Avaliação de conformidades nas práticas ventilatórias em recém-nascidos <32 semanas nas primeiras 24 horas de vida

Abstract

Introduction: The use of ventilatory support is one of the essential technological advances for the survival of premature newborns, having an important contribution to the reduction of infant mortality. Therefore, adequate ventilatory management in the first days of life is essential for a good prognosis, leading to shorter mechanical ventilation time, decreased respiratory morbidities, hospital returns, and thus lower public spending. Objective: To evaluate compliance in ventilatory practices performed in newborns <32 weeks in the first 24 hours of life. Methodology: Cross-sectional study, of the normative evaluative type, between January and May 2024. The study was carried out in the neonatal units of the César Cals General Hospital (HGCC), in Fortaleza/Ceará. Participants were recruited through active search. Data were collected through a form prepared by the researchers, with the authorization of the child's legal guardian and after approval by the research ethics committee of the Federal University of Ceará (UFC) and the hospital where the research field was conducted. The compliance rate of the points was obtained by adding the scores of the questions and transformed into a percentage proportion. In the end, the formula was used for the degree of conformity: Group 1 + Group II/ 2. Values below 60% (low compliance), between 60-80% (medium compliance) and above 80% (high compliance) were considered. Results: The research resulted in 80 newborns (NB) < 32 weeks. Group I (birth care) composed of variables such as: use of corticosteroids (N=73), CPAP (Continuous Positive Airway Pressure) in the delivery room (N=29), use of manual mechanical ventilator (VMM) in T (N=36), among others, had low compliance (65%). Group II (respiratory support used within 24 hours of life) obtained high compliance in the situations of CPAP (n=22) and Intermittent Positive Pressure Ventilation (IPPV) (n=1), 86.4% and 86%, respectively. In the VMI situation (n=57), it resulted in low compliance (60.7%). However, after applying the formula: Group I + Group II/2, when the evolution of the NB was for CPAP and PPV, the values obtained were 75.7% and 75.5%, respectively, i.e., medium compliance. In the final average in the VMI situation, low compliance resulted (62.8%). Conclusion: There are recommended practices that have not yet been effectively incorporated into the routine of the service, such as: low attempts at CPAP in the delivery room and low use of WMV in T. And yet, when the choice in the first 24 hours of life is for NIV (CPAP and/or IPPV), these children are more likely to benefit from a safer and more effective therapy. On the other hand, when VMI is chosen as support, these preterm infants run the risk of presenting more chances of inadequacy of the parameters offered.