Ventilação mecânica em recém-nascidos submetidos ao tratamento cirúrgico primário da gastrosquise: duração, fatores associados e taxa de sobrevida. Experiência de um hospital universitário brasileiro

Abstract

Objective: This study proposes to analyzing the duration of mechanical ventilation in newborns submitted to primary gastroschisis correction, as well to verify the survival rate and assessing factors associated to the tracheal intubation period. Methods: Descriptive study, with information gathered from medical records of 30 newborns with gastroschisis, who have undergone main closure of the anterior abdominal wall in the Pediatric Surgery, Neonatology and Pediatric Intensive Therapy services of Hospital das Clínicas, Federal University of Minas Gerais (UFMG) from June 2002 to June 2008. The following data were recorded in standardized protocols: type of birth, gestational age (weeks), prenatal ultrasonography, Apgar score (1 min), weight at birth (grams), duration of surgery, bladder pressure, duration of mechanical ventilation, duration of hospitalization, and survival rate. Results: Diagnosis by prenatal ultrasonograph was performed in 25 (83.3%) of 30 newborns. It is worth noting that 28 (93%) patients were cesarean born, and 58.6% of patients had Apgar score in the first minute equal or higher than seven. Eighteen (60%) newborns had gestational age equal or higher than 37 weeks. The weight ranged from 1,645 grams to 3,510 grams, mean 2,540 grams. There was a slight predominance of the female sex (53.3%). All patients were submitted to MV for a period ranging from 2 to 59 days, mean 10.4 days and median 7 days. Respiratory or pulmonary complications observed were: atelectasis in 3 (10%) patients and pneumonia in 1 (3.3%). There were 4 (13.7%) deaths and a global survival rate of 26 (86.7%) newborns at the end of MV. Neonatal sepsis was the main cause of death (75%). Conclusions: The low mortality (approximately 13%) found in this study is similar to the one reported in various recent studies from developed countries. Prenatal ultrasonography in approximately 80% of our cases has allowed for a close following of each patient and resulting in a higher survival rate. As to the MV duration, even though there were no statistically significant results on our data, we observed a tendency linking longer MV duration in patients with GA lower than 37 weeks and the occurrence (or not) of post-operatory complications. The factor that must be taken into account is that our sample included only patients submitted to primary care, reinforcing the favorable statistical results.