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Vol. 58. Núm. 1.
Páginas 45-51 (Enero 2003)
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Vol. 58. Núm. 1.
Páginas 45-51 (Enero 2003)
Acceso a texto completo
Proyecto EURAIL. Estrategias de prevención y tratamiento contra la inmadurez pulmonar en España
The europe against immature lung (Eurail) Project. Strategies for The Prevention and Treatment of Lung Immaturity in Neonates
Visitas
8300
A. Valls i Solera,
Autor para correspondencia
enadolf@eresmas.net

Correspondencia: Unidad Neonatal y de Investigación. Departamento de Pediatría. Hospital de Cruces. Universidad del País Vasco/EH.U. 48903 Barakaldo. Bilbao. España.
, S. Páramo Andrésa, B. Fernández-Ruanovaa, F. Morcillo Sopenab, F.J. Monleón Alegreb, V. Carretero Díazc, J. Marín Herreroc, por el Grupo Colaborativo Español EURAIL
a Unidad Neonatal y de Investigación. Departamento de Pediatría. Hospital de Cruces. Facultad de Medicina Universidad del País Vasco/EHU. Barakaldo. Bilbao
b Servicios de Neonatología y Obstetricia. Hospital Universitario La Fe. Valencia
c Unidad Neonatal. Servicio de Pediatría. Hospital San Pedro de Alcántara. Cáceres. España
Este artículo ha recibido
Información del artículo
Objetivo

Conocer la variabilidad de la práctica clínica habitual en la prevención y el tratamiento de la inmadurez pulmonar.

Pacientes y métodos

Estudio transversal dentro de un estudio en 13 países europeos. De todos los neonatos de muy bajo peso nacidos en los centros colaboradores se recogieron datos de las historias clínicas sin ningún tipo de instrumentación adicional.

Resultados

La encuesta fue remitida a 213 centros, de los cuales contestaron 72 (34 %), con un total de 162.157 nacimientos (40 % del total en 1999). El 8% de los recién nacidos eran de bajo peso, el 1,2 % de muy bajo peso (2.015) y el 0,45% de extremado bajo peso. El 52,5 % de los de muy bajo peso recibieron al menos una dosis de corticoides prenatales, el 28,8%, un ciclo completo, y el 9,3%, más de un ciclo. Todos los centros utilizan algún preparado surfactante, y cuentan con un protocolo escrito el 76,8 %. El 41 % de los recién nacidos de muy bajo peso fueron intubados al nacer, el 47,6 % precisaron ventilación mecánica durante más de 6 h y el 5% presión positiva continua. El 80,4% de centros usaban corticoides posnatales, la mitad para la prevención de enfermedad pulmonar crónica (EPC) y el 83,4 % como de terapéutica. La pauta más habitual era indicarlos a los 7-14 días de vida, durante 3-9 días. Entre la morbilidad neonatal destaca la EPC (14 %), conducto arterioso sintomático (16,7 %), hemorragia intraventricular (8,5 %) y enterocolitis necrosante (7,3 %).

Conclusiones

La tasa de exposición a corticoides prenatales fue baja y la práctica de repetir los ciclos y el empleo de corticoides posnatales para prevenir la EPC elevadas. Sigue siendo preciso difundir la reciente evidencia científica sobre el uso de corticoides prenatales y posnatales

Palabras clave:
Inmadurez
pulmonar
Cuidado prenatal
Corticoides
Surfactante
Objective

To determine clinical practice variability in the prevention and postnatal treatment of lung immaturity in Spain

Patients and methods

Cross-sectional study within a larger study in 13 European countries. Data were obtained from the medical records of all very low birth weight (VLBW) infants born in participating centers, without other instrumentation.

