Neonatal risk factors for respiratory morbidity during the first year of life among premature infants

Abstract

CONTEXT AND OBJECTIVE: There have been dramatic increases in very low birth weight infant survival. However, respiratory morbidity remains problematic. The aim here was to verify associations between pulmonary mechanics, pulmonary structural abnormalities and respiratory morbidity during the first year of life. DESIGN AND SETTING: Prospective cohort study at Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro. METHODS: Premature infants with birth weight < 1500 g were studied. Lung function tests and high-resolution chest tomography were performed before discharge. During the first year, infants were assessed for respiratory morbidity (obstructive airways, pneumonia or hospitalization). Neonatal lung tests and chest tomography and covariables potentially associated with respiratory morbidity were independently assessed using relative risk (RR). RR was subsequently adjusted via logistic regression. RESULTS: Ninety-seven newborn infants (mean birth weight: 1113g; mean gestational age: 28 weeks) were assessed. Lung compliance and lung resistance were abnormal in 40% and 59%. Tomography abnormalities were found in 72%; respiratory morbidity in 53%. Bivariate analysis showed respiratory morbidity associated with: mechanical ventilation, prolonged oxygen use (beyond 28 days), oxygen use at 36 weeks, respiratory distress syndrome, neonatal pneumonia and patent ductus arteriosus. Multivariate analysis gave RR 2.7 (confidence interval: 0.7-10.0) for simultaneous lung compliance and chest tomography abnormalities. Adjusted RR for neonatal pneumonia and mechanical ventilation were greater. CONCLUSIONS: Upon discharge, there were high rates of lung mechanism and tomography abnormalities. More than 50% presented respiratory morbidity during the first year. Neonatal pneumonia and mechanical ventilation use were statistically significant risk factors.

Fatores associados à morbidade respiratória entre 12 e 36 meses de vida de crianças nascidas de muito baixo peso oriundas de uma UTI neonatal pública

“…A rotina de acompanhamento das crianças durante o primeiro ano de vida foi mensal 8,9 , as informações referentes ao período (variáveis só-cio-demográficas, maternas, neonatais e pós-neonatais) foram publicadas previamente 7,8,9 enquanto o acompanhamento, a partir de 12 meses de vida, se caracterizou por consultas trimestrais. A cada consulta trimestral realizada eram coletadas as fichas com registros dos responsáveis sobre a presença de intercorrências respiratórias ocorridas desde a última consulta até a consulta atual, portanto, se a consulta ocorreu no trimestre imediatamente anterior, o registro seria referente a um período de observação de três meses.…”

“…Fatores como: uso de ventilação mecânica, pneumonia neonatal e alteração na função pulmonar apresentaram importante repercussão na incidência de morbidade respiratória no primeiro ano de vida de crianças nascidas prematuras 7,8,9 , porém no nosso meio ainda é pouco conhecido se a morbidade respiratória nessas crianças se ARTIGO ARTICLE mantém elevada e se tal associação se mantém relevante em relação à morbidade respiratória na infância, entre 1 e 3 anos de vida.…”

Validade concorrente e confiabilidade da Alberta Infant Motor Scale em lactentes nascidos prematuros

“…[7][8][9] Preterms may suffer from failure to thrive in terms of both height and weight, from motor development disorders, mental deficiencies, hearing loss, impaired vision, language difficulties, cardiovascular problems, respiratory problems, attention deficits and hyperactivity, among other problems. 3,10 The protocol used for follow-up of patients who have spent time in neonatal intensive care units includes a motor development evaluation and countless tools have been used to help professionals working in the area make more precise functional assessments. [11][12][13] The Alberta Infant Motor Scale (AIMS) is a standardized scale that was developed by Piper & Darrah (1994).…”

Risk factors for cognitive impairment in school-age children born preterm: application of a hierarchical model

“…The study excluded patients with genetic syndromes, congenital infections, congenital malformation and small for the gestational age, according to the criteria by Lubchenco et al 5 . This population was part of a study on risk factors for respiratory disease in the first year of life of VLBW preterm newborns 6 .…”