Teste das microbolhas estáveis nos fluidos oral e gástrico para predição da taquipnéia transitória do recém-nascido em neonatos a termo submetidos à cesariana eletiva

• Autor(a) principal: Estorgato, Geovana Rhoden
• Data de Publicação: 2014
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da PUC_RS
• Texto Completo: http://tede2.pucrs.br/tede2/handle/tede/1438
• topic: MEDICINA; PEDIATRIA; SURFACTANTES PULMONARES; RECÉM-NASCIDO - DOENÇAS; CNPQ::CIENCIAS DA SAUDE::MEDICINA

Background: Term neonates delivered by elective cesarean section who developed Transient Tachypnea of the Newborn have shown a low number of stable microbubbles on gastric fluid. The oral fluid has not been previously used to evaluate the pulmonary maturity after birth. Objective: To evaluate the Stable Microbubble Test in oral and gastric fluids for predicting of Transient Tachypnea of the Newborn. Methods: Patients with gestational age &#8805; 37 who were born by elective cesarean section were in the delivery room, oral fluid obtained immediately after birth and gastric fluid up to one hour of life. The samples were frozen to be analyzed blindly by two observers according to the method described by Pattle. Results: In total, 544 neonates were included in the study. Of these, 22 developed respiratory distress requiring hospitalization in the Neonatal Intensive Care Unit (NICU). Twenty four patients had mild transient respiratory symptoms and were not admitted to the NICU. Patients who were admitted to the neonatal intensive care unit, in oral fluid had a median, minimum and maximun of 67.5 (18-150) microbubbles/mm2 and 498 newborns without respiratory distress had a score of 350 (5-10000) microbubbles/mm2 - p < 0.001. In gastric fluid, the neonates had a score of 150 (24-1200) microbubbles/mm2 and neonates without respiratory distress were 600 (6-7000) microbubbles/mm2 - p< 0.05. The 24 patients with mild respiratory symptoms and not admitted to the NICU had a count of oral microbubbles, minimum and maximun of 137.5 (20-3750) microbubbles/mm2 in gastric fluid and 725 (20-4000) microbubbles/mm2. Considering only the 22 patients admitted and a cutoff point of 200 microbubbles/mm2, oral fluid showed a sensitivity of 81.8% and specificity of 76.9 % for the diagnosis of Transient Tachypnea of the Newborn. For the gastric fluid, with a cutoff point of 250 microbubbles/mm2, sensitivity was 68.2 % and specificity of 76.7 %. Conclusion: The results suggest that Transient Tachypnea of the Newborn is associated with alterations of the surfactant system. The oral fluid is an alternative method to the use of the amniotic fluid and gastric fluid for assessing fetal lung maturity after birth