Results

A questionnaire was sent to 213 centers. Seventy-two (34 %) responded, with 162,157 births (40 % of total births in 1999). Eight percent of infants were of low birth weight, 1.2% (2,015) of very low birth weight and 0.45 % were of extremely low birth weight. A total of 52.2% of VLBW infants received at least one dose of prenatal steroids, 28.8% received a full course and 9.3 % received more than one cycle. All centres used surfactant and 76.8 % had a written protocol. Forty-one percent of VLBW infants were intubated, 47.6% required mechanical ventilation for more than 6 hours, and 5% underwent continuous positive airway pressure. A total of 80.4 % used postnatal steroids, half of them for chronic lung disease prevention, and 83.4 % used steroids to treat this disease. Steroids were most frequently indicated at 7-14 days of life for 3-9 days. The most important causes of neonatal morbidity were chronic lung disease in 14 %, ductus arteriosus in 16.7 %, intraventricular hemorrhage in 8.5 %, and necrotizing enterocolitis in 7.3%.

Conclusions

Prenatal exposure to steroids was low. Repeat cycles and postnatal steroid use to prevent chronic lung disease was high. Recent scientific evidence on the use of pre- and postnatal steroids should be more widely disseminated.

Key words:
Immature lung
Neonatal respiratory
distress syndrome
Prenatal care
Corticosteroids
Surfactant
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Bibliografía
[1.]
L.S. Bakketeig, P. Bergsjo.
The epidemiology of preterm birth.
Textbook of Perinatal Medicine, pp. 1331-1336
[2.]
M.E. Avery, J. Meade.
Surface properties in relation to atelectasis and hyaline membrane disease.
Am J Dis Child, 97 (1959), pp. 517-523
[3.]
G.C. Liggins, R.N. Howie.
A controlled trial of antepartum gluco-corticoid treatment for prevention of respiratory distress syndrome in premature infants.
Pediatrics, 50 (1972), pp. 515-525
[4.]
T. Fujiwara, S. Chida, Y.J. Watabe, H. Meata, T. Morita, T. Abe.
Artificial surfactant therapy.
Lancet, 1 (1980), pp. 5-9
[5.]
P. Crowley, I. Chalmers, M.J.N.C. Keirse, I. Chalmers, M. Keirse.
The effects of corticosteroid administration before preterm delivery: An overview of the evidence from controlled trials.
Br J Obstet Gynecol, 97 (1990), pp. 11-25
[6.]
INH Consensus Developmental Panel on the effect of corticos-teroids for fetal maturation on perinatal outcomes.
JAMA, 273 (1996), pp. 413-418
[7.]
J.P. Empana, M.M. Anceschi, G.H.A. Visser, I. Szabó, G. Breart.
Use of antenatal corticosteroids in Europe.
Prenat Neonat Med, 6 (2001), pp. 1-7
[8.]
Colaborative European Multicenter Study Group. Surfactant replacement therapy for severe neonatal respiratory distress syndrome: An international randomized clinical trial.
Pediatrics, 82 (1988), pp. 683-689
[9.]
G. Bevilacqua, H.L. Halliday, S. Parmigiani, B. Robertson, P. Monici-Petri, R. Tubman.
Randomized multicentre trial of treatment with porcine natural surfactant for moderately severe neonatal respiratory distress syndrome.
J Perinat Med, 21 (1993), pp. 329-340
[10.]
H.L. Halliday, W.O. Tarnow-Mordi, J.D. Corcoran, C.C. Patterson.
Multicentre randomized trial comparing high and low dose surfactant regimens for the treatment of respiratory distress syndrome (the Curosurf 4 trial).
