Análise comparativa de parâmetros de função pulmonar entre escolares nascidos prematuros e a termo

• Autor(a) principal: Gonzaga, Ana Damaris [UNIFESP]
• Data de Publicação: 2019
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=7937154; https://repositorio.unifesp.br/handle/11600/59879
• topic: Child; Premature Birth; Pulmonary Function Tests; Risk Factors; Criança; Nascimento Prematuro; Testes De Função Pulmonar; Fatores De Risco

Objectives: To compare pulmonary function parameters in children born preterm and at full-term and to identify factors associated with altered lung function and pulmonary function parameters. Methods: Cross-sectional study with two groups of 6-9 year-old children matched by age and sex and submitted to pulmonary function tests. Inclusion criteria: Preterm group: children born with gestational age (GA) <37 weeks and birthweight <2000 grams and followed up at the Outpatient Clinic for preterm infants of Unifesp. Term group: children born at term and recruited at two public elementary schools. Exclusion criteria: congenital malformations, cognitive deficit, neuromuscular diseases and respiratory problems in the last 15 days. Perinatal and post-natal demographic and clinical data and anthropometric measures were collected. At study entry, the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was applied and the pulmonary function was evaluated using the interrupter technique (Rint) and spirometry, with analysis of the parameters expressed in z-score. Factors associated with pulmonary function parameters and altered pulmonary function were analyzed by linear and logistic regressions, respectively. Results: A total of 112 children were included in each group. Preterm infants had GA of 30.8±2.8 weeks and birth weight of 1349±334g, being 35.7% small for gestational age (SGA), 46.4% presented respiratory distress syndrome (RDS), 20,7% neonatal sepsis, 19.6% bronchopulmonary dysplasia, 9.8% oxygen dependence at 36 weeks of corrected age (O2 dep 36wks), 65.2% received mechanical ventilation and were hospitalized for 37 days in median. At study entry, preterm and full term infants were similar in age (7.7±0.9 vs. 7.8±0.9 years), weight (27.8±7.9 vs. 28.8±7.9kg), height (130.0±9.1 vs. 130.6±7.6cm), respectively. The diagnosis of asthma by ISAAC was more frequent in premature infants (14.3% vs. 6.0%, p=0.048). The values of pulmonary function parameters (z-scores) in preterm and term infants were: Rint (-0,65±1,82 vs. -1,50±1.33; p=0.007), FVC (-0.39±1.27 vs. -0.15±1.03; p=0.106), FEV1/FVC (-0.23±1.22 vs. 0.14±1.11; p=0.003), FEV1 (- 0.48±1.29 vs. -0.04±1.08; p=0.071) and FEF25-75 (1.16±1.37 vs. 2.08±1.26; p=0.005). The prevalence of altered lung function was higher in preterm infants (26.8% vs. 13.4%, p=0.012). Factors associated with pulmonary function parameters (in z-scores) were: 1) Rint post bronchodilator = GA<34wks (0.134; p=0.005), SGA (0.129; p=0.002) and days of mechanical ventilation (0.005; p=0.011); 2); FVC = BW<1500g (-0.168; p=0.050) and z-score height/age (0,087; p<0.001); 3) FEV1/FVC = O2 dep 36wks (-5.073; p=0.017), previous bronquiolitis (-3.395, p=0.019); and physical activities <4x/week (-3,315, p=0.020); 4) FEV1 = GA <34wks (-0.241; p=0.003), SGA (-0.190; p=0.008) and z-score height/age (0.077; p=0.001); 5) FEF25-75 = O2 dep 36wks (-0.458; p=0.004), previous bronquiolitis (-0.269, p=0.014) and z-score height/age (0.069; p=0.063). Factors associated with altered lung function were: need for mechanical ventilation (OR: 2.426, p=0.046) and wheezing in the last year (OR: 3.195, p=0.041). Conclusions: Compared to children born at term, preterm infants had a higher prevalence of pulmonary alterations, higher parameters of Rint and lower z-scores of FEV1/FVC, FEV1 e FEF25-75.Mechanical ventilation and wheezing in the last 12 months increased the chance of altered lung function. Lower GA, O2 dep 36wks, days of mechanical ventilation, lower z-scores height/age, previous bronquiolitis, astma and lower physical activities were associated with pulmonary function parameters.