Journal Information
Vol. 16. Issue 5.
Pages 779-795 (September - October 2010)
Share
Share
Download PDF
More article options
Vol. 16. Issue 5.
Pages 779-795 (September - October 2010)
Artigo Original/Original Article
Open Access
Uso do método INSURE versus CPAP nasal isolado em recém-nascidos de muito baixo peso com 30 ou menos semanas de gestação
Early nasal continuous positive airway pressure versus INSURE in VLBW neonates
Visits
6391
Ana Saianda1,
Corresponding author
asaianda@gmail.pt

Correspondência/Correspondence to: Ana Saianda, Departamento de Pediatria. Hospital de Santa Maria, Av. Professor. Egas Moniz, 1649-035 Lisboa
, Ricardo M. Fernandes1, Joana Saldanha2
1 Interno do Complementar. Departamento da Criança e da Família. Hospital de Santa Maria – Lisboa/Resident. Child and Family Health Service. Hospital de Santa Maria – Lisboa
2 Assistente graduada. Departamento da Criança e da Família. Unidade de Neonatologia. Hospital de Santa Maria – Lisboa/Consultant. Child and Family Health Service. Neonatal Unit. Hospital de Santa Maria – Lisboa
This item has received

Under a Creative Commons license
Article information
Resumo

Introdução: Pretende-se determinar se a utilização do método INSURE em recém-nascidos de muito baixo peso, com idade gestacional (IG)30 semanas se associa a menor morbilidade e mortalidade quando comparado com uso de nCPAP isolado. Métodos: Estudo de coorte retrospectiva dos RNMBP nascidos num hospital de apoio perinatal diferenciado entre Janeiro/2002-Agosto/2008. Incluíram-se as crianças registadas na Vermont-Oxford Network com IG ≤30semanas e com uso de nCPAP logo após o nascimento (N=96).

Estabeleceu-se Grupo nCPAP – uso de nCPAP isolado (N=40) e Grupo INSURE (N=56). Consideraram-se outcomes precoces: síndroma de dificuldade respiratória (SDR), necessidade de administrar surfactante com intuito terapêutico ou recurso a ventilação invasiva. Compararam-se igualmente outcomes tardios: doença pulmonar crónica da prematuridade (DPC), mortalidade e o outcome composto DPC-mortalidade. Resultados: No grupo INSURE verificou-se menor IG, não se registando diferenças relativamente ao peso ao nascer e indução da maturação pulmonar. Verificou-se SDR em 21/40 (53%) casos do grupo nCPAP e em 17/56 (30%) casos do grupo INSURE (OR ajustado [IC 95%] – 0,2 [0,1-0,6]). No grupo nCPAP todos estes casos realizaram surfactante com intuito terapêutico, não tendo sido efectuada nenhuma dose adicional de surfactante no grupo INSURE. Verificou-se maior número de casos com necessidade de VI no grupo nCPAP do que no grupo INSURE (11/40, 28% vs 9/56, 12%). Não foram encontradas diferenças estatisticamente significativas relativamente aos outcomes tardios. Conclusão: Em RNMBP com IG ≤30sem, o uso isolado de nCPAP poderá traduzir-se numa ligeira desvantagem em outcomes precoces, sem evidentes repercussões em termos de DPC ou mortalidade.

Rev Port Pneumol 2010; XVI (5): 779-795

Palavras-chave:
Recém-nascido muito baixo peso
nCPAP
INSURE
sindroma de dificuldade respiratória neonatal
doença pulmonar crónica da prematuridade
mortalidade
Abstract

Background: Evidence suggests the INSURE strategy (INtubate-SURfactant administration and Extubate to nasal continuous positive airway pressure [nCPAP]) is superior to mechanical ventilation (MV) with rescue surfactant for the management of respiratory distress syndrome (RDS) in very low birth weight (VLBW) neonates. There is limited data, however, to assess whether INSURE is superior to nCPAP alone. We aimed to compare these two strategies regarding early and late outcomes. Methods: Retrospective cohort study from Jan/2002 to Aug/2008. We included VLBW neonateswith gestational age (GA)30 weeks registered in the Vermont Oxford Network that used either nCPAP alone (nCPAP group, N=40), or with INSURE (INSURE group, N=56).