Arch Dis Child, 69 (1995), pp. 276-278
[11.]
H. Halliday.
Overview of clinical trials comparing natural and synthetic surfactants.
Biology Neonate, 67 (1995), pp. 32-47
[12.]
A. Jobe, B.R. Mitchell, J.H. Gunkel.
Beneficial effects of the com-bined use of prenatal corticosteroids and postnatal surfactant on preterm infants.
Am J Obstet Gynecol, 168 (1993), pp. 508-513
[13.]
M.A. Kari, M. Hallman, M. Eronen, K. Teramo, M. Virtanen, M. Kai-visto.
Prenatal dexamethasone treatment in conjunction with rescue therapy of human surfactant: A randomized placebo controlled multicentre study.
Pediatrics, 93 (1994), pp. 730-736
[14.]
E.V. Cosmi, G. Breart, H.L. Halliday, O.D. Saugstad, I. Szabó, G.H.A. Visser.
Antenatal and postnatal management of fetal lung immaturity in Europe. Report of EURAIL (Europe Against Immature Lung).
Prenat Neonat Med, 6 (2001), pp. 1-88
[15.]
R. Derom, J. Orlebeke, A. Erikson.
The epidemiology of multple births.
Textbook of Perinatal Medicine, pp. 1463-1480
[16.]
M.M. Anceschi, A. Antsaklis, A. Kurjak, A. Pal, L. Pereira Leite.
Beneficial effects of antepartum corticosteroids.
Prenat Neonat Med, 6 (2001), pp. 31-41
[17.]
G.H.A. Visser, T. Csermely, E.V. Casmi.
Side-effects of prenatal steroids.
Prenat Neonat Med, 6 (2001), pp. 42-49
[18.]
P. Truffert, G. Breart, R. Goelz, O.D. Saugstad, H.L. Halliday, G. Bevilaqua.
Treatment strategies in Europe for neonatal pulmonary morbidity using surfactant and postnatal corticosteroids.
Prenat Neonat Med, 6 (2001), pp. 8-14
[19.]
G.H.A. Visser, M.M. Anceschi.
Guidelines on antepartum corticosteroids.
Prenat Neonat Med, 6 (2001), pp. 78-80
[20.]
J.A. Quilivan, S.F. Evans, S.A. Dunlop, L.D. Beazley, J.P. Newnham.
Use of corticosteroids by Australian obstetricians-a survery of clinical practice.
Aust N Z J Obstet Gynaecol, 38 (1998), pp. 1-7
[21.]
P. Brocklehurst, S. Gates, K. Mckenzie-McHarg, Z. Alfirevic, G. Chamberlain.
Are we prescribing multiple courses of antenatal corticosteroids? A survey of practice in the U.K.
Br J Obstet Gynaecol, 106 (1999), pp. 977-979
[22.]
O. Dammann, S.G. Matthews.
Repeated Antenatal Glucocorticoid Exposure and the Developing Brain.
Pediatr Res, 50 (2001), pp. 563-564
[23.]
D.A. Guinn, M.W. Atkinson, L. Sullivan, M.J. Lee, S. MacGregor, B.V. Parilla.
Single vs weekly courses of antenatal corticosteroids for women at risk of preterm delivery. A randomized controlled trial.
JAMA, 286 (2001), pp. 1581-1587
[24.]
R.J. Bolt, M.M. Weissenbruch, H.N. Lafeber, H.A. Delemarre-van de Waal.
Glucocorticoids and Lung Development in the Fetus and Preterm Infant.
P Pulmonol, 32 (2001), pp. 76-91
[25.]
N. Modi, H. Lewis, N. Al-Naqeeb, M. Ajayi-Obe, C.J. Doré, M. Ruther-ford.
The Effects of Repeated Antenatal Glucocorticoid Therapy on the Developing Brain.
Pediatr Res, 50 (2001), pp. 581-585
[26.]
H.E. Edwards, W.M. Burnham.
Developing Nervous System: A series of Review Articles.
Pediatr Res, 50 (2001), pp. 433-440
[27.]
O. Baud, V. Laudenbach, P. Evrard, P. Gressens.
Neurotoxic effects of fluorinated glucocorticoid preparations on the developing mouse brain: Role of preservaties.
Pediatr Res, 50 (2001), pp. 706-711
[28.]
L.J. Van Marten, E.N. Allered, A. Levinton, M. Pagano, R. Parad, M. Moore.
