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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 ≥ 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 ≥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.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/1438 |
| Date | 31 March 2014 |
| Creators | Estorgato, Geovana Rhoden |
| Contributors | Fiori, Renato Machado |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Medicina/Pediatria e Sa?de da Crian?a, PUCRS, BR, Faculdade de Medicina |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 3098206005268432148, 500, 600, -8624664729441623247 |
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