ABSTRACT
OBJECTIVE: To evaluate the temporal trend of bronchopulmonary dysplasia (BPD) in preterm infants who survived to at least 36 weeks' post-menstrual age (PMA) and BPD or death at 36 weeks' PMA, and to analyse variables associated with both outcomes. DESIGN: Retrospective cohort with data retrieved from an ongoing national registry. SETTING: 19 Brazilian university public hospitals. PATIENTS: Infants born between 2010 and 2019 with 23-31 weeks and birth weight 400-1499 g. MAIN OUTCOME MEASURES: Temporal trend was evaluated by Prais-Winsten model and variables associated with BPD in survivors or BPD or death were analysed by logistic regression. RESULTS: Of the 11 128 included infants, BPD in survivors occurred in 22%, being constant over time (annual per cent change (APC): -0.80%; 95% CI: -2.59%; 1.03%) and BPD or death in 45%, decreasing over time (APC: -1.05%; 95% CI: -1.67%; -0.43%). Being male, small for gestational age, presenting with respiratory distress syndrome, air leaks, needing longer duration of mechanical ventilation, presenting with treated patent ductus arteriosus and late-onset sepsis were associated with an increase in the chance of BPD. For the outcome BPD or death, maternal bleeding, multiple gestation, 5-minute Apgar <7, late-onset sepsis, necrotising enterocolitis and intraventricular haemorrhage were added to the variables reported above as increasing the chance of the outcome. CONCLUSION: The frequency of BPD in survivors was constant and BPD or death decreased by 1.05% at each study year. These results show some improvement in perinatal care in Brazilian units which resulted in a reduction of BPD or death, but further improvements are still needed to reduce BPD in survivors.
ABSTRACT
Este estudo foi realizado por meio de entrevistas com médicos da região da Associação dos Municípios do Meio Oeste Catarinense (AMMOC). O objetivo foi avaliar se as vontades antecipadas de um paciente serão respeitadas pelos médicos no momento em que estiver incapacitado de se comunicar e se essa manifestação constitui um instrumento válido de inibição da distanásia. Entre os resultados encontrou-se que os médicos consideram conveniente o registro dos desejos do paciente por meio da declaração de vontade antecipada e as respeitariam, respectivamente, com uma pontuação de 7,68 e 8,26 em uma escala de 0 a 10. E também que os médicos consideram esse instrumento útil para a tomada de decisões, com avaliação de 7,57. Esses dados permitem supor que a regulamentação ética e legal das vontades antecipadas compreende medida favorável para o respeito à autonomia do paciente e relevante fator de inibição à distanásia.
Este estudio se llevó a cabo a través de entrevistas con médicos de la región de la Asociación de Municipios del Medio Oeste Catarinense (AMMOC). El objetivo fue evaluar si las voluntades anticipadas de un paciente serán respetadas por los médicos en el momento en que se encuentre incapacitado de comunicarse y si esa manifestación es un instrumento válido de inhibición de la distanasia. Entre los resultados se encontró que los médicos consideran conveniente el registro de los deseos del paciente por medio de la declaración de voluntad anticipada y los respetarían, respectivamente, con una puntuación de 7,68 y 8.26 en una escala de 0 a 10. Se encontró también que los médicos consideran ese instrumento útil para la toma de decisiones con evaluación de 7.57. Estos datos permiten suponer que la reglamentación ética y legal de las voluntades anticipadas constituye una medida favorable para el respeto de la autonomía del paciente y un importante factor de inhibición a la distanasia.
This study was conducted through interviews with physicians from the Association of Santa Catarina Midwestern Municipalities region (AMMOC). The objective was to evaluate if the patient's anticipated will are respected by doctors, when he is unable to communicate and whether this manifestation is considered a valid dysthanasia inhibiting instrument. The results indicated that physicians considered as a convenient record of patient's wishes by means of anticipated will statement and they would respect them, respectively, with a score of 7.68 and 8.26 on a scale of 0 to 10. It was also found that physicians consider them a useful tool for decision-making with evaluation of 7.57. These data allow for supposing that the ethical and legal regulation of anticipated will comprises a suitable measure to respect patient's autonomy and a relevant factor to inhibiting dysthanasia.
