Guimarães H, Rocha G, Vasconcellos G, Proença E, Carreira M L, Sossai M R, Morais B, Martins I, Rodrigues T, Severo M
NICU, Hospital de S. João, Porto.
Rev Port Pneumol. 2010 Mar-Apr;16(2):273-86.
With the advent of surfactant, prenatal corticosteroids (PNC) and advances in technology, the survival rate of extremely low birth weight (ELBW) infants has improved dramatically. Rates of bronchopulmonary dysplasia (BPD) vary widely among neonatal intensive care units (NICUs) and many studies using multiple interventions have shown some improvement in BPD rates. Implementing potentially better practices to reduce BPD has been an effort made over the last few decades.
To compare five Portuguese NICUs in terms of clinical practices in very low birth weight (VLBW) infants, in order to develop better practices to prevent BPD.
256 preterm neonates, gestational age (GA) <30 weeks and/or birthweight (BW) <1250g admitted to five Portuguese NICUs (centers 1 to 5) between 1st January 2004 and 31st December 2006, were studied. VLBW infants with major malformations, grade IV intraventricular haemorrhage in the first week of life and metabolic or neuromuscular disease were excluded. BPD was defined as oxygen dependency at 36 weeks of postconceptional age. We considered a practice to be improved as clinically significant whenever a decrease greater than 10% in the prevalence of BPD adjusted for the practice, GA and BW was achieved compared to BPD prevalence adjusted only for GA and BW.
The overall prevalence of BPD was 12.9%. Our results revealed that PNC use should be improved in centers 4 and 5; fluid policy in center 4; oxygen therapy and sepsis prevention in centers 1 and 2. Patent ductus arteriosus (PDA) treatment should be improved in center 2.
The implementation of potentially better practices to reduce lung injury in neonates in Portuguese NICUs, according to each NICU, must be addressed to increase the prescription of PNC, to use a lower FiO2, to be careful with fluid administration in the first weeks of life and to prevent PDA and sepsis. It is necessary to follow guidelines, recommendations or protocols to improve quality in the prevention of BPD.
随着表面活性剂的出现、产前皮质类固醇（PNC）的应用以及技术的进步，极低出生体重（ELBW）婴儿的存活率有了显著提高。新生儿重症监护病房（NICU）中支气管肺发育不良（BPD）的发生率差异很大，许多采用多种干预措施的研究表明BPD发生率有了一定改善。在过去几十年里，一直在努力实施可能更好的措施来降低BPD发生率。
比较五个葡萄牙NICU对极低出生体重（VLBW）婴儿的临床治疗方法，以便制定更好的预防BPD的措施。
研究对象为2004年1月1日至2006年12月31日期间入住五个葡萄牙NICU（中心1至5）的256例早产儿，其胎龄（GA）<30周和/或出生体重（BW）<1250g。排除患有严重畸形、出生后第一周发生IV级脑室内出血以及患有代谢或神经肌肉疾病的VLBW婴儿。BPD定义为孕龄36周时需氧依赖。如果与仅根据GA和BW调整的BPD患病率相比，根据治疗方法、GA和BW调整后的BPD患病率降低超过10%，我们认为该治疗方法在临床上有显著改善。
BPD的总体患病率为12.9%。我们的结果显示，中心4和5应改进PNC的使用；中心4应改进液体管理策略；中心1和2应改进氧疗和败血症预防措施。中心2应改进动脉导管未闭（PDA）的治疗。
葡萄牙NICU必须根据每个NICU的情况，实施可能更好的措施来减少新生儿肺损伤，包括增加PNC的处方量、使用较低的吸氧浓度、在出生后的头几周谨慎进行液体管理以及预防PDA和败血症。有必要遵循指南、建议或方案来提高预防BPD的质量。
