Made available in DSpace on 2015-04-14T13:33:09Z (GMT). No. of bitstreams: 1 459167.pdf: 601334 bytes, checksum: 717c74d4f578d29024efee12660fc997 (MD5) Previous issue date: 2014-03-31 / Background: Term neonates delivered by elective cesarean section who developed Transient Tachypnea of the Newborn have shown a low number of stable microbubbles on gastric fluid. The oral fluid has not been previously used to evaluate the pulmonary maturity after birth. Objective: To evaluate the Stable Microbubble Test in oral and gastric fluids for predicting of Transient Tachypnea of the Newborn. Methods: Patients with gestational age &#8805; 37 who were born by elective cesarean section were in the delivery room, oral fluid obtained immediately after birth and gastric fluid up to one hour of life. The samples were frozen to be analyzed blindly by two observers according to the method described by Pattle. Results: In total, 544 neonates were included in the study. Of these, 22 developed respiratory distress requiring hospitalization in the Neonatal Intensive Care Unit (NICU). Twenty four patients had mild transient respiratory symptoms and were not admitted to the NICU. Patients who were admitted to the neonatal intensive care unit, in oral fluid had a median, minimum and maximun of 67.5 (18-150) microbubbles/mm2 and 498 newborns without respiratory distress had a score of 350 (5-10000) microbubbles/mm2 - p < 0.001. In gastric fluid, the neonates had a score of 150 (24-1200) microbubbles/mm2 and neonates without respiratory distress were 600 (6-7000) microbubbles/mm2 - p< 0.05. The 24 patients with mild respiratory symptoms and not admitted to the NICU had a count of oral microbubbles, minimum and maximun of 137.5 (20-3750) microbubbles/mm2 in gastric fluid and 725 (20-4000) microbubbles/mm2. Considering only the 22 patients admitted and a cutoff point of 200 microbubbles/mm2, oral fluid showed a sensitivity of 81.8% and specificity of 76.9 % for the diagnosis of Transient Tachypnea of the Newborn. For the gastric fluid, with a cutoff point of 250 microbubbles/mm2, sensitivity was 68.2 % and specificity of 76.7 %. Conclusion: The results suggest that Transient Tachypnea of the Newborn is associated with alterations of the surfactant system. The oral fluid is an alternative method to the use of the amniotic fluid and gastric fluid for assessing fetal lung maturity after birth / Introdu??o: Os rec?m-nascidos submetidos ? cesariana eletiva que desenvolvem Taquipn?ia Transit?ria do Rec?m-nascido tem apresentado uma baixa contagem de microbolhas est?veis no fluido g?strico. O fluido oral n?o foi usado anteriormente para avaliar a maturidade pulmonar ap?s o nascimento. Objetivo: Avaliar o Teste das Microbolhas Est?veis nos fluidos oral e g?strico ao nascimento para a predi??o da Taquipn?ia Transit?ria do Rec?m-nascido. M?todos: Pacientes com idade gestacional &#8805;37 semanas, nascidos por cesariana eletiva, tiveram na sala de parto o fluido oral obtido imediatamente ap?s o nascimento e o fluido g?strico com at? uma hora de vida. As amostras foram congeladas para serem analisadas, cegamente, por dois observadores, conforme o m?todo descrito por Pattle. Resultados: No total, 544 neonatos foram inclu?dos no estudo. Destes, 22 desenvolveram dificuldade respirat?ria, necessitando de interna??o na Unidade de Terapia Intensiva Neonatal. Vinte e quatro pacientes apresentaram sintomas respirat?rios transit?rios leves e n?o foram admitidos na Unidade de Terapia Intensiva Neonatal. Os pacientes que foram admitidos na unidade neonatal tiveram no fluido oral uma contagem mediana, m?nimo e m?ximo de 67,5 (18-150) microbolhas/mm2 e os 498 neonatos sem dificuldade respirat?ria tiveram uma contagem de 350 (5-10000) microbolhas/mm2 p<0,001. No fluido g?strico, os neonatos internados tiveram uma contagem de 150 (24-1200) microbolhas/mm2 e os neonatos sem dificuldade respirat?ria tiveram 600 (6-7000) microbolhas/mm2 p<0,05. Os 24 pacientes com sintomas respirat?rios leves e n?o internados na Unidade de Terapia Intensiva Neonatal tiveram uma contagem de microbolhas oral, m?nimo e m?ximo de 137,5 (20-3750) microbolhas/mm2 e no fluido g?strico 725 (20-4000) microbolhas/mm2. Considerando somente os 22 pacientes admitidos e com um ponto de corte de 200 microbolhas/mm2, o fluido oral mostrou uma sensibilidade de 81,8% e especificidade de 76,9% para o diagn?stico de Taquipn?ia Transit?ria do Rec?m-nascido. Para o fluido g?strico, com um ponto de corte de 250 microbolhas/mm2, a sensibilidade foi de 68,2% e a especificidade de 76,7%. Conclus?o: Os resultados sugerem que a Taquipn?ia Transit?ria do Rec?m-nascido est? associada a altera??es do sistema surfactante. O fluido oral ? uma alternativa ? utiliza??o do fluido g?strico para avaliar a maturidade pulmonar ap?s o nascimento.

