Association of Maternal, Obstetric and Neonatal Variables on the Use of Bronchial Hygiene Maneuvers and Impact on Morbidity, Mortality and Survival in Neonatal Intensive Care Unit

Abstract

Objective: To analyze whether maternal, obstetric, anthropometric data of the neonate and respiratory variables influence the use of BHMs in neonates admitted to the NICU. In addition, to evaluate the impact of the applicability of this type of technique on the morbidity, mortality and survival of these neonates. Methods: Retrospective, quantitative study with descriptive and inferential analysis. Initially, the sample consisted of 599 medical records. The study involved newborns of both sexes admitted to the Neonatal Intensive Care Unit (NICU) of the tertiary referral hospital at maternal and child health, during 2017. The respiratory variables, maternal, obstetric, data of the neonate, morbidity and mortality were selected. Results: BHMs were associated with neonates whose mothers had a number of pregnancies ≥ 3 or newborns who had cephalic presentation at the time of delivery. In addition, there are particularities among neonates who receive this intervention, such as higher capillary glycemia, lower head circumference and occurrence of jaundice. The technique was not related to prematurity factors, such as pregnancy time ≤ 24 weeks, or respiratory factors, such as apnea, flapping of the nose wing, cyanosis and intercostal retraction. However, the use of the BHMs increases neonatal survival and reduces the mortality. Conclusion: The BHMs use is determined by maternal, obstetric and neonatal variables, being determinant to reduce the risk of death and increase the survival in NICU. RESUMO Objetivo: Analisar se dados maternos, obstétricos, antropométricos e variáveis respiratórias influenciam o uso de BHMs em neonatos internados em UTIN. Além disso, avaliar o impacto da aplicabilidade desse tipo de técnica na morbimortalidade e sobrevida desses neonatos. Métodos: Estudo retrospectivo, quantitativo com análise descritiva e inferencial. Inicialmente, a amostra era composta por 599 prontuários. O estudo envolveu recém-nascidos de ambos os sexos internados na Unidade de Terapia Intensiva Neonatal (UTIN) do hospital terciário de referência em saúde materno-infantil, durante 2017. Foram selecionadas as variáveis respiratórias, maternas, obstétricas, dados do neonato, morbimortalidade.Resultados: os BHMs foram associados a neonatos cujas mães tiveram um número de gestações ≥ 3 ou recém-nascidos que apresentaram apresentação cefálica no momento do parto. Além disso, existem particularidades entre os neonatos que recebem essa intervenção, como aumento da glicemia capilar, menor perímetro cefálico e ocorrência de icterícia. A técnica não foi relacionada a fatores de prematuridade, como tempo de gestação ≤ 24 semanas, ou fatores respiratórios, como apneia, batimento da asa nasal, cianose e retração intercostal. Porém, o uso dos BHMs aumenta a sobrevida neonatal e reduz a mortalidade. Conclusão: O uso de BHMs é determinado por variáveis maternas, obstétricas e neonatais, sendo determinante para reduzir o risco de óbito e aumentar a sobrevida em UTIN.

Thoracoabdominal rebalancing is not superior to manual hyperinflation to increase the amount of pulmonary secretion removed in preterm newborns: A randomized crossover trial

“…Once neonatal chest manipulation is not risk free, it should only be performed by trained professionals, with a considerable level of expertize. 16 Considering the search for safe and effective interventions in newborns, especially for bronchial hygiene, 17,18 this study aimed to evaluate the effects of manual hyperinflation maneuver (MHM) and thoracoabdominal rebalancing method (TRM) in PTNB. We hypothesized that MHM would mobilize more pulmonary secretion than TRM, but the autonomous, motor, and regulatory systems would be altered after MHM.…”