Perfil de sobrevida e alterações no ultrassom transfontanelar em prematuros menores que 32 semanas
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Data
2011-08-18
Autores
Castro, Márcia Pimentel de [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Avaliar a sobrevida de recém-nascidos (RN) prematuros de acordo com a idade gestacional e peso ao nascer, e identificar as complicações da prematuridade associadas à maior mortalidade. Estudo prospectivo do tipo coorte. Foram incluídos RN entre 25 e 31 semanas e 6 dias nascidos vivos sem anomalias congênitas, e admitidos na UTI neonatal do Hospital Regional da Asa Sul, Brasília, entre 1º de agosto de 2009 e 31 de outubro de 2010. Os óbitos em sala de parto, não foram incluídos. Os RN foram estratificados em três faixas de idade gestacional: 25 a 27 semanas e 6 dias; 28 a 29 semanas e 6 dias; 30 a 31 semanas e 6 dias e acompanhados até 28 dias de vida. Variáveis independentes: dados gestacionais, de nascimento e evolução neonatal. Desfechos: sobrevida aos 28 dias e alterações no ultrassom de crânio. Para análise dos resultados utilizou-se o teste do Qui-quadrado, análise de variância, teste de Kruskal-Wallis, razão de risco com intervalo de confiança e regressão logística múltipla, com significância em 5%. A coorte compreendeu 198 prematuros < 32 semanas, estratificados em três grupos: G1=59 (25 a 27semanas e 6 dias), G2=43 (28 a 29 semanas e 6 dias) e G3=96 (30-31 semanas e 6 dias). Corioamnionite e reanimação ao nascimento foram mais frequentes em G1 e G2. Parto vaginal e RN PIG foram mais frequentes em G1. A morbidade neonatal foi inversamente proporcional à idade gestacional, exceto a enterocolite necrosante e a leucomalácia periventricular, que não diferiram entre os grupos. O risco de óbito foi significativamente maior em G1 e G2 em relação ao G3 (RR:4,14; IC:2,23-7.68 e RR=2,84; IC:1,41-5.74), respectivamente. A sobrevida em G1 foi de 52,5%, em G2 foi 67,4% e em G3 88,5%. A partir de 27 semanas e do peso de 700g a sobrevida foi maior que 50%. A regressão logística mostrou...
To assess the survival rates of premature infants according to gestational age and birth weight, and to identify complications of prematurity associated with higher mortality. Prospective cohort study. Preterm infants with gestational age between 25 and 31 weeks and 6 days, born alive without congenital anomalies, and admitted in the NICU of Hospital Regional da Asa Sul, Brasília, between August 1st 2009 and October 31, 2010 were included. Neonates who died in the delivery room were excluded. Neonate were stratified into three gestational age groups: 25- 27 weeks and 6 days; 28- 29 weeks and 6 days; 30-31 weeks and 6 days, and followed until 28 days of life. Gestational data, delivery data and neonatal course were analyzed. Outcome: survival at 28 days and cranial ultrasound abnormalities. Data analysis was performed using the chi-square test, analysis of variance and the Kruskal-Wallis test, hazard ratio with confidence interval and multiple logistic regression. The level of significance was 5%. The cohort comprised 198 preterm infants less than 32 weeks, stratified into three groups: G1=59 (25-27weeks and 6 days), G2=43 (28- 29 weeks and 6 days) and G3=96 (30-31 weeks and 6 days). Chorioamnionitis and resuscitation in the delivery room were more frequent in G1 and G2. Vaginal delivery and newborns small for gestational age occurred significantly more in G1. Neonatal morbidity was inversely proportional to gestational age, except for necrotizing enterocolitis and leukomalacia that did not differ between the groups. The risk of death was significantly higher in groups 1 and 2 compared to 3 (RR: 4.14, CI: 2,23-7 .68 and RR = 2.84, CI:1,41 5-.74), respectively. The logistic regression analysis showed that pulmonary hemorrhage (OR: 3.33, 95% CI 1.41 to 7.90) and hyaline membrane disease... (Complete abstract click electronic access below)
To assess the survival rates of premature infants according to gestational age and birth weight, and to identify complications of prematurity associated with higher mortality. Prospective cohort study. Preterm infants with gestational age between 25 and 31 weeks and 6 days, born alive without congenital anomalies, and admitted in the NICU of Hospital Regional da Asa Sul, Brasília, between August 1st 2009 and October 31, 2010 were included. Neonates who died in the delivery room were excluded. Neonate were stratified into three gestational age groups: 25- 27 weeks and 6 days; 28- 29 weeks and 6 days; 30-31 weeks and 6 days, and followed until 28 days of life. Gestational data, delivery data and neonatal course were analyzed. Outcome: survival at 28 days and cranial ultrasound abnormalities. Data analysis was performed using the chi-square test, analysis of variance and the Kruskal-Wallis test, hazard ratio with confidence interval and multiple logistic regression. The level of significance was 5%. The cohort comprised 198 preterm infants less than 32 weeks, stratified into three groups: G1=59 (25-27weeks and 6 days), G2=43 (28- 29 weeks and 6 days) and G3=96 (30-31 weeks and 6 days). Chorioamnionitis and resuscitation in the delivery room were more frequent in G1 and G2. Vaginal delivery and newborns small for gestational age occurred significantly more in G1. Neonatal morbidity was inversely proportional to gestational age, except for necrotizing enterocolitis and leukomalacia that did not differ between the groups. The risk of death was significantly higher in groups 1 and 2 compared to 3 (RR: 4.14, CI: 2,23-7 .68 and RR = 2.84, CI:1,41 5-.74), respectively. The logistic regression analysis showed that pulmonary hemorrhage (OR: 3.33, 95% CI 1.41 to 7.90) and hyaline membrane disease... (Complete abstract click electronic access below)
Descrição
Palavras-chave
Prematuros - Doenças - Diagnóstico, Neonate - Brain injuries
Como citar
CASTRO, Márcia Pimentel de. Perfil de sobrevida e alterações no ultrassom transfontanelar em prematuros menores que 32 semanas. 2011. 53 f. Dissertação (mestrado) - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, 2011.