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Análise dos dados de mortalidade dos prematuros extremos no HSM para elaboração de uma calculadora de sobrevivência
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Introdução: Graças à melhoria dos cuidados de saúde pré-natais e neonatais, a sobrevivência dos recém-nascidos (RN) aumentou, sobretudo nos países desenvolvidos, sendo possível, em alguns locais, efetuar ressuscitação às 22/23 semanas de gestação. Isto despoletou novos desafios na tomada de decisões na zona de periviabilidade e na definição do limiar de viabilidade, uma vez que este difere entre países e instituições. Para auxiliar os pais e médicos nessa tomada de decisão existem calculadoras de sobrevivência que combinam vários fatores preditivos de sobrevivência e mortalidade, sendo que as mais fidedignas são as baseadas nos dados da instituição na qual o RN se encontra.
Objetivo: Analisar os dados de sobrevivência de 2011 a 2021 no serviço de neonatologia do Hospital de Santa Maria (HSM) com o intuito de elaborar uma ferramenta que auxilie os pais e profissionais de saúde nas tomadas de decisão.
Métodos: Estudo descritivo dos dados dos RN prematuros extremos (idade gestacional <28 semanas) internados no serviço de neonatologia do HSM de 2011 a 2021. Os dados foram recolhidos da base nacional de Recém-Nascidos de Muito Baixo Peso (RNMBP). Realizou-se uma análise estatística da sobrevivência e fatores preditivos da mesma em Excel e SPSS ®. Foi considerado resultado significativo p=ou<0,05.
Resultados: Nos 220 RN analisados, uma idade gestacional e um índice de Apgar mais elevados, associaram-se a uma maior sobrevivência (p<0,05). Verificou-se, apesar de não significativa, uma associação do sexo feminino e uso de corticoides pré-natais a uma maior sobrevivência.
Conclusões: Este estudo permitiu definir quais os fatores preditivos com maior influência na sobrevivência dos prematuros extremos, que serão colocados na calculadora do HSM.
Introduction: Thanks to the improvement of prenatal and neonatal health care, the survival of newborns (NB) has increased, especially in developed countries, making it possible to perform resuscitation at 22/23 weeks of gestation. This triggered new challenges in decision-making in the periviability zone and in defining the viability threshold, as this differs between countries and institutions. To help both parents and physicians in this decision-making process, there are survival calculators that combine several predictive factors of survival and mortality, the most reliable of which are those based on data from the institution where the NB is located. Objective: To analyze survival data from 2011 to 2021 in the neonatology service of Hospital de Santa Maria (HSM) in order to develop a tool to assist parents and health professionals in decision-making. Methods: Descriptive study from extremely preterm NB (gestational age <28 weeks) admitted to the HSM neonatology service from 2011 to 2021. Data were collected from the national database of Very Low Weight Newborns. A statistical analysis of survival and predictive factors was performed using Excel and SPSS ®. A p-value =or<0.05 was considered a significant result. Results: In the 220 newborns analyzed, a higher gestational age and Apgar score were associated with longer survival (p<0.05). It was found, although not significant, an association between , female sex and the use of prenatal corticosteroids, consistently allowing greater survival. Conclusions: This study allowed us to define which predictive factors have the greatest influence on survival of extremely preterm NB, which will be included in the HSM calculator.
Introduction: Thanks to the improvement of prenatal and neonatal health care, the survival of newborns (NB) has increased, especially in developed countries, making it possible to perform resuscitation at 22/23 weeks of gestation. This triggered new challenges in decision-making in the periviability zone and in defining the viability threshold, as this differs between countries and institutions. To help both parents and physicians in this decision-making process, there are survival calculators that combine several predictive factors of survival and mortality, the most reliable of which are those based on data from the institution where the NB is located. Objective: To analyze survival data from 2011 to 2021 in the neonatology service of Hospital de Santa Maria (HSM) in order to develop a tool to assist parents and health professionals in decision-making. Methods: Descriptive study from extremely preterm NB (gestational age <28 weeks) admitted to the HSM neonatology service from 2011 to 2021. Data were collected from the national database of Very Low Weight Newborns. A statistical analysis of survival and predictive factors was performed using Excel and SPSS ®. A p-value =or<0.05 was considered a significant result. Results: In the 220 newborns analyzed, a higher gestational age and Apgar score were associated with longer survival (p<0.05). It was found, although not significant, an association between , female sex and the use of prenatal corticosteroids, consistently allowing greater survival. Conclusions: This study allowed us to define which predictive factors have the greatest influence on survival of extremely preterm NB, which will be included in the HSM calculator.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Calculadora de sobrevivência Periviabilidade Sobrevivência Mortalidade Prematuridade extrema Pediatria