Taquipnea transitoria del recién nacido asociada a cesárea con y sin labor de parto / Transient tachypnea of ​​the newborn associated with caesarean section with and without labor

Contexto: la taquipnea transitoria del recién nacido (TTRN) es una entidad frecuente en neonatos nacidos por cesárea. Objetivo: identificar factores de riesgo potencialmente modificables que contribuyan a la disminución de la patología respiratoria neonatal derivada de un parto por cesárea Sujetos y métodos: se presenta un estudio observacional retrospectivo de cohorte analítico que identifico expedientes clínicos de recién nacidos por cesárea, atendidos en el Hospital de la Policía Quito N°1 en el periodo enero de 2001 a diciembre de 2015; el estudio incorporó neonatos entre 35 y 41 semanas de gestación, a quienes se clasificaron en 2 grupos: con y sin labor de parto previo a la cesárea. Resultados: la frecuencia de recién nacidos con taquipnea transitoria que se determinó en el presente estudio fue 25,6%, 29,4% y 44,8% en los respectivos grupos de edad gestacional determinándose una proporción es 5,1:1; 1,9:1 y 0,5:1 para cada grupo por lo que la relación entre un pretérmino leve frente a RN a término es 10 veces mayor para el grupo que desarrolla TTRN. Existe una mayor frecuencia de TTRN en neonatos de cesáreas sin labor de parto previa comparado con el grupo de neonatos nacidos por cesárea con labor de parto previa; esta diferencia es estadísticamente significativa con un OR de 5,8. Conclusión: se determinó que la labor de parto previa a la cesárea, constituyo un factor protector para taquipnea transitoria del recién nacido en neonatos entre 35 y 38 semanas. La labor de parto previa a la cesárea no fue un factor de protección frente al riesgo de desarrollar taquipnea transitoria del recién nacido en neonatos de 39 o más semana de gestación.(AU)

Context: transient tachypnea of the newborn (TTRN) is a frequent entity in neonates born by caesarean section, Objective: identify potentially modifiable risk factors that contribute to the reduction of neonatal respiratory pathology derived from a cesarean delivery Subjects and methods: We present a retrospective observational study of an analytical cohort that identified clinical records of newborns by caesarean section, attended at Quito Police Hospital No. 1 in the period January 2001 to December 2015; The study included neonates between 35 and 41 weeks of gestation, who were classified into 2 groups: with and without labor prior to cesarean section. Results: the frequency of newborns with transient tachypnea that was determined in the present study was 25.6%, 29.4% and 44.8% in the respective gestational age groups determining a proportion is 5.1: 1; 1.9: 1 and 0.5: 1 for each group, so that the relationship between a preterm mild versus a term BN is 10 times higher for the group that develops TTRN. There is a greater frequency of TTRN in neonates of caesarean sections without previous labor compared with the group of neonates born by caesarean section with previous labor; this difference is statistically significant with an OR of 5.8. Conclusion: labor prior to caesarean section constitutes a protective factor for transient tachypnea of thnewborn in neonates between 35 and 38 weeks. Labor prior to cesarean section is not a protective factor againsthe risk of developing transient tachypnea of the newborn in infants of 39 or more weeks of gestation.(AU)

Comparação entre o método Reequilíbrio Toracoabdominal e a fisioterapia respiratória convencional em recém-nascidos com taquipneia transitória: um ensaio clínico randomizado / Comparison between Thoracic-abdominal Rebalance Method and conventional respiratory physiotherapy in neonates with transient tachypnea: a randomized clinical trial

Introdução: Recém-nascidos acometidos pela taquipneia transitória do recém-nascido (TTRN) cursam com desequilíbrio da biomecânica toracoabdominal e desconforto respiratório e necessitam de cuidados especiais. A fisioterapia respiratória convencional em recém-nascidos tem efeitos adversos, podendo ser o método reequilíbrio toracoabdominal (RTA) uma alternativa terapêutica. Objetivo: Comparar a fisioterapia respiratória convencional com o método RTA em recém-nascidos com TTRN. Métodos: Ensaio clínico intervencional, comparativo e randomizado. 49 recém-nascidos foram divididos em dois grupos: fisioterapia respiratória convencional (n=20) e RTA (n=29). Parâmetros fisiológicos (frequência respiratória, frequência cardíaca, saturação de pulso de oxigênio, temperatura axila), dor, estado comportamental, desconforto respiratório e desequilíbrio da biomecânica respiratória foram avaliados antes e após os manuseios. Resultados: A mediana da idade gestacional foi 38 semanas e a do peso de nascimento 2.940 g. Após os manuseios, não houve diferença entre os grupos quanto à dor (p=0,63), o estado comportamental (p=0,11) e os parâmetros fisiológicos (frequência respiratória, p=0,18; frequência cardíaca, p=0,82; SpO2, p=0,74; temperatura axila, p=0,29). O método RTA mostrou-se superior a fisioterapia respiratória convencional na melhora da biomecânica respiratória (elevação do esterno, p=0,01; elevação dos ombros, p=0,02) e do desconforto respiratório (p=0,009). Conclusão: O método RTA mostrou-se seguro e superior à fisioterapia respiratória convencional em recém-nascidos com TTRN. (AU)

