbidity associated with: mechanical ventilation, prolonged oxygen use (beyond 28 days), oxygen use at 36 weeks, respiratory distress syndrome, neonatal pneumonia and patent ductus arteriosus. Multivariate analysis gave RR 2.7 (confidence interval: 0.7-10.0) for simultaneous lung compliance and chest tomography abnormalities. Adjusted RR for neonatal pneumonia and mechanical ventilation were greater. CONCLUSIONS Upon discharge, there were high rates of lung mechanism and tomography abnormalities. More than 50% presented respiratory morbidity during the first year. Neonatal pneumonia and mechanical ventilation use were statistically significant risk factors.

Análise situacional do atendimento ambulatorial prestado a recém-nascidos egressos das unidades de terapia intensiva neonatais no Estado do Rio de Janeiro

A diminuicao da mortalidade neonatal contribui para o aumento de criancas que necessitam de maior atencao em relacao a morbidades clinicas e a evolucao do desenvolvimento neuropsicomotor. O objetivo deste estudo foi discutir a situacao da assistencia as criancas egressas das Unidades de Terapia Intensiva Neonatais (UTIN) em cinco unidades em diferentes regioes do Estado do Rio de Janeiro; em nenhuma havia informacoes sobre o perfil dos egressos da UTIN. Evidenciou-se restricao ao acesso e baixa estruturacao da rede em relacao a assistencia prestada a esses bebes. Nao ha uniformidade no atendimento prestado, e ambulatorios especificos para essa populacao concentram-se na cidade do Rio de Janeiro. Constatou-se deficiencia de profissionais nas areas de reabilitacao - fisioterapia motora, terapia ocupacional, fonoaudiologia e psicologia -, e de especialistas para atendimento oftalmologico adequado e para a crianca portadora de deficiencia auditiva. Os autores discutem possiveis explicacoes para essa situacao, propondo a organizacao de um sistema de atendimento em graus de complexidade para poder viabilizar o acesso das criancas de risco a um atendimento diferenciado, importante para deteccao precoce de anormalidades do desenvolvimento.

Predictive factors for neuromotor abnormalities at the corrected age of 12 months in very low birth weight premature infants

BACKGROUND The increase in survival of premature newborns has sparked growing interest in the prediction of their long-term neurodevelopment. OBJECTIVE To estimate the incidence of neuromotor abnormalities at the corrected age of 12 months and to identify the predictive factors associated with altered neuromotor development in very low birth weight premature infants. METHOD Cohort study. The sample included 100 premature infants. The outcome was neuromotor development at 12 months classified by Bayley Scale (PDI) and neurological assessment (tonus, reflexes, posture). A multivariate logistic regression model was constructed. Neonatal variables and neuromotor abnormalities up to 6 months of corrected age were selected by bivariate analysis. RESULTS Mean birth weight was 1126g (SD: 240). Abnormal neuromotor development was presented in 60 children at 12 months corrected age. CONCLUSION According to the model, patients with a diagnosis including bronchopulmonary dysplasia, hypertonia of lower extremities, truncal hypotonia showed a 94.0% probability of neuromotor involvement at 12 months.

Justificativas para uso de suplemento em recém-nascidos de baixo risco de um Hospital Amigo da Criança

The Baby-Friendly Hospital Initiative recommends not giving newborn infants any food or drink other than breast milk unless medically indicated. This study investigated the prevalence and alleged reasons for giving formula supplementation to rooming-in newborns at a Baby-Friendly Hospital. Participants were 300 formula-supplemented, exclusively rooming-in newborns at a Baby-Friendly Hospital in Rio de Janeiro, Brazil. Reasons for formula supplementation were classified as acceptable or unacceptable in accordance with the WHO/UNICEF Baby-Friendly Hospital Initiative guidelines. A supplementation prevalence of 33.3% was found. The main allegations were: hypogalactia/ agalactia (36.8%), conditions involving risk of hypoglicemia (21.1%), cesarean section (7.9%), stomatognathic system-related conditions (7.4%), maternal conditions (6.3%), and absence of maternal HIV serology (4.5%). Cesarean section was associated with a higher risk of supplementation (RP = 2.1; 95%CI: 1.77-2.55) as compared to vaginal delivery. Supplementation prevalence was high, and only 9% of the allegations were justified.

Bronchopulmonary dysplasia as a predictor factor for motor alteration at 6 months corrected age in premature infants

OBJECTIVE The study aimed to assess bronchopulmonary dysplasia (BPD) as a predisposing factor for alteration in the psychomotor development index (PDI) in premature infants and verify the incidence of neuromotor alterations at 6 months corrected age. METHOD This was a prospective cohort study that followed the neuromotor development of 152 very low birth weight premature infants, with psychomotor development index as the outcome. The study used the Bayley Scale of Infant Development at 6 months corrected age, and neurological examination. RESULTS Incidence of BPD was 13.2% (n = 20). Logistic regression analysis showed an association between BPD and altered psychomotor development index (OR 3.98; 95%CI: 1.04-15.1) after adjusting for confounding variables. Neurological examination was altered in 67.1% of the 152 infants. CONCLUSION Bronchopulmonary dysplasia acted as an independent predisposing factor for alteration in the psychomotor development index in premature infants at 6 months corrected age.