Função pulmonar em crianças de seis meses a um ano de idade corrigida, nascidas prematuras de muito baixo peso

Função pulmonar em crianças de seis meses a um ano de idade corrigida, nascidas prematuras de muito baixo peso

Alternative title Lung function in children aged six months to one year of corrected age, born prematurely with very low birth weight
Author Goncalves, Daniela de Melo Miranda Autor UNIFESP Google Scholar
Advisor Dos Santos, Amelia Miyashiro Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Graduate program Pediatria e Ciências Aplicadas à Pediatria – EPM
Abstract Objetivos: Avaliar a funcao pulmonar e fatores associados a menores parametros de funcao pulmonar em lactentes de seis meses a um ano de idade corrigida, scidos prematuros de muito baixo peso. Metodos: Estudo transversal realizado apos assinatura do Termo de Consentimento e aprovacao do Comite de Etica da instituicao. Incluiram-se lactentes de 6 meses a um ano de idade corrigida, nascidos prematuros com peso <1500g. Excluiram-se criancas com alformacoes, doencas neuromusculares e doencas respiratorias agudas ha menos de 15 dias. Foram coletados dados sobre antecedentes neonatais, evolucao clinica neonatal e posneonatal, historia previa de sibilancia utilizando-se o questionario elaborado pelo Estudo Internacional sobre Prevalencia de Sibilancia Recorrente em Lactentes e provas de funcao pulmonar. Os volumes pulmonares foram avaliados por pletismografia de corpo total com o pletismografo de 90 litros e os fluxos expiratorios forcados pela tecnica de compressao toracica utilizando-se o equipamento Infant Pulmonary Lab (Collins-nSpire, EUA), apos sedacao com dose unica de 60 a 80 mg/kg de hidrato de cloral. Resultados: Foram estudados 51 lactentes de 8,2 ± 1,9 meses de idade corrigida, nascidos com 30,0 ± 2,5 semanas de gestacao e peso de 1179 ± 247g. Na unidade neonatal, 26 (51,0%) prematuros apresentaram sindrome de desconforto respiratorio, 28 (54,9%) apneia, 13 (25,5%) persistencia de canal arterial, 10 (19,6%) sepse precoce, 10 (19,6%) sepse tardia, 20 (39,2%) hemorragia peri-intraventricular, 14 (27,5%) dependencia de oxigenio com 28 dias de vida, 7 (13,7%) dependencia de oxigenio com 36 semanas de idade gestacional corrigida, 23 (45,1%) foram submetidos a ventilacao mecanica e o tempo de internacao foi em mediana 53 dias. Apos a alta da unidade neonatal, 25 (49,0%) prematuros apresentaram infeccoes de vias aereas superiores, 34 (66,7%) apresentaram pelo menos um episodio de siblilancia sendo 10 (19,6%) com sibilancia recorrentes, 18 (35,3%) bronquiolite, 9 (17,6%) pneumonia e 20 (39,2%) necessitaram de internacao hospitalar. Em relacao a fatores de risco para asma, 17 (33,3%) criancas apresentavam historia familiar de asma, 30 (58,8%) de rinite, 8 (15,7%) de dermatite atopica, 20 (39,2%) tinham animal de estimacao no domicilio, 23 (45,1%) eram expostos ao fumo domiciliar, 17 (33,3%) apresentavam mofo na casa e 3 (5,9%) frequentavam creches. Trinta (58,8%) criancas receberam leite materno ate um mes e 10 (19,6%) ate seis meses de idade. A porcentagem de lactentes que presentaram valores preditos <80% ou <-2 escores-z para os parametros avaliados foram: CPT (8,5%), VRE (14,3%), CRF (6,4%), VR (10,6%), VRE/CPT (10,6%), VC (11,8%), CVF (9,8%), VEF0,5 (11,8%), FEF50 (9,8%), FEF75 (7,8%), FEF85 (7,8%), FEF25-75 (11,8%), perfazendo 20 (39,2%) lactentes com funcao pulmonar alterada, sendo 15 (29,4%) de carater obstrutivo, 4 (7,8%) restritivo e 1 (2,0%) misto. Na regressao linear univariada, os fatores associados a menores escores de funcao pulmonar foram: dependencia de oxigenio com 28 dias para FEF25-75 (-0,651), com 36 semanas para FEF75 (-0,864), FEF85 (-0,692) e FEF25-75, (-0,961), ventilacao mecanica para FEF0,5/CVF (-1,099), FEF50 (-0,988), FEF75 (-0,543), FEF85 (-0,53) e FEF25-75 (-0,730). Na regressa linear multipla, associaram-se a menores parametros de funcao pulmonar: ser pequeno para a idade gestacional com escore-z de CVF (-1,005; p=0,007) e escore-z de VEF0,5 (-0,643; p=0,032); ter menor idade gestacional com escore-z de CVF (0,215; p=0,014) e % do valor previsto para CRF (-2,205; p=0,048), receber ventilacao mecanica para escore-z de VEF0,5 (-0,659; p=0,022) e escore-z de FEF25-75 (-0,602; p=0,030); e apresentar sibilos recorrentes para % do valor previsto para CRF (16,925; p=0,011). Conclusoes: Lactentes nascidos prematuros de muito baixo peso apresentaram alta prevalencia de funcao pulmonar alterada, sobretudo de carater obstrutivo. Os fatores associados a menores escores de funcao pulmonar foram: menor idade gestacional, pequeno para a idade gestacional e ventilacao mecanica

