Preterm premature rupture of the fetal membranes: factors associated with bronchopulmonary dysplasia

OBJETIVO: identificar os fatores obst??tricos e neonatais associados ao desfecho de displasia broncopulmonar em pacientes com amniorrexe prematura no pr??-termo. M??TODOS: foram analisados 213 prontu??rios do Instituto Fernandes Figueira, entre 1998 e 2002, cujas pacientes evolu??ram com quadro de amniorrexe prematura ???34 semanas de gesta????o. Foram exclu??das gesta????es m??ltiplas. As vari??veis de natureza cl??nico-obst??tricas e neonatais foram cotejadas com o desfecho de displasia broncopulmonar. Os dados foram submetidos ?? an??lise bivariada, sendo os valores que exibiam signific??ncia estat??stica (p???0,05) submetidos ?? regress??o log??stica. RESULTADOS: a preval??ncia de displasia broncopulmonar foi de 6.10%. A an??lise univariada dos fatores associados ao desfecho de displasia broncopulmonar exibiu os seguintes resultados: tempo de ventila????o mec??nica neonatal >10 dias (OR: 54,00 [11,55-278,25] p=0,000); idade gestacional <30 semanas (OR: 6,33 [1,26-43,06] p=0,017) peso ???1.000 g (OR: 4,82 [1,34-17,53] p=0,010); peso ???1.500 g (OR: 14,09 [1,82-300,50] p=0,003; persist??ncia do canal arterial (OR: 12,33 [3,07-50,10], p=0,000); doen??a da membrana hialina (OR: 8,46 [2,21-35,00] p=0,000); pneumonia cong??nita (OR: 7,48 [2,03-27,93] p=0,000); uso de surfactante neonatal (OR: 19,66 [4,54-97,76] p=0,000) e infec????o neonatal (OR: 7,67 [0,99-163,79] p=0,049). No modelo multivariado final, somente as vari??veis ???ventila????o mec??nica???>10 dias (p=0,001) e ???uso de surfactante??? (p=0,040) permaneceram independentemente associadas ao desfecho. CONCLUS??ES: observou-se que os fatores associados ?? displasia broncopulmonar s??o de natureza neonatal, sendo que a ventila????o mec??nica duradoura e o uso de surfactante neonatal influenciaram no desenvolvimento dessa doen??a.PURPOSE: to analyze obstetric and neonatal factors associated with bronchopulmonary dysplasia outcome in patients with preterm premature amniorrhexis. METHODS: we analyzed 213 medical records of patients of Fernandes Figueira Institute who suffered premature amniorrhexis (???34 weeks of gestation) in the period from 1998 to 2002. Multiple gestations were excluded. Clinical-obstetric and neonatal variables were considered in relation to the bronchopulmonary dysplasia outcome. Data were subjected to bivariate analysis, and the values showing statistical significance (p???0.05) were subjected to logistic regression analysis. RESULTS: the prevalence of bronchopulmonary dysplasia was 6.10%. Univariate analysis of the factors associated with the pulmonary dysplasia outcome were: neonatal mechanical ventilation for more than ten days(OR: 54.00 [11.55-278.25] p=0.000); birth gestational age of less than 30 weeks (OR: 6.33 [1.26- 43.06] p=0.017); birth weight ???1,000 g (OR: 4.82 [1.34-17.53] p=0.010); birth weight ??1.500 g (OR: 14.09 [1.82-300.50] p=0.003; patent ductus arteriosus (OR: 12.33 [3.07-50.10], p=0.000); hyaline membrane disease (OR: 8.46 [2.21-35.00] p=0.000); congenital pneumonia (OR: 7.48 [2.03-27.93] p=0.000); use of neonatal surfactant (OR: 19.66 [4.54-97.76] p=0.000), and neonatal infection (OR: 7.67 [0.99-163.79] p=0.049). In the final multivariate model, only the variables ???neonatal mechanical ventilation???>10 days (p=0.001) and ???use of a surfactant??? (p=0.040) remained independently associated with bronchopulmonary dysplasia.CONCLUSIONS: the factors associated with bronchopulmonary dysplasia are related to neonatal features, asprolonged mechanical ventilation and the use of a surfactant influencethe development of thedisease