Avaliação da administração do Palivizumabe em pacientes prematuros no período neonatal e no seguimento ambulatorial no primeiro ano de vida
Carregando...
Arquivos
Data
2021-07-12
Autores
Santos, Ivana Dalcol Rodrigues dos [UNESP]
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
O vírus sincicial respiratório (VSR) é um dos principais responsáveis por infecções respiratórias em prematuros (PT) e pacientes com doença pulmonar crônica (DPC). Existe um programa de administração do Palivizumabe (PVZ) do Ministério da Saúde (MS) para esses pacientes. Objetivos: Avaliar a cobertura do PVZ em PT ≤ 28 semanas de idade gestacional (IG) e/ou com DPC na internação e no seguimento ambulatorial durante o 1º ano de vida, e compará-los em 2 grupos: com e sem displasia broncopulmonar, DBP (dependência de oxigênio com 36 semanas de idade pós conceptual); identificar se os pacientes que receberam PVZ de acordo com a recomendação do MS (5 doses dentro do período de sazonalidade, consecutivas ou não), apresentaram infecção por VSR; determinar a incidência de re-internação por VSR e a mortalidade. Métodos: Estudo longitudinal, retrospectivo, realizado na Unidade Neonatal, no ambulatório de seguimento e no Centro de Referência de Imunobiológicos Especiais do HC, no período de 2016-19. Foram incluídos PT≤ 28 semanas de IG ou portadores de DPC (dependência de oxigênio por 28 dias), que receberam alta da Unidade e que foram encaminhados ao ambulatório de seguimento de PT, durante o 1ºano de vida. Variáveis: maternas, neonatais, re-internações por infecções respiratórias e por VSR, nº de doses de PVZ previstas e recebidas durante a internação e no seguimento e morte por VSR. Comparação entre grupos: com e sem DBP. Análise estatística: descritiva e comparação entre grupos com testes paramétricos e não paramétricos, com p<0,05. Resultados: Foram incluídos 93 PT com IG e PN médios de 27sem e 6 dias e 1020g. DBP ocorreu em 52% dos casos e 11% receberam alta com oxigênio. A administração do PVZ durante a internação foi de 85% e no seguimento ambulatorial foi de 71%. O número de PT que não receberam o PVZ foi maior no grupo sem DBP (2% vs 15,5%). O esquema de 5 doses foi aplicado em 70% de ambos os grupos. A re-internação ocorreu em 28 casos, 30%, sendo 10% (9/93 casos) por VSR, sem diferença entre os grupos. 4 pacientes internaram em UTI, mas não houveram mortes. Conclusão: Houve menor adesão na imunização dos pacientes com PVZ no seguimento ambulatorial. PT sem DBP foram os que mais deixaram de receber a imunoglobulina. A infecção por VSR foi baixa sem diferença entre os grupos e sem mortes. Estratégias para otimizar o uso da imunoglobulina são necessárias.
Respiratory syncytial virus (RSV) is one of the most important agent of respiratory infections in premature infants (PT), patients with chronic lung disease (CLD). There is a program for administering Palivizumab (PVZ) by the Ministry of Health (MS) for these patients. Objectives: To evaluate the coverage of PVZ in PT ≤ 28 weeks of gestational age (GA) and/or with CLD at admission and in outpatient follow-up during the 1 st year of life, and compare them into 2 groups: with and without bronchopulmonary dysplasia BPD (oxygen dependence at 36 weeks post-conceptual age); identify whether patients who received PVZ as recommended by the MS (5 doses within the seasonality period, consecutive or not) had RSV infection; determine the incidence of readmission for RSV and the mortality. Methods: longitudinal, retrospective study, carried out at the Neonatal Unit, at the follow-up clinic and at the Reference Center for Special Immunobiologicals of the clinical hospital Botucatu, in the period 2016-19. PT≤ 28 weeks of GA or patients with CLD (dependence on oxygen for 28 days), who were discharged from the Unit and who were referred to the PT follow-up clinic during the 1st year of life were included. Variables: maternal, neonatal, readmissions for respiratory infections and RSV, number of PVZ doses predicted and received during hospitalization and in follow-up and occurrence of death for RSV. Comparison between groups: with and without BPD. Statistical analysis: descriptive and comparison between groups with parametric and nonparametric tests, with p<0.05. Results: 93 PT with GA and birth weight (BW) of 27 weeks and 6 days and 1020g were included. BPD occurred in 52% of cases and 11% were discharged with oxygen. The administration of PVZ during hospitalization was 85% and in the outpatient follow-up it was 71%. The number of PT who did not receive PVZ was higher in the group without BPD (2% vs 15.5%). The 5-dose regimen was applied in 70% of both groups. Readmission occurred in 28 cases (30%), 10% (9/93cases) due to RSV, with no difference between groups. 4 patients were admitted to the Intensive Care Unit, but there were no deaths. Conclusion: There was a lower adhesion to the immunization of patients with PVZ in the follow-up. PT without BPD were the ones who most stopped receiving immunoglobulin. RSV infection was low with no difference between groups and no deaths. Strategies to optimize the use of immunoglobulin are needed.
Respiratory syncytial virus (RSV) is one of the most important agent of respiratory infections in premature infants (PT), patients with chronic lung disease (CLD). There is a program for administering Palivizumab (PVZ) by the Ministry of Health (MS) for these patients. Objectives: To evaluate the coverage of PVZ in PT ≤ 28 weeks of gestational age (GA) and/or with CLD at admission and in outpatient follow-up during the 1 st year of life, and compare them into 2 groups: with and without bronchopulmonary dysplasia BPD (oxygen dependence at 36 weeks post-conceptual age); identify whether patients who received PVZ as recommended by the MS (5 doses within the seasonality period, consecutive or not) had RSV infection; determine the incidence of readmission for RSV and the mortality. Methods: longitudinal, retrospective study, carried out at the Neonatal Unit, at the follow-up clinic and at the Reference Center for Special Immunobiologicals of the clinical hospital Botucatu, in the period 2016-19. PT≤ 28 weeks of GA or patients with CLD (dependence on oxygen for 28 days), who were discharged from the Unit and who were referred to the PT follow-up clinic during the 1st year of life were included. Variables: maternal, neonatal, readmissions for respiratory infections and RSV, number of PVZ doses predicted and received during hospitalization and in follow-up and occurrence of death for RSV. Comparison between groups: with and without BPD. Statistical analysis: descriptive and comparison between groups with parametric and nonparametric tests, with p<0.05. Results: 93 PT with GA and birth weight (BW) of 27 weeks and 6 days and 1020g were included. BPD occurred in 52% of cases and 11% were discharged with oxygen. The administration of PVZ during hospitalization was 85% and in the outpatient follow-up it was 71%. The number of PT who did not receive PVZ was higher in the group without BPD (2% vs 15.5%). The 5-dose regimen was applied in 70% of both groups. Readmission occurred in 28 cases (30%), 10% (9/93cases) due to RSV, with no difference between groups. 4 patients were admitted to the Intensive Care Unit, but there were no deaths. Conclusion: There was a lower adhesion to the immunization of patients with PVZ in the follow-up. PT without BPD were the ones who most stopped receiving immunoglobulin. RSV infection was low with no difference between groups and no deaths. Strategies to optimize the use of immunoglobulin are needed.
Descrição
Palavras-chave
Prematuridade, Displasia broncopulmonar, Vírus sincicial respiratório, Prevenção, Palivizumabe, Prematurity, Bronchopulmonary dysplasia, Respiratory syncytial virus, Prevention