Morbidade e fatores associados à longa permanência hospitalar e à displasia broncopulmonar em recém-nascidos prematuros acompanhados em ambulatório de alto risco

Abstract

Premature newborn (PTNB) is one born with less than 37 completed weeks of gestational age. The greater the degree of prematurity, the greater the risk of complications and death for these babies, which implies longer periods in Neonatal Intensive Care Units (NICUs). It is relevant to know more deeply about this population group to support the development of strategies to improve care. This work addressed the theme in two different studies. The first aimed to characterize the profile of hospital morbidity, and identify the factors associated with long stay in the NICU for PTNBs followed up at a high-risk outpatient clinic in the city of Montes Claros (MG) and the second, aimed to identify the incidence and factors associated with Bronchopulmonary Dysplasia (BPD) for the same group. Both studies come from a retrospective cohort with babies discharged from the NICUs in the city and assisted at the high risk newborn follow-up outpatient clinic. The study population consisted of premature newborns, admitted from march 2014 to july 2018, regardless of birth weight. Children with severe malformations were excluded. Data collection was carried out using a form specially designed for this research and conducted by a trained team. The response variable for the first study was length of stay in NICUs. To define this variable, the length of stay in the NICU of all newborns evaluated was distributed into quartiles, defining as long stay the constant length of stay in the last quartile. Variables associated with long stays were defined based on bivariate analysis, and variables associated up to the 20% level (p<0.20) were jointly analyzed using binary logistic regression, assuming a level of significance of 5% (p<0.05) for the final model, with registration of the respective Odds Ratio and 95% confidence intervals. The response variable for the second study was the BPD record, following the same analysis process as in the first study. A total of 293 newborns participated in the study. Most of the group consisted of moderately preterm infants, with a gestational age of 32 to 36 weeks and 6 days (n=148; 50.5%). The stay in the NICU for the assessed group ranged from three to 347 days, with a median of 37 days and 76 newborns (25.9%) stayed for a period equal to or greater than 63 days, defined as a long stay. After multiple analysis, the variables: gestational age (p<0.001), birth weight (p<0.001), late-onset sepsis (p<0.001) and necrotizing enterocolitis (p<0.036) maintained a statistically significant association with length of stay. Regarding BPD, the variables associated after multiple analysis were gestational age (p<0.001), birth weight (p<0.003), and late-onset sepsis (p<0.004). The results highlight the need for greater vigilance with regard to prenatal care and safe monitoring of pregnancy, in order to avoid premature delivery, in addition to the need for greater vigilance regarding hospital infection control mechanisms in NICUs.