Avaliação indireta da maturidade pulmonar do recém-nascido através da determinação da maturidade da pele neonatal pela luz de LED

Abstract

Introduction: The identification of premature based on the degree of lung maturity remains a significant goal for health systems, as early intervention in respiratory distress syndrome (RDS) can reduce neonatal morbidity and mortality. In this regard, optoelectronic equipment has been developed to indirectly assess newborns’ lung maturity.

Objective: To assess the association between neonatal lung maturity and skin maturity, particularly through their photobiological properties.

Methods: Two scientific articles were presented as part of this thesis. The first article, a systematic literature review, is titled 'The Role of Chest X-ray in the Diagnosis of Neonatal Respiratory Distress Syndrome: A Systematic Review.' The second study, a case-control nested within a cohort design, examined the correlation between skin-lung maturity. It is entitled 'Assessment of skin maturity by LED light at birth and its association with lung maturity: clinical trial secondary outcomes'. Newborns with RDS were the case group, while those without RDS were the control. Skin maturity was assessed using an optoelectronic device that recorded reflectance on the sole for comparative analysis. Clinical data were collected from medical records over a 72-hour following birth or until discharge or death, whichever came first. To assess the association of skin-reflectance with RDS and factors such as admission to the neonatal intensive care unit (NICU) and ventilatory support use, both univariate and multivariate logistic regression analyses were employed.

Results: In the systematic review, out of 1,686 studies, 23 articles were selected, involving 2,245 newborns. In general, these studies demonstrated a low risk of bias. The results suggest the utility of radiography for diagnosing and classifying RDS. However, there was no specific emphasis on its mandatory inclusion in scientific studies, and the findings may not fully align with current global clinical practices. Regarding the case-control study, 640 newborns were included, with 470 (73.4%) in the RDS group and 170 (26.6%) control. Skin reflectance was associated with RDS, Exp(B) of 0.982 (95% CI: 0.979 to 0.985), model R2 of 0.632, and P-value of <0.001. Furthermore, an association was observed with ventilatory support, Exp(B) of 0.996 (95% CI: 0.992 to 0.999), model R2 of 0.814, and P-value of 0.01, as well as admission to the NICU, Exp(B) of 0.994 (95% CI: 0.990 to 0.998), model R2 of 0.867, and P-value of 0.004.

Conclusion: The role of chest radiography in diagnosing RDS has evolved, but its necessity and relevance remain subjects of debate. With the advent of an accessible and user-friendly technological tool that can seamlessly integrate into current clinical practice, a promising avenue emerges for the indirect assessment of lung maturity. This research stands as the pioneering study to unveil the intriguing link between skin and lung maturity, allowing for non-invasive assessment during the postnatal period.