Introduction: Newborn infants who are affected by transient tachypnea of the newborn (TTNB) have an imbalance of thoracoabdominal biomechanics and respiratory distress and so, require special care. The conventional respiratory physiotherapy in newborns has adverse effects, and the Thoracic-Abdominal Rebalance (TAR) method may be a therapeutic alternative. Objective: To compare conventional respiratory physiotherapy and TAR method in newborns with TTNB. Methods: Randomized, comparative, interventional clinical trial. 49 newborn infants divided into two groups: conventional respiratory physiotherapy (n=20) and TAR method (n=29). Physiological parameters (respiratory rate, heart rate, pulse oxygen saturation (SpO2), axilla temperature), pain, behavioral status, respiratory discomfort, and imbalance of respiratory biomechanics were evaluated before and after handling. Results: The median of gestational age of 38 weeks, and birthweight was 2,940 g. After the interventions, we did not observe difference between the groups regarding pain (p=0.63), behavioral status (p=0.11) and physiological parameters (respiratory rate, p=0.18; heart rate, p=0.82; SpO2, p=0.74 and axilla temperature, p=0.29). The TAR method was better than conventional respiratory physiotherapy in improvement of respiratory biomechanics (sternum elevation, p=0.01, elevation of the shoulders, p=0.02) and respiratory distress (p=0.009). Conclusion: The TAR method proved to be safe and superior to conventional respiratory physiotherapy in newborn infants with TTNB. (AU)

Evaluación de la calidad de la atención de la taquipnea transitoria en recién nacidos afiliados al Seguro Médico Siglo XXI / Evaluation of the quality of care of transient tachypnea in newborns affiliated with the Medical Insurance Siglo XXI program

Introducción: La evaluación de la calidad de la atención del recién nacido con complicaciones es un elemento indispensable para las estrategias de mejora orientadas a reducir las tasas de mortalidad neonatal. El objetivo de este trabajo fue evaluar la calidad de atención técnica e interpersonal en el manejo de la taquipnea transitoria del recién nacido (TTRN) de pacientes afiliados al Seguro Médico Siglo XXI. Métodos: Se realizó un estudio transversal en 61 hospitales de la Secretaría de Salud, que durante el primer semestre de 2011 reportaron al menos dos casos de TTRN. Se analizaron diferentes variables con respecto a la madre, el embarazo, el nacimiento y las complicaciones neonatales, así como intervenciones realizadas al recién nacido y condiciones de salud al egreso. Para medir la calidad de atención, se definieron y validaron indicadores de calidad en los ámbitos de la prevención, diagnóstico y tratamiento. Resultados: Se analizaron 256 expedientes de casos con diagnóstico de TTRN. El 8.9% de las madres tenía alguno de los factores de riesgo (asma, diabetes) y el 53.5% presentó complicaciones en el embarazo. El 60% de los casos de TTRN nacieron por cesárea; un tercio tuvieron bajo peso al nacimiento y el 14% fueron trasladados a otro hospital. En cuanto a los indicadores de calidad, en el rubro de prevención se identificó que en más del 90% se registraron los factores de riesgo (tabaquismo, asma, parto por cesárea); los de diagnóstico reflejaron que en el 86-98% se buscaron manifestaciones de insuficiencia respiratoria. Los de tratamiento lograron cifras satisfactorias para las medidas de monitorización y soporte. Conclusiones: Los resultados permiten considerar que la mayoría de los casos con TTRN recibieron un tratamiento apropiado. Es recomendable desarrollar estrategias efectivas, como reducir la creciente tasa de partos por cesárea, para prevenir la TTRN.

Background: Evaluation of the quality of care of the newborn with complications is an indispensable element for the improvement of strategies directed to reduce newborn mortality rates. The aim of this work was to evaluate the quality of technical and interpersonal care in the management of transient tachypnea of the newborn (TTN) of patients affiliated with the program "Medical Insurance Siglo XXI". Methods: A cross-sectional study was conducted in 61 hospitals affiliated with the Health Ministry with at least two cases of TTN during the first semester of 2011. Variables such as mother's health, pregnancy, birth and birth complication characteristics were analyzed. Also, newborn interventions and health conditions upon discharge were included. To measure the quality of care according to prevention, diagnosis and treatment, quality indicators were defined and validated. Results: We analyzed 256 case files with a diagnosis of TTN; 8.9% of the mothers presented risk factors (asthma, diabetes) and 53.5% had complications during pregnancy. There were 60% of cases with TTN born by cesarean delivery; one third of these children had low birth weight and 14% were transferred to another hospital. As for the quality indicators in the area of prevention, more than 90% of risk factors (smoking, asthma, cesarean delivery) were identified. Diagnostic indicators showed that 86-98% of respiratory distress symptoms were sought. Indicators of treatment achieved satisfactory figures for monitoring and support measures. Conclusions: Prevention, diagnosis and treatment indicators made it possible to consider that most TTN cases received appropriate treatment. It is advisable to develop effective strategies to prevent TTN, such as increasing efforts to reduce the increasing rates of cesarean deliveries.