Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-04-03T22:22:48Z No. of bitstreams: 1 DeboraFeitosaDeFranca_DISSERT.pdf: 1200684 bytes, checksum: 04833e314831a68a3846b63143d49ffa (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-04-10T23:05:57Z (GMT) No. of bitstreams: 1 DeboraFeitosaDeFranca_DISSERT.pdf: 1200684 bytes, checksum: 04833e314831a68a3846b63143d49ffa (MD5) / Made available in DSpace on 2017-04-10T23:05:57Z (GMT). No. of bitstreams: 1 DeboraFeitosaDeFranca_DISSERT.pdf: 1200684 bytes, checksum: 04833e314831a68a3846b63143d49ffa (MD5) Previous issue date: 2016-12-06 / Objetivou-se analisar os eventos adversos relacionados ? terapia respirat?ria em rec?m-nascidos de alto risco de uma unidade neonatal. Trata-se de um estudo observacional, longitudinal e prospectivo, realizado em uma maternidade, unidade de referencia no Estado do Rio Grande do Norte para gravidez e nascimento de alto risco. Os dados foram coletados no per?odo de abril a setembro 2016, ap?s aprova??o do projeto no Comit? de ?tica em Pesquisa da UFRN com CAAE n? 51832415.0.0000.5537. A amostra foi composta por 82 rec?m-nascidos submetidos ? terapia ventilat?ria nas modalidades: ventila??o mec?nica invasiva, ventila??o mec?nica n?o invasiva e press?o positiva cont?nua das vias a?reas por prong nasal. Os resultados apontam que a incid?ncia dos eventos adversos foi de 48,8%, sendo o mais frequente a extuba??o n?o planejada (34%), seguida da les?o de septo nasal (13%), pneumonia associada ? ventila??o mec?nica (7%) e o pneumot?rax (6%). A probabilidade de ocorr?ncia de um evento adverso em rec?m-nascido submetido ? terapia ventilat?ria nos primeiros cinco dias de terapia ultrapassou os 40% (IC 95%). Existe associa??o entre a idade gestacional e a ocorr?ncia de eventos adversos, sendo os rec?m-nascidos com menos de 28 semanas os mais suscept?veis (p-valor 0,024). A raz?o de chance de um rec?m-nascido sofrer um evento adverso em gestacional extrema ? 5,57 vezes maior do que um a termo, IC 95% [1,44;21,60]. H? associa??o entre a modalidade de ventila??o mec?nica n?o invasiva e a ocorr?ncia de les?o de septo nasal (p-valor <0,001), em contra ponto n?o foi apontado associa??o entre a ocorr?ncia do mesmo evento e a modalidade CPAP nasal (p-valor 0,160). Os resultados da regress?o log?stica apontam associa??o entre a malforma??o cong?nita e a ocorr?ncia do evento adverso de uma forma geral (p-valor 0,003) e por tipo especificamente a extuba??o n?o planejada (p-valor 0,039). Portanto conclui-se que os rec?m-nascidos prematuros e portadores de malforma??o cong?nita s?o suscept?veis a ocorr?ncia desses eventos adversos. E como oportunidade de melhoria da assist?ncia recomenda-se a constru??o e valida??o de protocolos de preven??o da extuba??o n?o planejada, que atenda as especificidades dos portadores de malforma??o cong?nita, al?m do protocolo de manuseio m?nimo para prematuros extremos. / The objective was to analyze the adverse events related to respiratory therapy in high-risk newborns of a neonatal unit. It is an observational, longitudinal and prospective study, performed in a maternity unit, a reference unit in the State of Rio Grande do Norte for high-risk pregnancy and birth. The data were collected from April to September 2016, after approval of the project in the Research Ethics Committee of UFRN with CAAE n? 51832415.0.0000.5537. The sample consisted of 82 newborns submitted to ventilatory therapy in the modalities: invasive mechanical ventilation, non-invasive mechanical ventilation and continuous positive airway pressure per prong nasal. Results show that the incidence of adverse events was 48.8%, most frequently unplanned extubation (34%), followed by nasal septum injury (13%), ventilator-associated pneumonia (7%), and Or pneumothorax (6%). The probability of an adverse event occurring in a neonate undergoing ventilatory therapy in the first five days of therapy exceeded 40% (95% CI). There is an association between gestational age and the occurrence of adverse events, with newborn infants less than 28 weeks being the most susceptible (p-value 0.024). The odds ratio for a newborn suffering an adverse event in gestational extreme is 5.57 times greater than one full-term, 95% CI [1.44, 21.60]. There was an association between the non-invasive mechanical ventilation and the occurrence of nasal septum lesion (p-value <0.001). On the contrary, there was no association between the occurrence of the same event and the nasal CPAP modality (p-value 0.160). The results of the logistic regression show an association between the congenital malformation and the occurrence of the general adverse event (p-value 0.003) and by type specifically the unplanned extubation (p-value 0.039). Therefore it is concluded that premature newborns with congenital malformations are susceptible to the occurrence of these adverse events. And as an opportunity to improve care, it is recommended the construction and validation of protocols for prevention of unplanned extubation, which meets the specificities of patients with congenital malformations, in addition to the minimum protocol for the management of extremely premature infants.