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EFFECTS OF THERAPEUTIC APPROACH ON THE NEONATAL EVOLUTION OF VERY LOW BIRTH WEIGHT INFANTS WITH PATENT DUCTUS ARTERIOSUS
Alternative title
Efeitos da abordagem terapêutica da persistência de canal arterial sobre a evolução neonatal de recém-nascidos de extremo baixo pesoAuthor
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Abstract in Portuguese
Objetivo: analisar os efeitos da terapêutica adotada para o canal arterial (CA) em recém-nascidos (RN) < 1.000gadmitidos em unidades neonatais (UN) da Rede Brasileira de PesquisasNeonatais (RBPN), sobre os desfechos: óbito, displasia broncopulmonar (DBP), hemorragiaintraventricular grave (HIVIII/IV), retinopatia da prematuridade cirúrgica (ROPcir), enterocolitenecrosante cirúrgica (ECNcir) e o desfecho combinado óbito e DBP.Métodos: estudo multicêntrico, de coorte, coleta de dados retrospectiva, incluindo RN de 16UN da RBPN de 01/01/2010 a 31/12/2011, PN < 1.000 g, idade gestacional (IG) < 33 semanase diagnóstico ecocardiográfico de PCA. Excluídos: óbitos ou transferências até o terceiro diade vida, infecc¸ões congênitas ou malformac¸ões. Grupos: G1 --- conservadora (sem intervenc¸ãomedicamentosa ou cirúrgica), G2 --- farmacológica (indometacina ou ibuprofeno) e G3 --- cirúrgico(com ou sem tratamento farmacológico anterior). Analisou-se: uso de esteroide antenatal, partocesárea, PN, IG, Apgar5’ < 4, sexo masculino, SNAPPE II, síndrome do dDesconforto respiratório (SDR), sepse tardia, ventilac¸ão mecânica (VM), surfactante < 2 horas de vida, tempo de VMe os desfechos: óbito, dependência de oxigênio com 36 semanas (DBP36s), HIV III/IV, ROPcir,ECNcire óbito/DBP36s. Estatística: Teste t-Student, Qui-Quadrado ou teste Exato de Fisher.Testes de Regressão Binária Logística e Regressão Múltipla Stepwise Backward. MedCalc (MedicalCalculator) software, versão 12.1.4.0.p < 0,05.Resultados: foram selecionados 1.097 RN e 494 foram incluídos: G1-187 (37,8%), G2-205 (41,5%)e G3-102 (20,6%). Verificou-se: maior mortalidade (51,3%) no G1 e menor no G3(14,7%); maiorfrequência DBP36s(70,6%) e ROPcir(23,5%) no G3; maior frequência de óbito/DBP36sno G2(58,0%). As abordagens farmacológica (OR-0,29; 95%, IC-0,14-0,62) e conservadora (OR-0,34;95%, IC- 0,14-0,79) foram protetoras somente para o desfecho óbito/DBP36sem.Conclusão: em RN com PCA, a abordagem conservadora relacionou-se à maior mortalidade,a cirúrgica à ocorrência de DBP36se ROPcir., enquanto o tratamento farmacológico mostrou-seprotetor para o desfecho óbito/DBP 36sem.
Abstract
Objective: to analyze the effects of treatment approach on the outcomes of newborns (birthweight [BW] < 1,000 g) with patent ductus arteriosus (PDA), from the Brazilian NeonatalResearch Network (BNRN) on: death, bronchopulmonary dysplasia (BPD), severe intraventricu-lar hemorrhage (IVH III/IV), retinopathy of prematurity requiring surgical (ROPsur), necrotizingenterocolitis requiring surgery (NECsur), and death/BPD.Methods: this was a multicentric, cohort study, retrospective data collection, including new-borns (BW < 1000 g) with gestational age (GA) < 33 weeks and echocardiographic diagnosis ofPDA, from 16 neonatal units of the BNRN from January 1, 2010 to Dec 31, 2011. Newborns whodied or were transferred until the third day of life, and those with presence of congenital mal-formation or infection were excluded. Groups: G1 --- conservative approach (without treatment),G2 --- pharmacologic (indomethacin or ibuprofen), G3 --- surgical ligation (independent of previ-ous treatment). Factors analyzed: antenatal corticosteroid, cesarean section, BW, GA, 5 min.Apgar score < 4, male gender, Score for Neonatal Acute Physiology Perinatal Extension (SNAPPEII), respiratory distress syndrome (RDS), late sepsis (LS), mechanical ventilation (MV), surfac-tant (< 2 h of life), and time of MV. Outcomes: death, O2dependence at 36 weeks (BPD36wks),IVH III/IV, ROPsur, NECsur, and death/BPD36wks.Statistics: Student’s t-test, chi-squared test, orFisher’s exact test; Odds ratio (95% CI); logistic binary regression and backward stepwise mul-tiple regression. Software: MedCalc (Medical Calculator) software, version 12.1.4.0. p-values <0.05 were considered statistically significant.Results: 1,097 newborns were selected and 494 newborns were included: G1 - 187 (37.8%), G2- 205 (41.5%), and G3 - 102 (20.6%). The highest mortality was observed in G1 (51.3%) and thelowest in G3 (14.7%). The highest frequencies of BPD36wks(70.6%) and ROPsurwere observed inG3 (23.5%). The lowest occurrence of death/BPD36wksoccurred in G2 (58.0%). Pharmacological(OR 0.29; 95% CI: 0.14-0.62) and conservative (OR 0.34; 95% CI: 0.14-0.79) treatments wereprotective for the outcome death/BPD36wks.Conclusion: the conservative approach of PDA was associated to high mortality, the surgicalapproach to the occurrence of BPD36wksand ROPsur, and the pharmacological treatment wasprotective for the outcome death/BPD36wks.
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