Avaliação da intervenção de não aspiração do resíduo gástrico pré-prandial em recém-nascidos pretermos

Abstract

The objective of this dissertation is to evaluate the effect of the intervention of non-aspiration of pre-prandial gastric residue in preterm newborns in comparison with the members of a historical control group which routinely had their gastric contents measured. It was a retrospective cohort study of therapeutic intervention carried out with 140 QualiNEO forms and medical records of newborns admitted to the Neonatal Intensive Care Unit of a tertiary reference maternity hospital, located in Fortaleza, Ceara state, Brazil. The established inclusion criteria were: being preterm newborns, being less than 35 weeks old and of both genders who were referred to the Neonatal Intensive Care Units, using an orogastric tube for gavage. Documents from participants with morphological abnormalities of the gastrointestinal tract and those who had undergone previous abdominal surgery were ineligible. The following censorship criteria were established: documents of newborns who, after starting data collection, started a transpyloric diet, underwent abdominal surgery, died and were transferred to another hospital before starting the enteral diet. Duration to reach the daily nutritional requirement, Duration of parenteral use, Recovery of birth weight and Occurrence of Necrotizing Enterocolitis were considered as primary outcomes. For data analysis, an inter-group comparison was carried out regarding clinical characterization, diet and hospital discharge. Spearman's tests were applied, given the non-normal distribution of the analyzed variables, to verify the association between quantitative outcomes and independent quantitative predictors and, when appropriate, multiple linear regression was performed for quantitative outcomes with quantitative and/or qualitative predictors. For qualitative outcomes, Fisher's exact or chi-square tests were adopted to identify the presence of association between independent variables of interest and the outcome. Logistic regression techniques were applied to identify the chance associated with occurrences, with 95% confidence intervals. Applied the stepwise method, for the elaboration of final reduced model. The evaluation of the fit of the final model was performed using the Hosmer and Lemeshow test. R2 of Nagelkerke and Teste Omnibus. A significance level of 5% was adopted. The research project received a favorable opinion from the Research Ethics Committee, under number 4,185,213. Exposed Group 1 was composed of 71 preterm newborns who routinely had their gastric residue measured. Unexposed Group was composed of 69 preterm newborns who did not have routine aspiration of pre-prandial gastric residue. Newborns who routinely had their gastric residue aspirated had a greater volume of gastric residue (63.36 ±146.25 vs. 15.62 ±16.93; p= 0.042), had more discontinued diets (84.51 vs. 62.32%; p= 0.003) and/or suspended (53.52 vs. 34.78%; p= 0.026). On the other hand, newborns who did not routinely have their gastric residue aspirated showed a greater progression of enteral diet (27.25 ±11.74 vs. 24.71 ±19.19; p= 0.026) and a higher percentage of regurgitation (56. 52 vs. 38.03%; p= 0.028). Newborns who did not routinely have their pre-prandial gastric residue aspirated showed a faster achievement of the daily nutritional requirement (11.90 ±8.52 vs. 14.22 ±7.27) and shorter parenteral diet permanence (9.53 ±7.25 vs. 11.58 ±10.40), with no significant increase in the Occurrence of Necrotizing Enterocolitis (5 vs. 3; p= 0.441). The time of use of parenteral diet increases as the greater as the volume of gastric residue and as the greater the number of discontinued diets for newborns who had their gastric residue aspirated. Necrotizing enterocolitis predicts an increase of just over 12 days in the duration of the parenteral diet. There

was no statistical difference between the groups in the Birth Weight Recovery. However, it was found a trend of shorter life time for Birth Weight Recovery (10.77 ±4.48 vs. 12.67 ±5.33; p = 0.144) for newborns who did not have their gastric residue aspirated. Based on our results, we advocated to omit the routine aspiration of pre-prandial gastric residue in preterm newborns as it reveals nutritional and clinical benefits, without increasing adverse health outcomes.