Made available in DSpace on 2015-04-14T13:32:58Z (GMT). No. of bitstreams: 1 438704.pdf: 1089872 bytes, checksum: 26e9b82adb7d51a185543e38c2cdc8d2 (MD5) Previous issue date: 2011-12-20 / BACKGROUND: Due to meconium's obstructive effect on the airways and its inhibitory action over the surfactant system, treatment with bronchoalveolar lavage and surfactant replacement are currently under evaluation. OBJECTIVE: To evaluate, in an experimental model, the effect on the arterial blood gases and pulmonary mechanics of the treatment of meconium aspiration syndrome with exogenous surfactant, preceded or not of bronchoalveolar lavage with diluted surfactant in low volumes. DESIGN/METHODS: 21 newborn piglets were mechanically ventilated with predetermined settings. Meconium aspiration syndrome was induced by instillation of 5 ml/kg of meconium 20% diluted in isotonic saline, and afterwards the piglets were randomly allocated to: group I (n=7) - control; group II (n=7) - surfactant (Curosurf?) 200mg/kg; group III (n=7) - bronchoalveolar lavage with diluted surfactant 5mg/ml (15 ml/kg in 2ml aliquots), followed by a supplementary dose of surfactant 125mg/kg. Arterial blood gases, compliance, resistance, and tidal volume were measured five times at specific intervals during the six hours of the study. RESULTS: After instillation of meconium, before treatment, the PaO2 fell to a mean of 50mmHg and the PaCO2 increased to 76mmHg (no statistically difference among groups). Mean PaO2 (mmHg) in groups I, II and III were 72, 106 and 172 (p=0,01); 70, 95 and 198 (p<0.01); 79, 110 and 217 (p=0.01) at 30 minutes, 3 and 6 hours after treatment, respectively. Mean PaCO2 (mmHg) in Groups I, II and III were 81, 65 and 35 (p=0.01); 82, 59 and 37 (p=0.01); 82, 75 and 32 (p<0.01) at 30', 3 and 6 hours after treatment, respectively. Mean Compliance (ml/cmH2O) in Groups I, II, III were 0.76, 1.01 and 1.57 (p<0.05); 1.02, 0.69, e 1.79(p<0.05) at 30 minutes and 6 hours after treatment, respectively. Mean resistance (cmH2O/L/S) in Groups I, II, III were 422.57, 385.29 and 268.86 (p<0.05); 408.83, 564.86 e 248.43(p<0.05) at 30 minutes and 6 hours after treatment, respectively. CONCLUSIONS: Bronchoalveolar lavage with diluted surfactant, with low volumes and small aliquots, followed by a supplementary dose of surfactant, significantly improved arterial blood gases and pulmonary function measurements when compared to the administration of a single dose of surfactant in an experimental model of meconium aspiration syndrome. / INTRODU??O: devido ao efeito obstrutivo do mec?nio nas vias a?reas e a a??o inibit?ria sobre o sistema surfactante, o lavado broncoalveolar e a reposi??o de surfactante est?o sendo avaliados nos ?ltimos tempos para o tratamento da s?ndrome da aspira??o de mec?nio. OBJETIVO: Avaliar, em modelo experimental, o efeito sobre os gases sangu?neos arteriais e a mec?nica pulmonar do tratamento da s?ndrome de aspira??o de mec?nio grave com surfactante ex?geno, precedido ou n?o de lavado broncoalveolar com surfactante dilu?do em pequenos volumes. M?TODOS: 21 porcos rec?m-nascidos eram ventilados mecanicamente com par?metros respirat?rios predeterminados. Para induzir a s?ndrome de aspira??o de mec?nio foi instilado 5ml/kg de mec?nio dilu?do a 20% em solu??o salina isot?nica. Ap?s, os porcos foram randomizados em 3 grupos: grupo I (n=7) - controle; grupo II (n=7) - surfactante (Curosurf?) 200mg/kg; grupo III (n=7) - lavado broncoalveolar com surfactante dilu?do 5mg/ml (15ml/kg em al?quotas de 2ml) seguido de uma dose suplementar de surfactante 125mg/kg. Gases arteriais sangu?neos, complac?ncia, resist?ncia e volume corrente foram avaliados durante as 6 horas do estudo em 5 momentos espec?ficos. RESULTADOS: ap?s a instila??o de mec?nio, antes do tratamento, a PaO2 caiu para uma m?dia em torno de 50mmHg e a PaCO2 aumentou para uma m?dia em torno de 76mmHg, n?o havendo diferen?a significativa entre os grupos. Ap?s o tratamento a m?dia da PaO2(mmHg) nos grupos I, II e III aos 30 minutos, 3 e 6 horas foi de 72, 106 e 172 (p=0,01) - 70, 95 e 198 (p<0,01) e 79, 110 e 217 (p=0,01), respectivamente. A m?dia da PaCO2 (mmHg) nos grupos I, II e III foi 81, 65 e 35 (p=0,01) - 82, 59 e 37 (p=0,01) e 83, 75 e 33 (p<0,01), respectivamente. Ap?s o tratamento a m?dia da