Coorte de recém-nascidos expostos ao risco infeccioso: avaliação de um novo protocolo
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Data
2023-06-16
Autores
Pereira, Kissila da Silva
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: Muitos recém-nascidos expostos a fatores de risco materno, mesmo assintomáticos, recebem antibióticos inadvertidamente nos primeiros dias de vida. Objetivos: Avaliar a implantação do protocolo de sepse precoce (SP) em recém-nascidos (RN) com idade gestacional (IG) 35 semanas, peso de nascimento (PN) 2.000g, expostos à risco infeccioso, assintomático, admitidos no Alojamento Conjunto (AC) do HCFMB UNESP logo após o nascimento e investigar: quantos evoluíram para sepse e quantos permaneceram assintomáticos, sem coleta de exames e sem antibióticos. Métodos: Estudo de coorte prospectiva realizado no AC- HCFMB, entre julho de 2021 a julho de 2022. Foram incluídos, todos os RN, com IG 35 semanas, PN ≥ 2000g, com fatores de risco de risco para SP, assintomáticos ao nascer internados no AC- HCFMB. Amostra foi constituída de todos que preencheram critérios de inclusão, 172 RN. Foram estudadas variáveis maternas, do parto e neonatais. Desfecho primário: sepse precoce. Sepse precoce foi definida como alterações clínicas, laboratoriais, com ou sem isolamento do agente, nas primeiras 72 horas de vida. Delineamento: Os RN incluídos foram submetidos ao protocolo com avaliação clínica sistematizada e seriada sem coleta de exames, exceto no caso de sinais e sintomas não explicados, múltiplos ou persistentes. Se diagnosticados com sepse, eles eram transferidos para a Unidade Neonatal e iniciado terapia antimicrobiana. Estatística: descritiva com tabelas de frequência e associação. Resultados: No período estudado, foram internados no AC 1795RN e destes 172 foram incluídos. Apenas 4RN (2,4%) foram investigados para sepse. Não houve nenhum caso de sepse e nenhum RN recebeu antibióticos. 60% dos RN apresentaram alguma sintomatologia, que em mais de 80% dos casos foi a hipotermia ambiental, de forma isolada. Conclusão: o protocolo de sepse precoce, com manejo conservador, se mostrou seguro, contribuindo para redução da coleta de exames laboratoriais e do uso de antibióticos, sem impacto negativo no diagnóstico de sepse e na alta hospitalar.
Introduction: Many newborns exposed to maternal risk factors, even asymptomatic, receive antibiotics inadvertently in the first days of life. Objectives: To evaluate the implementation of the early sepsis (SP) protocol in newborns (NB) with gestational age (GA) 35 weeks, birth weight (BW) 2,000g, exposed to infectious risk, asymptomatic, admitted in rooming-in of the HCFMB UNESP shortly after birth and investigate: how many evolved to sepsis and how many remained asymptomatic, without collection of exams and without antibiotics. Methods: Prospective cohort study carried out at rooming-in of HCFMB, from July 2021 to July 2022. All newborns with GA 35 weeks, BW ≥ 2000g, with risk factors for PS, asymptomatic at birth, were included hospitalized at rooming-in of the HCFMB. The sample consisted of all who met the inclusion criteria, 172 NB. Maternal, childbirth and neonatal variables were studied. Primary outcome: early sepsis. Early sepsis was defined as clinical and laboratory alterations, with or without identification of the etiological agent, in the first 72 hours of life. Design: The NB included were submitted to the protocol with systematic and serial clinical evaluation without collection of exams, except in the case of unexplained, multiple, or persistent signs and symptoms. If diagnosed with sepsis, they were transferred to the Neonatal Unit and started on antimicrobial therapy. Statistics: descriptive with frequency and association tables. Results: During the studied period, 1795RN were admitted to the rooming-in and of these 172 were included. Only 4NB (2.4%) were investigated for sepsis. There were no cases of sepsis and no NB received antibiotics. 60% of the newborns presented some symptomatology, which in more than 80% of the cases was isolated environmental hypothermia. Conclusion: the early sepsis protocol, with conservative management, proved to be safe, contributing to a reduction in the collection of laboratory tests and the use of antibiotics, with no negative impact on the diagnosis of sepsis and hospital discharge. Keywords: early sepsis, newborn, infectious risk.
Introduction: Many newborns exposed to maternal risk factors, even asymptomatic, receive antibiotics inadvertently in the first days of life. Objectives: To evaluate the implementation of the early sepsis (SP) protocol in newborns (NB) with gestational age (GA) 35 weeks, birth weight (BW) 2,000g, exposed to infectious risk, asymptomatic, admitted in rooming-in of the HCFMB UNESP shortly after birth and investigate: how many evolved to sepsis and how many remained asymptomatic, without collection of exams and without antibiotics. Methods: Prospective cohort study carried out at rooming-in of HCFMB, from July 2021 to July 2022. All newborns with GA 35 weeks, BW ≥ 2000g, with risk factors for PS, asymptomatic at birth, were included hospitalized at rooming-in of the HCFMB. The sample consisted of all who met the inclusion criteria, 172 NB. Maternal, childbirth and neonatal variables were studied. Primary outcome: early sepsis. Early sepsis was defined as clinical and laboratory alterations, with or without identification of the etiological agent, in the first 72 hours of life. Design: The NB included were submitted to the protocol with systematic and serial clinical evaluation without collection of exams, except in the case of unexplained, multiple, or persistent signs and symptoms. If diagnosed with sepsis, they were transferred to the Neonatal Unit and started on antimicrobial therapy. Statistics: descriptive with frequency and association tables. Results: During the studied period, 1795RN were admitted to the rooming-in and of these 172 were included. Only 4NB (2.4%) were investigated for sepsis. There were no cases of sepsis and no NB received antibiotics. 60% of the newborns presented some symptomatology, which in more than 80% of the cases was isolated environmental hypothermia. Conclusion: the early sepsis protocol, with conservative management, proved to be safe, contributing to a reduction in the collection of laboratory tests and the use of antibiotics, with no negative impact on the diagnosis of sepsis and hospital discharge. Keywords: early sepsis, newborn, infectious risk.
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Palavras-chave
sepse precoce, recém-nascido, risco infeccioso, Early sepsis, Newborn, Infectious risk