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Vol. 61. Núm. 2.
Páginas 118-123 (agosto 2004)
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Vol. 61. Núm. 2.
Páginas 118-123 (agosto 2004)
Acceso a texto completo
Tratamiento con corticoides prenatales y surfactante precoz en recién nacidos de igual o menos de 30 semanas de gestación
Prenatal corticosteroid and early surfactant therapy in infants born at ≤ 30 weeks' gestation
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12366
A. Valls i Solera,
Autor para correspondencia
enadolf@eresmas.net

Correspondencia: Unidad Neonatal. Departamento Pediatría. Hospital de Cruces. Universidad del País Vasco/EHU. 48903 Baracaldo. Bilbao. España
, S. Páramo Andrésb, B. Fernández-Ruanovab
a Unidades Neonatal y de. Hospital de Cruces. Universidad del País Vasco/EHU. Baracaldo. Bilbao. España
b Unidades Epidemiología Neonatal. Departamento de Pediatría. Hospital de Cruces. Universidad del País Vasco/EHU. Baracaldo. Bilbao. España
Grupo Colaborativo Español Surfactantec
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Estadísticas
Antecedentes

Los corticoides prenatales y el surfactante exógeno mejoran la morbimortalidad de los recién nacidos de muy bajo peso (RNMBP). Sin embargo, su eficacia en la prevención de la enfermedad pulmonar crónica (EPC) es dudosa

Objetivo

Evaluar el efecto de los corticoides prenatales en la incidencia de EPC en RNMBP de menos o igual a 30 semanas, tratados precozmente con surfactante

Pacientes y métodos

Estudio multicéntrico, longitudinal. Se exploró la base de datos del Grupo Colaborativo (n = 1.275 casos) y se seleccionaron 211 (16,5 %) RNMBP de menos o igual a 30 semanas, tratados precozmente con surfactante (< 30 min). Se evaluaron los antecedentes, manejo neonatal, tasas de mortalidad y complicaciones. Los resultados del subgrupo que recibió corticoides prenatales (157; 74,4 %) se compararon con los 54 no expuestos a corticoides prenatales

Resultados

La media (±DE) del peso y gestación fueron de 944 g (226) y 27 semanas (1,8). El surfactante se administró a los 16 ± 13 min (61% ≤ 15 min). Desarrollaron síndrome de dificultad respiratoria 124 niños (58,8 %). El peso, la edad gestacional, el test de Apgar al minuto y 5 min fueron similares, siendo la edad a la primera dosis de surfactante menor en los expuestos a corticoides prenatales. Los tratados con corticoides prenatales precisaron menos dosis de surfactante, fueron extubados antes (58,9 h frente a 161 h) y requirieron menores fracciones inspiratorias de oxígeno a las 48 h. Además, presentaron menor tasa de mortalidad (15,9 % frente a 27,8 %), hemorragia intraventricular (25,2 % frente a 50 %), ductus arterioso (40,3 % frente a 63,5 %) y enterocolitis necrosante (9 % frente a 19,2 %). Sin embargo, la tasa de EPC fue similar en ambos subgrupos

Conclusiones

La exposición a corticoides prenatales en RNMBP de menos o igual a 30 semanas tratados con surfactante precoz, disminuyó las tasas de mortalidad y de ciertas complicaciones, pero no la incidencia de EPC

Palabras clave:
Muy bajo peso natal
Síndrome de la dificultad respiratoria
Corticoides prenatales
Surfactante exógeno
Enfermedad pulmonar crónica
Background

Prenatal corticosteroid (PNC) exposure and postnatal surfactant therapy improve outcome in very low birth weight infants (VLBWI). However, the efficacy of PNC in the prevention of chronic lung disease is debated

Objective

To study the effects of PNC exposure on outcome in VLBWI born at ≤ 30 weeks' gestation

Patients and methods

We performed a multicenter, longitudinal study. The Spanish Surfactant Group database (n = 1,275) was searched and 211 VLBWI born at ≤ 30 weeks who received early surfactant therapy (≤ 30 min) were identified. Perinatal events, neonatal management and rates of mortality and complications were evaluated. Data on the subgroup of infants who received PNC (157, 74.4%) were compared with data on 54 infants who did not receive this therapy

Results

Mean (± SD) birth weight and gestational age were 944 (226) g and 27 (1.8) weeks. Surfactant was given at 16 ± 13 min (61% ≤ 15 min). A total of 124 infants (58.8 %) developed respiratory distress syndrome. No differences were found in birth weight, gestational age, or Apgar score at 1 and 5 min. However the age at first surfactant dose was lower in infants exposed to PNC. PNC-exposed infants required fewer doses of surfactant, were extubated earlier (58.9 vs. 161 h) and needed a lower FiO2 at 48 h (0.28 vs. 0.35). Moreover, neonatal mortality (15.9 vs. 27.8 %), the incidence of intraventricular hemorrhage (25.2 vs. 50 %), ductus arteriosus (40.3 vs. 63.5 %) and necrotizing enterocolitis (9 vs. 19.2 %) were lower in infants receiving PNC. However, the incidence of chronic lung disease was similar in both groups

Conclusions

PNC exposure of VLBWI born at ≤ 30 weeks receiving early surfactant therapy reduced mortality and the incidence of certain complications but did not decrease the incidence of chronic lung disease

Key words:
Very low birth weight infants
Respiratory distress syndrome
Prenatal corticosteroids
Surfactant therapy
Chronic lung disease
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Copyright © 2004. Asociación Española de Pediatría
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