We assessed early (RDS, need for rescue surfactant, and CPAP failure with MV) and late outcomes (chronic lung disease of prematurity (CLD), mortality, and composite outcome of mortality and/or CLD). Results: Neonates in the INSURE group had lower mean GA, while other baseline variables were comparable. The proportion of RDS was significantly superior in the nCPAP group (53% vs. 30%; adjusted OR [95% CI] – 0.2 [0.1-0.6]). Therapeutic surfactant was administered to all cases with RDS in the nCPAP group, but to none from the INSURE group. MV was more frequently required in the nCPAP group (11/ 40, 28% vs. 9/ 56, 12%; p=0.04). No statistically significant differences were found in either of the late outcomes. Conclusion: The use of nCPAP alone in VLBW neonates with GA30 weeks may be associated with slightly poorer early outcomes than the INSURE strategy, but there were no significant differences in CLD or mortality.

Rev Port Pneumol 2010; XVI (5): 779-795

Key-words:
Very low birth weight
nCPAP ventilation
INSURE
respiratory distress syndrome (newborn)
chronic lung disease of prematurity
mortality
Full text is only aviable in PDF
Bibliografia/Bibliography
[1.]
B. Jónsson, M. Katz-Salamon, G. Faxelius, U. Broberger, H. Lagercrantz.
Neonatal care of very-low-birthweight infants in special-care units and neonatal intensive-care units in Stockholm. Early nasal continuous positive airway pressure versus mechanical ventilation: gain and losses.
Acta Paediatr Suppl, 419 (1997), pp. 4-10
[2.]
A. Ammari, M. Suri, V. Milisavljevic, R. Sahni, D. Bateman, et al.
Variables associated with the early failure of nasal CPAP in very low birth weigth infants.
J Pediatr, 147 (2005), pp. 341-347
[3.]
H. Aly, A.N. Massaro, K. Patel, A. El-Mohandes.
Is it safer to intubate Premature Infants in the delivery room?.
Pediatrics, 115 (2005), pp. 1660-1665
[4.]
D. Sweet, G. Bevilacqua, V. Carnielli, G. Greisen, R. Plavka, et al.
European consensus guidelines on the management of neonatal respiratory distress syndrome.
J Perinat Med, 35 (2007), pp. 175-186
[5.]
T.P. Stevens, E.W. Harrington, M. Blennow, R.F. Soll.
Early surfactant administration with brief ventilation vs. selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome.
Cochrane Database Syst Rev, 17 (2007 Oct),
[6.]
M.A. Thomson.
Continuous positive airway pressure and surfactant; Combined data from animal experiments and clinical trials.
Biol Neonate, 81 (2002), pp. 16-19
[7.]
Jean-Michel Hascoet, Sandrine Espange, Isabelle Hamon.
CPAP and the preterm infant. Lessons from COIN trial and other studies.
Early Hum Dev, 84 (2008), pp. 791-793
[9.]
C.J. Morley, P.G. Davis, L.W. Doyle, L.P. Brion, J.M. Hascoet, et al.
Nasal CPAP or intubation at birth for very preterm infants.
N Engl J Med, 358 (2008), pp. 700-708
[10.]
H. Verder, B. Robertson, G. Greisen, F. Ebbesen, P. Albertsen, et al.
Surfactant therapy and nasal continuos positive airway pressure for newborns with respiratory distress syndrome.
N Engl J Med, 331 (1994), pp. 1051-1055
[11.]
H. Verder, P. Albertsen, F. Ebbesen, G. Greisen, B. Robertson, et al.
Nasal continuos positive airway pressure and early surfactant therapy for respiratory distress syndrome in newborns of less than 30 weeks’ gestation.
Pediatrics, 103 (1999),
[12.]
J. Horbar, J.H. Carpenter, J. Buzas, R.F. Soll, G. Suresh, et al.
Timing of initial surfactant treatment for infants 23 to 29 weeks’ gestation; is routine practice evidence based?.
Pediatrics, 113 (2004), pp. 1593-1602
[13.]
K. Bohlin, T. Gudmundsdottir, M. Katz-Salamon, B. Jonsson, M. Blennow.
Implementation of surfactant treatment during continuous positive airway pressure.
J Perinatol, 27 (2007), pp. 422-427
[14.]
M.A. Rojas, J.M. Lozano, M.X. Rojas, M. Laughon, C.L. Bose, et al.
Very early surfactant without mandatory ventilation in premature infants treated with early continuous positive airway pressure: a randomized, controlled trial.
Pediatrics, 123 (2009), pp. 137-142
[15.]
W. Engle.
Surfactant-replacement therapy for respiratory distress in the preterm and term neonate.
Pediatrics, 121 (2008), pp. 419-432
[16.]
V. Martins.
Consenso Nacional da Sociedade Portuguesa de Neonatologia – nCPAP.
Apresentado no “V seminário – Ventilação no recém-nascido – dos aspectos básicos à aplicação prática”. Braga, (15–16 Maio 2009),
Copyright © 2010. Sociedade Portuguesa de Pneumologia/SPP
Pulmonology
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?