Uso do surfactante na doença da membrana hialina por meio de técnica minimamente invasiva em uma unidade neonatal de Belo Horizonte
Conteúdo do artigo principal
Resumo
Introdução: A doença da membrana hialina (DMH), também conhecida como síndrome do desconforto respiratório (SDR) e, contemporaneamente, referida apenas como deficiência de surfactante, é a causa mais comum de desconforto respiratório em bebês prematuros, correlacionando-se com a imaturidade pulmonar estrutural e funcional. Objetivos: Descrever a experiência da técnica minimamente invasiva de surfactante (MIST) em recém-nascidos (RN) com doença da membrana hialina e avaliar os resultados do protocolo do serviço, definindo possíveis pontos a serem melhorados. Métodos: Estudo transversal realizado com dados da unidade entre junho de 2018 e fevereiro de 2020. Foram incluídos os RN submetidos a técnica MIST (Prematuros menores de 32 semanas com SDR: FiO2 > 30% para manter saturação entre 90-95% em CPAP). Foram excluídos RN que evoluíram para óbito e transferências. Resultados: O surfactante foi administrado em doses de 100 a 200 mg/ kg, sendo que 47,4% dos RN receberam dentro das primeiras 6 horas de vida e 11,8% nas primeiras 2 horas. A analgesia utilizada foi a não farmacológica com glicose a 25%. Não foram observados efeitos adversos significativos, sendo o refluxo de surfactante o principal deles. Todos os RN submetidos à MIST com menos de 28 semanas evoluíram com displasia broncopulmonar (DBP), sendo 54,5% leve e 45,5% moderada a grave. Nos RN > 28 semanas, 53,5% evoluíram DBP, no entanto, 84,6% de forma leve e apenas 15,4% de forma moderada a grave. Conclusão: A MIST foi considerada uma prática segura na assistência de RN prematuros, havendo indicadores do sucesso do protocolo implantado.
Downloads
Detalhes do artigo
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Referências
1 Hermansen CL, Lorah KN. Respiratory Distress in the Newborn Table 1. Differential Diagnosis of Respiratory Distress in the Newborn. Vol. 76. 2007.
2 Malloy MH, McGovern JP. Hyaline membrane disease (HMD): an historical and Oslerian perspective. J Perinatol. 2018;38:1602-6.
3 Rubarth LB, Quinn J. Respiratory Development and Respiratory Distress Syndrome. Neonatal Netw. 2015;34:231-8.
4 Gupta BK, Saha AK, Mukherjee S, Saha B. Minimally invasive surfactant therapy versus InSurE in preterm neonates of 28 to 34 weeks with respiratory distress syndrome on non-invasive positive pressure ventilation—a randomized controlled trial. Eur J Pediatr. 2020;179:1287-93.
5 Han T, Liu H, Zhang H, Guo M, Zhang X, Duan Y, et al. Minimally Invasive Surfactant Administration for the Treatment of Neonatal Respiratory Distress Syndrome: A Multicenter Randomized Study in China. Front Pediatr. 2020;8:182.
6 Fischer HS, Bührer C. Avoiding endotracheal ventilation to prevent bronchopulmonary dysplasia: A meta-analysis. Pediatrics. 2013;132:e1351-60.
7 Góngora JJG. Displasia broncopulmonar. Rev Mex Pediatr. 2010;77:27-37.
8 Rojas-Reyes MX, Morley CJ, Soll R. Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev. 2012;2012.
9 NN F, WA C, MC W, W R, MG G, AR L, et al. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med. 2010;362:1970-9.
10 Dunn MS, Kaempf J, De Klerk A, De Klerk R, Reilly M, Howard D, et al. Randomized trial comparing 3 approaches to the initial respiratory management of preterm neonates. Pediatrics. 2011;128.
11 Gengaimuthu K. Minimally Invasive Surfactant Therapy: An Analytical Report of Our Prospective Dubai Cohort. Cureus. 2020;12.
