Viabilidade de aplicação do escore pediátrico de alerta na identificação da deterioração clínica em lactentes com displasia broncopulmonar: estudo piloto

Abstract

Introduction: In children, recognizing clinical deterioration is more critical due to their physiological dynamics; thus, failure to identify deterioration in a timely manner may lead to serious and preventable adverse events. The Pediatric Early Warning Score (PEWS) is an instrument developed in Brazil, validated, and adapted to the context of the Brazilian public health system. However, PEWS has not yet been validated for children with bronchopulmonary dysplasia (BPD). Objective: To analyze the feasibility of applying PEWS in identifying clinical deterioration in infants with BPD. Method: This was a prospective pilot diagnostic test study. A reproducibility study and a scoping review were also conducted to support the study’s contextualization. Data collection took place between April and July 2025. The study setting was the Intermediate Neonatal Care Units of a philanthropic hospital located in Belo Horizonte, Minas Gerais, Brazil. Infants older than 28 days and younger than 1 year, born at less than 32 weeks of gestational age, and diagnosed with BPD were included. Prior to data collection, the research team underwent training and evaluator calibration. The study included 23 infants, recruited through convenience sampling, and involved the application of three instruments: a sociodemographic data form, a gold-standard assessment tool, and the Pediatric Early Warning Score. Data were entered in Stata® MP/12.0 and analyzed in MedCalc® version 20.00. Results: The pilot study showed a prevalence of clinical deterioration of 21.7% in infants. The accuracy found was 0.800. The analysis indicated that the most appropriate cutoff point to signal deterioration was ≥3, with a sensitivity of 40% and specificity of 100%. Interobserver reproducibility was 0.96, considered almost perfect. Conclusion: The findings suggest that PEWS may be a feasible tool to support clinical practice in the assessment and monitoring of this population. PEWS appears to be a promising instrument for the early identification of clinical deterioration in infants with BPD, and future studies may consolidate these findings and strengthen clinical practice.