Sobrevida e morbidade em prematuros com menos de 32 semanas de gestação na região central do Brasil

Abstract

, análise de variância, teste de Kruskal-Wallis, razão de risco com intervalo de confiança (IC) e regressão logística múltipla, com significância em 5%. RESULTADOS: A coorte compreendeu 198 prematuros, sendo G25=59, G28=43 e G30=96. O risco de óbito foi significativamente maior em G25 e G28, em relação ao G30 (RR=4,1; IC95% 2,2-7,6 e RR=2,8; IC95% 1,4-5,7). A sobrevida encontrada foi, respectivamente, 52,5, 67,4 e 88,5%. A partir da 26ª semana e peso ≥700 g, a sobrevida foi superior a 50%. A morbidade foi inversamente proporcional à idade gestacional, exceto para enterocolite necrosante e leucomalácia, que não diferiram entre os grupos. A análise de regressão logística mostrou que a hemorragia pulmonar (OR=3,3; IC95% 1,4-7,9) e a síndrome do desconforto respiratório (OR=2,5; IC95% 1,1-6,1) foram fatores independentes de risco para óbito. Houve predomínio das lesões cerebrais hemorrágicas graves em G25. CONCLUSÕES: Sobrevivência superior a 50% ocorreu a partir da 26ª semana de gravidez e peso ≥700 g. A hemorragia pulmonar e a síndrome do desconforto respiratório foram preditores independentes de óbito. Há necessidade de identificar e instituir práticas para melhorar a sobrevida de prematuros extremos. Abstract PURPOSE:To evaluate the survival and complications associated with prematurity of infants with less than 32 weeks of gestation. METHODS: It was done a prospective cohort study. All preterm infants with a gestational age between 25 and 31 weeks and 6 days, born alive without congenital anomalies and admitted to the NICU between August 1 st , 2009 and October 31 st , 2010 were included. Newborns were stratified into three groups: G25, 25 to 27 weeks and 6 days; G28, 28 to 29 weeks and 6 days; G30, 30 to 31 weeks and 6 days, and they were followed up to 28 days. Survival at 28 days and complications associated with prematurity were evaluated. Data were analyzed statistically by c 2 test, analysis of variance, Kruskal-Wallis test, odds ratio with confidence interval (CI) and multiple logistic regression, with significance set at 5%. RESULTS: The cohort comprised 198 preterm infants (G25=59, G28=43 and G30=96). The risk of death was significantly higher in G25 and G28 compared to G30 (RR=4.14,). Survival was 52.5%, 67.4% and 88.5%, respectively. Survival was greater than 50% in preterm >26 weeks and birth weight ≥700 g. Neonatal morbidity was inversely proportional to gestational age, except for necrotizing enterocolitis and leukomalacia, which did not differ among groups. Logistic regression showed that pulmonary hemorrhage (OR=3.3, 95%CI 1.4-7.9) and respiratory distress syndrome (OR=2.5, 95%CI 1.1-6.1) were independent risk factors for death. There was a predominance of severe hemorrhagic brain lesions in G25. CONCLUSION: Survival above 50% occurred in infants with a gestational age of more than 26 weeks and ≥700 g birth weight. Pulmonary hemorrhage and respiratory distress syndrome were independent predictors of neonatal death. It is necessary to identify the best practices to improve the survival of extrem...

Quality of Life of Preterm Children: Risk and Protective Factors

“…Best cognitive performance of children of our sample can be attributed to neonate risk indexes more favorable than those found in other studies with extremely premature children (Castro, Rugolo, & Margotto, 2012;Leversen et al, 2011), such as low prevalence of extremely low birth weight children and SGA, children with good recovery for clinical risk at 5 minutes after birth and consequent time of reduced hospitalization (median, 52 days). In addition, 51.1% of mothers had completed elementary school; they had 8 or more years of formal education.…”

“…More than half of the sample had respiratory discomfort and asphyxia at birth, features that make the respiratory system more susceptible to new infection; these factors are associated with longer hospital stay and increased hospital readmissions after discharge (Castro et al, 2012), posing difficulty for adaption and development and, consequently, leading to worse quality of life.…”

Predictive factors of the interruption of exclusive breastfeeding in premature infants: a prospective cohort

“…Neonatal morbidity is inversely proportional to gestational age and birth weight. These factors are critical for the infant's survival (19) . Therefore, we believe that birth weight and gestational age are important variables in the context of the feeding of premature infants but should not be considered as isolated factors for the onset and maintenance of infants' breastfeeding.…”

Seguimento ambulatorial de prematuros: acompanhamento nutricional

“…Cerca de 80% de RNPT têm alcançado a sobrevida devido melhorias no cuidado em terapia intensiva. Logo, a existência de ambulatórios de seguimento para atender o prematuro egresso dessas unidades de terapia intensiva é essencial para que haja o acompanhamento e avaliação de riscos que acometem o desenvolvimento a longo prazo destes prematuros 3 .…”