Terapia imunológica oral em recém-nascidos prematuros : análise dos resultados da implantação de um protocolo assistencial

• Ano de defesa: 2018
• Autor(a) principal: Salcher, Fernanda Gava
• Orientador(a): Fiori, Humberto Holmer
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Pontifícia Universidade Católica do Rio Grande do Sul
• Programa de Pós-Graduação: Programa de Pós-Graduação em Medicina/Pediatria e Saúde da Criança
• Departamento: Escola de Medicina
• País: Brasil
• Palavras-chave em Português: Colostro; Administração Orofaríngea de Colostro; Leite Humano; Lactação; Recém-Nascido Prematuro
• Palavras-chave em Inglês: Colostrum; Oropharyngeal Administration of Colostrum; Milk Human; Lactation; Infant; Preterm
• Área do conhecimento CNPq: CIENCIAS DA SAUDE::MEDICINA; MEDICINA::SAUDE MATERNO-INFANTIL
• Link de acesso: http://tede2.pucrs.br/tede2/handle/tede/8120

INTRODUCTION: Colostrum therapy, also called oral immunological therapy, is the administration of colostrum via the oropharyngeal route to preterm infants and can be started within the first six hours of life. Small doses of colostrum are administered to the oral mucosa and upper respiratory tract of the infant, which may exert a protective effect on the mucosal membrane. In addition, immunoglobulin A, colostrum cytokines, antioxidant agents and all anti-infective agents may interact with lymphoid cells within the oropharynx, stimulating the infant's immune function. Recently, studies have reported the importance of colostrum administered by the oropharyngeal route, especially for extremely low birth weight preterm infants, with nutritional and immune defense effects already demonstrated. The more premature the baby, the more it will benefit from early exposure to colostrum. OBJECTIVE: To estimate the success rate after implantation of a colostrum administration protocol in low birth weight preterm infants at the Hospital Saúde, in Caxias do Sul, RS. METHODOLOGY: The study took place between March and July 2017, after the ethical approval of the project. The participants were 41 mother / baby pairs whose mothers, after signing the free and informed consent, made attempts to exhaust the breast to provide colostrum to their children. Preterm infants between 24 and 32 weeks of age who had an indication of colostrum therapy prescribed by the physician were included, and attempts were made to exhaust the breast before six hours of the newborn's life. Two data collection instruments created by the researcher were used, one with information about mothers and newborns and the other for the Neonatal Intensive Care Unit nursing team to respond. After the observation of the attempt to obtain the colostrum, the questions of the collection instrument were considered, as if the puerpera managed to exhaust 0.2 mL of colostrum or not, or if the breast was exhausted before six hours. Through the charts of each baby, the data on administration were collected. It was observed if there was a decrease in oxygen saturation and / or an increase in respiratory and cardiac frequencies at the time of administration of colostrum. The success of colostrum therapy was considered to be the administration of at least one dose of colostrum within the first 72 hours of life, and the success rate was reported as a percentage of the cases that were successful among all included. RESULTS: Among the 41 premature infants included in the protocol, 19 (46.3%) received at least one dose of colostrum within the first 72 hours of life and 22 (53.7%) did not receive colostrum. There was an association between being able to deplete the breast earlier and the baby to be able to receive colostrum, regardless of when it was received. All 22 cases of colostrum failure were due to failure to obtain colostrum within 72 hours postpartum. There was no association between whether or not colostrum could be collected and maternal age or gestational age. There were no adverse events, such as alterations in the respiratory and cardiac frequencies or decrease in oxygen saturation, in the 19 infants who received oropharyngeal colostrum. Regarding the perception of the professional care team about colostrum therapy, more than half reported being partially knowledgeable about the practice and only one felt totally knowledgeable. However, most of the care team (83.4%) reported being satisfied, very satisfied or totally satisfied with the implementation of the colostrum protocol. CONCLUSIONS: In general, this study demonstrated difficulties in the implantation of the protocol of colostrum therapy to premature infants at Hospital Saúde in Caxias do Sul. The obstacles to the success of a protocol of colostrum therapy were revealed, which mainly resided in the fact that the puerperae had difficulty in exhausting the breast in the first few days after preterm birth, and as a consequence, most newborns were unable to receive maternal colostrum within the first three days of life. In successful cases, the mother's satisfaction with the fact that the child received her colostrum was rewarding. There was a insufficient deepening in the training of the professional care team. These results brought important data that can be used in the execution of a new protocol, in the same unit as well as in other units with the same characteristics. Additional studies should be performed to reveal ways to achieve better success in the application of colostrum therapy protocol, supplanting the difficulties of early breast exhaustion, and can thus benefit from the administration of oropharyngeal colostrum to premature infants.