Coleta de líquido cefalorraquidiano precoce e risco de hemorragia intraventricular em recém-nascidos de muito baixo peso

• Ano de defesa: 2017
• Autor(a) principal: Testoni, Daniela [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Newborn; Premature; Cerebral hemorrhage; Lumbar puncture; Bacterial meningitis; Recém-nascido; Prematuro; Hemorragia cerebral; Punção lombar; Meningites bacterianas
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=5200676; http://repositorio.unifesp.br/handle/11600/50401

Objective: To determine whether early lumbar puncture in very low birth weigh infants is associated with increased risk for severe intraventricular hemorrhage during the neonatal period. Methods: All infants with birth weight <1500g were identified from a cohort of 887,910 infants discharged from 348 neonatal intensive care units managed by the Pediatrix Medical Group® between 1997 and 2012. Severe intraventricular hemorrhage was defined by Papile (1978) as grades III or IV. Logistic regression was used to determine the association between early lumbar puncture and the incidence of severe intraventricular hemorrhage by 28 days for each day of life from day 0 (birth) to day 3, adjusting for gestational age, small for gestational age, Apgar score at 5 minutes, type of delivery, prenatal antibiotics, prenatal steroids, proven early onset sepsis,ventilator use, inotropic support, ibuprofen or indomethacin use, and thrombocytopenia. Results: A total of 82,488 infants did not received a lumbar puncture, 496 received lumbar puncture on Day 0; 453 on Day 1; 419 on Day 2; and 386 on Day 3. Mean ± standard deviation of gestational age for infants without a lumbar punctured was 28.9 ±2.8 weeks and, for infants with lumbar puncture on days 0, 1, 2 and 3, it was respectively 28.6±2.5; 27.8±2.5; 27.9±2.3 and 27.8±2.4 weeks (p<0.001). Severe intraventricular hemorrhage during neonatal period occurred in 4% (3,493/84,242) of the population. After adjustment, the risk of severe intraventricular hemorrhage was higher for infants with a lumbar puncture performed on each studied day, expressed in odds ratio (95%CI): Day 0 - 2.56 (1.74-3.77); Day 1- 2.42 (1.66-3.53); Day 2 - 1.74 (1.07-2.83); Day 3 - 1.99 (1.20-3.31). Conclusions: Early lumbar puncture in the first days of life was associated with an increased chance of severe intraventricular hemorrhage during the neonatal period in very low birth weight infants.