Objectives: To assess pulmonary function and factors associated with lower parameters of pulmonary function in relation to the predicted value in children aged 6 months to 1 year of corrected age born prematurely with very low birthweight. Methods: This is cross - sectional study approved by the Ethics Committee of the institution and performed after parents have signed a consent form . Children aged 6 months to 1 year of corrected age born prematurely with birth weight <1500g were included. Children with malformation, neuromuscular and acute respiratory diseases In the last 15 days were excluded. The following step were performed: data collection in regard to the neonatal and post - neonatal clinical evolution by chart review; assessmentof the history of wheezing during infancy using a questionnaire of The International Study on Prevalence of Recurrent Wheezing in Children and assessment of the pulmonary function. Pulmonary volumes were evaluated by total body plethymography with a 90 liters plethysmograph, and forced respiratory flow by the chest compression technique using the Infant Pulmonary Lab equipment (Collins - nSpire, USA), after sedation with a single dose of 60 to 80 mg/kg of chloral hydrate. Results: Fifty one children with 8. 2±1. 9months of corrected age, born with 30. 0 ±2. 5 weeks of gestation and weight of 1179 ±247g were studied. In the Neonatal Unit, 26 (51.0%) preterm neonates presented respiratory distress syndrome, 28 (54.0%) apnea, 13 (25.5%) patent ductus arteriosus, 10 (19.6%) early sepsis, 10 (19.6%) late sepsis, 20 (39.2%) peri-intraventricular hemorrhage, 14 (27.5%) oxygen dependence at 28 days of life, 7 (13.7%) oxygen dependence at 36 weeks of corrected gestational age, 23 (45.1%) were submitted to mechanical ventilation and the hospitalization period was 53 days in median. After being discharged from neonatal unit, 25 (49.0%) children developed upper airway respiratory tract infection, 34 (66.7%) presented at least one episode of wheezing, being 10 (19.6%) with recurrent wheezing, 18(35.3%) had bronchiolitis, 9 (17.6%) pneumonia and 20 (39.2%) needed hospitalization . In regard to the risk factors for the development of asthma, 17 (33.3%) children presented family history of asthma, 30 (58.8%) of rhinitis, 8 (15.7%) of atopic dermatitis, 20 (39.2%) had pets at home, 23 (45.1%) were exposed to smoking at home, 17 (33.3%) had mold in their houses and 3 (5.9%) attended day care centers. Thirty (58.8%) infants were breastfed until one month of age and 10 (19.6%) until six months of age. The percentage of children who presented predicted values <80% or <-2 Z score for the assessed pulmonary parameters were: TL C (8.5%), VRE (14.3%), FRC (6.4%), RV (10.6%), VRE/TLC (10.6%), VC (11.8%) FVC (9.8%), FEV 0.5(11.8%), FEF 50 (9.8%), FEF 75 (7.8%), FEF 85 (7.8%), FEF 25 -75 (11.8%), totaling 20 (39.2%) feeding infants with deficit of pulmonary function, being 15 (29.4%) obstructive, 4 (7.8%) restrictive and 1 (2.0%) mixed. By univariate linear regression analysis, the factors associated with lower scores of lung function were: dependence of oxygen at 28 days for FEF 25 -75 (-0.651); dependency at 36 weeks for FEF 75 (-0, 864), FEF 85 (-0.692) and FEF 25 -75 (- 0.961); and mechanical ventilation For FEF 0.5 /FVC (- 1.099), FEF 50 (- 0.988), FEF 75 (- 0.543), FEF 85 (-0.53), and FEF 25 -75 (- 0.730).By multiple linear regression, being small for gestational age was associated with lower Z-score for FVC (-1.005; p=0.007) and lower Z-score for FEV 0,5 (-0.643; p=0.032); having lower gestational age with a Z-score for FVC (0.215; p=0.014) and % of the estimated value for FRC (-2.205; p=0.048), receiving mechanical ventilation to a Z-score of FEV 0.5 (-0.659; p=0.022) and a Z-score for FEF 25 - 75 (-0.602; p=0.030); and presenting recurrent wheezing For % of the estimated value for FRC (16.925; p=0. 011). Conclusions: Children born prematurely with very low weight presented high prevalence of abnormal lung function, especially of obstructive nature. The factors associated to lower scores of lung function parameters were: low gestational age, being small for gestational age and need for mechanical ventilation.
Keywords Prematuro
Criança
Respiração Artificial
Displasia Broncopulmonar
Language Portuguese
Date 2014
Published in GONÇALVES, Daniela de Melo Miranda. Função pulmonar em crianças de seis meses a um ano de idade corrigida, nascidas prematuras de muito baixo peso. 2014. 90 f. Dissertação (Mestrado em Ciências) – Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo, 2014.
Publisher Universidade Federal de São Paulo (UNIFESP)
Extent 90 p.
Access rights Open access Open Access
Type Dissertation
URI http://repositorio.unifesp.br/handle/11600/23103

Show full item record




File

Name: Tese-14344.pdf
Size: 923.3Kb
Format: PDF
Description:
Open file

This item appears in the following Collection(s)

Search


Browse

Statistics

My Account