12 Wang XA, Chen LJ, Chen SM, Su PH, Chen JY. Minimally invasive surfactant therapy versus intubation for surfactant administration in very low birth weight infants with respiratory distress syndrome. Pediatr Neonatol. 2020;61:210-5.
13 Shim GH. Update of minimally invasive surfactant therapy. Korean J Pediatr. 2017;60:273-81.
14 Klotz D, Porcaro U, Fleck T, Fuchs H. European perspective on less invasive surfactant administration—a survey. Eur J Pediatr. 2017;176:147–54.
15 Herting E, Härtel C, Göpel W. Less invasive surfactant administration (LISA): chances and limitations. Arch Dis Child Fetal Neonatal Ed. 2019;104:F655.
16 Eichenwald EC, Stark AR. Bronchopulmonary dysplasia: Definition, pathogenesis, and clinical features - UpToDate. UpToDate. 2022.
17 Kaniewska U, Gulczyńska E. The influence of the technique of surfactant administration (LISA vs INSURE) on the outcomes of respiratory distress syndrome treatment in preterm infants. Dev Period Med. 2019;23:163-71.
18 Bao Y, Zhang G, Wu M, Ma L, Zhu J. A pilot study of less invasive surfactant administration in very preterm infants in a Chinese tertiary center. BMC Pediatr. 2015;15.
19 Härtel C, Paul P, Hanke K, Humberg A, Kribs A, Mehler K, et al. Less invasive surfactant administration and complications of preterm birth. Sci Rep. 2018;8.
20 Zhu J, Bao Y, Du L, Huang H, Lv Q, Jiang Y, et al. Less invasive surfactant administration versus endotracheal surfactant instillation followed by limited peak pressure ventilation in preterm infants with respiratory distress syndrome in China: study protocol for a randomized controlled trial. Trials. 2020;21.
21 Mehler K, Oberthuer A, Keller T, Becker I, Valter M, Roth B, et al. Survival Among Infants Born at 22 or 23 Weeks’ Gestation Following Active Prenatal and Postnatal Care. JAMA Pediatr. 2016;170:671-7.
22 Herting E, Härtel C, Göpel W. Less invasive surfactant administration: best practices and unanswered questions. Curr Opin Pediatr. 2020;32:228-34.
23 Härtel C, Glaser K, Speer CP. The Miracles of Surfactant: Less Invasive Surfactant Administration, Nebulization, and Carrier of Topical Drugs. Neonatology. 2021;118:225-34.
24 Dargaville PA, Kamlin COF, Orsini F, Wang X, Paoli AG De, Kutman HGK, et al. Effect of Minimally Invasive Surfactant Therapy vs Sham Treatment on Death or Bronchopulmonary Dysplasia in Preterm Infants With Respiratory Distress Syndrome: The OPTIMIST-A Randomized Clinical Trial. JAMA. 2021;326:2478-87.
25 Dargaville PA, Ali SKM, Jackson HD, Williams C, De Paoli AG. Impact of Minimally Invasive Surfactant Therapy in Preterm Infants at 29 32 Weeks Gestation. Neonatology. 2018;113:7-14.
26 Laughon MM, Langer JC, Bose CL, Smith PB, Ambalavanan N, Kennedy KA, et al. Prediction of Bronchopulmonary Dysplasia by Postnatal Age in Extremely Premature Infants. Am J Respir Crit Care Med. 2011;183:1715.
27 Ambulkar H, Williams EE, Hickey A, Bhat R, Dassios T, Greenough A. Respiratory monitoring during less invasive surfactant administration in the delivery suite. Early Hum Dev. 2021;154:105311.
28 Hanke K, Rausch TK, Paul P, Hellwig I, Krämer C, Stichtenoth G, et al. The effect of less invasive surfactant administration on cerebral oxygenation in preterm infants. Acta Paediatr. 2020;109:291-9.
29 Bamat N, Jensen EA, Kirpalani H. Duration of continuous positive airway pressure in premature infants. Semin Fetal Neonatal Med. 2016;21:189-95.