OBJETIVOS: Revisar as complicações pulmonares e intervenções fisioterapêuticas disponíveis para recém-nascidos com persistência do canal arterial (PCA). FONTES DE DADOS: Artigos publicados nas fontes de dados Medline e Lilacs, além de capítulos de livros nos idiomas português e inglês, entre 1992 e 2006. As palavras-chave utilizadas para busca foram: "canal arterial", "prematuridade", "síndrome do desconforto respiratório", "complicações" e "pulmão". SÍNTESE DOS DADOS: A PCA é uma intercorrência freqüente em recém-nascidos pré-termos, que pode se associar a complicações pulmonares, tais como atelectasias, infecções pulmonares e falha na extubação, aumentando o tempo de ventilação mecânica e de internação na Unidade de Terapia Intensiva Neonatal. Os recursos fisioterapêuticos visam melhorar as condições pulmonares, propiciando o aumento da complacência pulmonar e a diminuição da resistência de vias aéreas, além de otimizar o mecanismo de depuração mucociliar e, dessa forma, reduzir o trabalho respiratório. CONCLUSÕES: A fisioterapia respiratória contribui para melhorar a evolução dos neonatos com complicações pulmonares por persistência de canal arterial, permitindo otimizar a mecânica respiratória, além de melhorar a oxigenação e a relação ventilação/perfusão.
ObjectiveTo analyze the incidence of early-onset nasal injury in infants with very low
birth weight and indication for noninvasive ventilation via nasal prongs. MethodsA prospective case series of infants with gestational age <37 weeks, weight
<1.500 g and postnatal age <29 days. The patients were evaluated three times
daily from the installation of nasal prongs to the 3rd day of use. The patients'
clinical conditions and the device's characteristics and its application were
analyzed. The initial analysis was descriptive, indicating the prevalence of nasal
injury and factors associated with it. Categorical data were analyzed using the
chi-squared test or Fisher's exact test, and numerical data were analyzed using
the t-test or the Mann-Whitney test. ResultsEighteen infants were included; 12 (with a gestational age of 29.8±3.1 weeks,
birth weight of 1.070±194 g and a Score for Neonatal Acute Physiology - Perinatal
Extension (SNAPPE) of 15.4±17.5) developed nasal injuries (injury group), and 6
(with a gestational age of 28.0±1.9 weeks, weight of 1.003±317 g and SNAPPE of
26.2±7.5) showed no nasal injury (uninjured group). The injury group subjects were
more often male (75% versus 17%), and their injuries appeared after an average of
18 hours, predominantly during the night (75%). ConclusionThe incidence of nasal injury in preterm infants who experienced noninvasive
ventilation via nasal prongs was high, and a study of associated factors may be
planned based on this pilot.
In conclusion, this study suggests that children born prematurely with very low birth weight, especially those who had bronchopulmonary dysplasia present limited functional capacity during exercise.
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