complac?ncia (ml/cmH2O) aos 30 minutos e 6 horas nos grupos I, II, III foi de 0,76, 1,01 e 1,57(p<0,05) e de 1,02, 0,69 e 1,79 (p<0,05), respectivamente. A m?dia da resist?ncia (cmH2O/L/S) nos grupos I, II e III foi de 422,57, 385,29 e 268,86(p<0,05) e de 408,83, 564,86 e 248,43 (p<0,05) aos 30 minutos e 6 horas, respectivamente. CONCLUS?O: o lavado broncoalveolar com surfactante dilu?do, com baixos volumes e pequenas al?quotas, seguido por uma dose suplementar de surfactante, melhorou significativamente os gases sangu?neos arteriais e a mec?nica pulmonar quando comparado com uma dose de surfactante sem lavado broncoalveolar e com um grupo controle, em um modelo experimental de s?ndrome de aspira??o de mec?nio.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2016-10-10T17:48:51Z No. of bitstreams: 1 TES_MANOEL_ANTONIO_DA_SILVA_RIBEIRO_PARCIAL.pdf: 688919 bytes, checksum: 8a56a70e578bd3446bdbd3b5c916e884 (MD5) / Made available in DSpace on 2016-10-10T17:48:51Z (GMT). No. of bitstreams: 1 TES_MANOEL_ANTONIO_DA_SILVA_RIBEIRO_PARCIAL.pdf: 688919 bytes, checksum: 8a56a70e578bd3446bdbd3b5c916e884 (MD5) Previous issue date: 2016-07-08 / BACKGROUND: The stable microbubbles test on the gastric aspirate has been used for the diagnosis of respiratory distress syndrome of the newborn. However, its use in the preterm newborn oral aspirate was not determined. OBJECTIVE: To evaluate the performance of the stable microbubbles test done on oral aspirate from preterm newborns to predict of respiratory distress syndrome. METHOD: In the study were included infants with gestational age < 34 weeks. Oral secretion sample was obtained immediately after birth and gastric secretion was collected within 30 minutes of life. The samples were frozen and tested within 72 hours. RESULTS: The sample was composed of paired secretion of 70 newborns. The median (interquartile range) of the stable microbubbles count in the oral samples of infants with respiratory distress syndrome was significantly lower than those who did not develop or had respiratory symptoms from other causes: 12 (8 - 22) versus 100 (48 - 230) versus 70 (44 - 208) (p <0.01). The correlation between microbubble count in gastric and bucal aspirates was 0.88 (95%CI: 0,72 ? 0,93; p <0.01). Taking a cut-off point of 15 microbubbles/mm2, the sensitivity of test was 95.4%, the specificity 66.7%, and the agreement of the oral fluid with the gastric fluid was 0.76. CONCLUSION: The study suggests that the stable microbubbles test in gastric aspirate made at birth is a reliable alternative to the gastric fluid in the prediction of respiratory distress syndrome of the newborn. / INTRODU??O: O teste das microbolhas est?veis no aspirado g?strico tem sido utilizado para o diagn?stico de s?ndrome do desconforto respirat?rio do rec?m-nascido. Entretanto, a sua utiliza??o no fluido bucal em rec?m-nascidos pr?-termo ainda n?o foi avaliada. OBJETIVO: Avaliar o desempenho do teste das microbolhas est?veis no aspirado bucal de neonatos pr?-termo para a predi??o da s?ndrome do desconforto respirat?rio. M?TODO: Foram inclu?dos no estudo, rec?m-nascidos com menos de 34 semanas de idade gestacional. A secre??o bucal foi obtida imediatamente ap?s o nascimento e a secre??o g?strica at? 30 minutos de vida. As amostras foram congeladas e testadas em at? 72 horas. RESULTADOS: A amostra foi constitu?da de secre??o pareada de 70 rec?m-nascidos. A mediana (amplitude interquartil) da contagem das microbolhas est?veis no fluido bucal dos rec?m-nascidos com s?ndrome do desconforto respirat?rio foi significativamente menor do que os que n?o desenvolveram ou dos tiveram sintomas respirat?rios por causas indeterminadas: 12 (8-22) versus 100 (48 - 230) versus 70 (44 - 208) (p<0,01), respectivamente. A correla??o entre o teste das microbolhas nos aspirados g?strico e bucal foi 0,88 (IC95%: 0,72 ? 0,93; p <0.01). O melhor ponto de corte para predizer a s?ndrome do desconforto respirat?rio foi 15 microbolhas/ mm2, apresentando sensibilidade de 95,4%, especificidade de 66,7% e concord?ncia com o aspirado g?strico de 0,76. CONCLUS?O: O estudo sugere que o teste das microbolhas est?veis no aspirado bucal ao nascimento ? uma alternativa confi?vel ao fluido g?strico na predi??o da s?ndrome do desconforto respirat?rio do rec?m-nascido.