and the Neonatology Committee for The Development Epidemiology Network. Antenatal glucocorticoid does not reduce chronic lung disease among surviving preterm infants.
J Pediatr, 138 (2001), pp. 198-204
[29.]
R.K. Silver, C. Vyskocil, S.L. Solomon, A. Ragin, M.G. Neerhof, E.E. Farell.
Randomized Trial of Antenatal Dexamethasone in Surfactant-Treated Infants Delivered Before 30 Weeks' Gestation.
Obstet Gynecol, 87 (1996), pp. 638-691
[30.]
Valls i Soler A, Paramo S, of behalf of the Spanish Surfactant Collaborative Study Group. Prenatal steroids do not modify surfactant needs after prophylaxis in infants 28-30 weeks. Pediatr Res 2001; p. 49
[31.]
O.D. Saugtad, G. Bevilacqua, M. Katona, C.P. Speer, A. Valls i Soler.
Surfactant therapy in the newborn.
Prenat Neonat Med, 6 (2001), pp. 56-59
[32.]
V.M. Navas Serrano, M.A. Cuevas García, J.A. Vila Alvarez, V. Martínez Fernández, F. Morcillo Sopena, A. Valls i Soler.
Profilaxis y tratamiento del síndrome de distrés respiratorio con diferentes surfactantes.
An Esp Pediatr, 56 (2002), pp. 40-44
[33.]
C.S. Phibbs, R.H. Phibbs, A. Wakeley, M.A. Schlueter, S. Sniderman, W.H. Tooley.
Cost effects of surfactant therapy for neonatal respiratory distress.
J Pediatr, 123 (1993), pp. 953-962
[34.]
J. Egberts, R. Brand, H. Walti, G. Bevilacqua, G. Breart, F. Gardini.
Mortality, severe respiratory distress syndrome, and chronic lung disease of the newborn are reduced more after prophylactic than after therapeutic administration of the surfactant Curosurf.
Pediatrics, 100 (1997), pp. 1-4
[35.]
H. Walti, J. Paris-Llado, G. Breart, M. Couchard.
Porcine surfactant replacement therapy in newborns of 25-31 weeks'gestation: A randomized, multicentre trial of prophylaxis versus rescue with multiple low does. The French Collaborative Multicentre Study Group.
Acta Paediatr, 84 (1995), pp. 913-921
[36.]
H.L. Halliday.
Clinical trials of postnatal corticosteroids: Inhaled and systemic.
Biol Neonate, 76 (1999), pp. 29-40
[37.]
H.L. Halliday.
Benefits and side-effects of steroids in neonatal medicine.
Prenat Neonat Med, 6 (2001), pp. 50-55
[38.]
A.H. Jobe.
Glucocorticoids in Perinatal medicine: Misguided rockets?.
J Pediatr, 137 (2000), pp. 1-3
[39.]
N.N. Finer, A. Craft, Y.E. Vaucher, R.H. Clark, A. Sola.
Postnatal steroids: Short-term gain, long-tern pain?.
J Pediatr, 137 (2000), pp. 9-13
[40.]
E.S. Shinwell, M. Karplus, D. Reich, Z. Weintraub, D. Blazer, D. Bader.
Early postnatal dexamethasone treatment and increased incidence of cerebral palsy.
Arch Dis Child Fetal Neonatal Ed, 83 (2000), pp. 177-181
[41.]
The Vermont Oxford Network Steroid Study Group. Early Post-natal dexamethasone Therapy for the Prevention of Chronic Lung Disease.
Pediatrics, 108 (2001), pp. 741-748
[42.]
A. Valls i Soler, E. Sulyok, E. Gastiasoro, F.J. Alvarez, B. Lachmann.
New developments in neonatal respiratory treatment: From conventional to liquid ventilation.
Prenat Neonat Med, 6 (2001), pp. 66-74
[43.]
G. Bevilacqua, R. Goelz, H.L. Halliday.
Guidelines on surfactant treatment.
Prenat Neonat Med, 6 (2001), pp. 84-88
[44.]
H.L. Halliday.
Guidelines on neonatal steroids.
Prenat Neonat Med, 6 (2001), pp. 81-83
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