RESUMO
Objective: To correlate the timing of treatment using exogenous surfactant with the main variables related to respiratory distress syndrome or prematurity. Methods: A historic cohort study between January 1, 2004 and June 30, 2007, including very low birth weight newborns (birth weight <1,500 g) admitted to the hospital and who required surfactant therapy. Newborns were divided into three study groups: early (treatment during the first two hours); intermediate (treatment between two and six hours) and late (treatment after six hours). Variables analyzed were: air leak syndrome, mortality, bronchopulmonary dysplasia, intracranial hemorrhage, patent ductus arteriosus, retinopathy of prematurity, duration of oxygen therapy, duration of mechanical ventilation, length of hospital stay and number of surfactant doses. Results: A total of 63 newborns were included (Early Group, n = 21; Intermediate Group, n = 26 and Late Group, n = 16), there was a statistical significance between birth weight and gestational age. Multivariate logistic regression analysis was used to compensate the effects of gestational age, birth weight and other possible interferences over the variables. This analysis revealed a greater incidence of air leak syndrome among newborns of the Early Group compared to the Intermediate Group (OR = 6.98; 95%CI = 1.24-39.37; p = 0.028), with no difference compared to the Late Group (OR = 3.72; 95% CI = 0.28-49.76; p = 0.321). There were no differences regarding the other variables analyzed. Conclusions: In this retrospective, non-randomized study, surfactant administration during the first two hours of life enhanced the risk of air leak syndrome, compared to the treatment between two and six hours after birth, with no reduction of early or late neonatal mortality or bronchopulmonary dysplasia, compared to later treatment after birth.
Objetivo: Relacionar o momento do tratamento com surfactante com as principais variáveis relacionadas à síndrome do desconforto respiratório do recém-nascido ou à prematuridade. Métodos: Coorte histórica, sendo analisados os dados de recém-nascidos de muito baixo peso (peso de nascimento < 1.500 g) admitidos no período entre 1º de janeiro de 2004 e 30 de junho de 2007, que necessitaram de tratamento com surfactante. Os recém-nascidos foram divididos em três grupos: precoce (tratamento até a segunda hora); intermediário (tratamento entre duas e seis horas); e tardio (tratamento a partir da sexta hora). Foram analisadas: ocorrência de síndrome de escape de ar, mortalidade, displasia broncopulmonar, hemorragia intracraniana, persistência do canal arterial, retinopatia da prematuridade, tempo de oxigênio, de ventilação mecânica, tempo de internação e o número de doses de surfactante. Resultados: Foram analisados 63 recém-nascidos (Grupo Precoce, n = 21; Grupo Intermediário, n = 26 e Grupo Tardio, n = 16); os grupos diferiram em relação ao peso de nascimento e à idade gestacional. Na análise multivariada por regressão logística, realizada para compensar os efeitos da idade gestacional, do peso de nascimento e de outras possíveis interferências sobre as variáveis analisadas, foi observada uma maior incidência de síndrome de escape de ar entre os recém-nascidos do Grupo Precoce em relação aos do Grupo Intermediário (OR = 6,98; IC95% = 1,24-39,37; p 0,028), porém sem diferença em relação ao Grupo Tardio (OR = 3,72; IC95 = 0,28-49,76; p = 0,321). Não foram observadas diferenças em relação às outras variáveis analisadas. Conclusões: Neste estudo retrospectivo e não-randomizado, a administração de surfactante nas primeiras duas horas de vida aumentou o risco da ocorrência de síndrome de escape de ar em relação ao tratamento realizado entre duas e seis horas de vida, sem redução na mortalidade neonatal precoce ou tardia e sem modificação na evolução para displasia broncopulmonar, em comparação com o tratamento realizado em períodos mais tardios em relação ao nascimento.
RESUMO
OBJECTIVE: To correlate the timing of treatment using exogenous surfactant with the main variables related to respiratory distress syndrome or prematurity. METHODS: A historic cohort study between January 1, 2004 and June 30, 2007, including very low birth weight newborns (birth weight <1,500 g) admitted to the hospital and who required surfactant therapy. Newborns were divided into three study groups: early (treatment during the first two hours); intermediate (treatment between two and six hours) and late (treatment after six hours). Variables analyzed were: air leak syndrome, mortality, bronchopulmonary dysplasia, intracranial hemorrhage, patent ductus arteriosus, retinopathy of prematurity, duration of oxygen therapy, duration of mechanical ventilation, length of hospital stay and number of surfactant doses. RESULTS: A total of 63 newborns were included (Early Group, n = 21; Intermediate Group, n = 26 and Late Group, n = 16), there was a statistical significance between birth weight and gestational age. Multivariate logistic regression analysis was used to compensate the effects of gestational age, birth weight and other possible interferences over the variables. This analysis revealed a greater incidence of air leak syndrome among newborns of the Early Group compared to the Intermediate Group (OR = 6.98; 95%CI = 1.24-39.37; p = 0.028), with no difference compared to the Late Group (OR = 3.72; 95% CI = 0.28-49.76; p = 0.321). There were no differences regarding the other variables analyzed. CONCLUSIONS: In this retrospective, non-randomized study, surfactant administration during the first two hours of life enhanced the risk of air leak syndrome, compared to the treatment between two and six hours after birth, with no reduction of early or late neonatal mortality or bronchopulmonary dysplasia, compared to later treatment after birth.