Cuidar da pessoa em situação critica no serviço de urgência: contributos do enfermeiro especialista para a qualidade dos cuidados / Caring for the critically ill person in the emergency department: the specialist nurse's contribution to the quality of care

Este relatório de estágio surge no âmbito do curso de Mestrado em Enfermagem Médico- Cirúrgica e pretende evidenciar as experiências e atividades desenvolvidas no sentido de adquirir e desenvolver competências especializadas. A estrutura do relatório teve como linha orientadora os domínios de competências definidas para o Enfermeiro Especialista pela Ordem dos Enfermeiros, enquadradas nos domínios académicos preconizados pela Instituição de Ensino. O perfil de conhecimentos e competências do Enfermeiro Especialista na área da pessoa em situação crítica deve responder de forma competente à frágil e complexa situação clínica, sendo o seu papel suportado por um quadro de competências diferenciadas enquadradas no respeito pelo Ser Humano e pelos seus direitos inalienáveis. Focados no crescimento e desenvolvimento de competências especificas na área da pessoa em situação crítica, bem como no contributo da visão diferenciada do Enfermeiro Especialista na melhoria da qualidade dos cuidados, procuramos dar resposta aos problemas encontrados na prática clínica. Das atividades desenvolvidas destacamos a criação de um fluxograma de apoio ao enfermeiro triador no encaminhamento interno dos doentes e de um protocolo terapêutico de atuação no adulto com febre na triagem de manchester. Evidenciamos também, o investimento resiliente no desenvolvimento e implementação de um protocolo complexo, no âmbito da prestação de cuidados em contexto de urgência, ao doente em estado de agitação/agressividade que visa mitigar um problema recorrente. No domínio académico da investigação desenvolvemos um estudo qualitativo com recurso à técnica de Focus Group, com o objetivo de construir um modelo de documentação padronizado, simplificado e facilitador do registo de enfermagem que documente a atuação do enfermeiro na avaliação e intervenção ao doente, durante o transporte inter-hospitalar. As conclusões deste estudo de investigação validaram um modelo de registo sustentado numa mnemónica, uniformizadora e facilitadora dos registos de enfermagem durante o transporte inter-hospitalar do doente crítico. Consideramos que as experiências que decorreram deste estágio foram fundamentais e permitiram o desenvolvimento das competências inerentes ao Enfermeiro Especialista.

This internship report appears within the scope of the Master's degree in Medical-Surgical Nursing and aims to highlight the experiences and activities developed in order to acquire and develop specialized skills. The structure of the report was guided by the domains of competences defined for the Specialist Nurse by the Order of Nurses, framed in the academic domains recommended by the Educational Institution. The profile of knowledge and skills of the Specialist Nurse in terms of people in critical situations must respond competently to the fragile and complex clinical situation, with their role supported by a framework of differentiated skills framed in respect for the Human Being and their inalienable rights . Focused on the growth and development of specific skills in the area of people in critical situations, as well as the contribution of the Specialized Nurse's differentiated vision to improving the quality of care, we seek to respond to problems encountered in clinical practice. The activities developed highlight the creation of a flowchart to support the triage nurse in the internal referral of patients and a therapeutic protocol for working with adults with fever in the manchester triage. We also highlight the resilient investment in the development and implementation of a complex protocol, within the scope of providing care in an emergency context, to patients in an agitated/aggressive state that aims to mitigate a recurring problem. In the academic domain of research, we developed a qualitative study using the Focus Group technique, with the objective of building a standardized, simplified documentation model that facilitates the nursing record that documents the nurse's role in evaluating and intervening with the patient, during the inter-hospital transport. The conclusions of this research study validated a recording model based on a mnemonic, standardizing and facilitating nursing records during the inter-hospital transport of critically ill patients. We consider that the experiences that took place during this internship were fundamental and allowed the development of skills inherent to Specialist Nurses.

Neonatal polycythemia: prevalence, risk factors and predictors of severity.

BACKGROUND: Polycythemia is a disorder with several causes and risk factors. The clinical presentation is variable, ranging from asymptomatic newborns to cases with severe physiological changes. The aim of this study was to assess the prevalence, risk factors and predictors of severity of polycythemia in a Portuguese level III Neonatal Intensive Care Unit (NICU). METHODS: Case-control study of all term newborns with the diagnosis of polycythemia admitted to the NICU of the São João Universitary Hospital Center, Porto, Portugal, from January 1, 1999 to December 31, 2019; and who met one of the following inclusion criteria were eligible for the study: 1) Hct>65% or Hb>22 g/dL; and 2) Hb≥21 g/dL with clinical manifestations of polycythemia. RESULTS: A total of 53 newborns fulfilled the inclusion criteria and were included in the study, corresponding to a prevalence of 0.57%. Birth outside the hospital was the only risk factor with statistical significance. Of 53 cases, 51 (96.23%) had symptomatic polycythemia. The most frequent symptoms were: hyperbilirubinemia (69.81%), hypoglycemia (52.83%), thrombocytopenia (50.94%), cardiorespiratory (33.96%), and neurological symptoms (33.96%). Of the 53 newborns evaluated, 41 (77.36%) needed treatment. The only risk factors that influenced the hematocrit value were maternal diabetes and fetal growth restriction. CONCLUSIONS: The best way to improve the prognosis of polycythemia is to identify the risk factors present throughout pregnancy and make an early diagnosis and treatment. Out-of-hospital births should be avoided. The diagnosis should not be excluded, even if hemoglobin and hematocrit are within normal limits.

Neonatal Skull Depression: The Role of Cranial Ultrasound.

Nontraumatic congenital neonatal skull depression is a rare condition resulting from external forces shaping the fetal skull. Typically, newborns are asymptomatic, and, usually, the condition resolves in a few months with no need for intervention. However, many newborns undergo a CT scan, an ionizing technique, to check for fractures or intracranial lesions. We report a case of congenital skull depression without neurological deficits, managed conservatively through clinical monitoring and ultrasound.

Predictors of poor neurodevelopmental outcomes of very preterm and very low birth weight infants.

BACKGROUND: Despite recent improvements, premature infants remain at high risk for long-term morbidity and poorer neurodevelopment, particularly very preterm (VP) and very low birth weight (VLBW). The aim of this study was to describe neurodevelopmental outcomes at two years and identify potential predictors of worse performance. METHODS: In a retrospective cohort, a two-years' neurodevelopmental evaluation was analyzed. Multivariable regressions were used to study the association of perinatal history with neurodevelopmental outcomes. Subjects included VP and/or VLBW born at a Portuguese III-level perinatal center between 2011-2017. Milestones outcomes were assessed using the Griffiths' Mental Development Scales. RESULTS: One hundred seventy-seven infants were included. Two-years milestones were not achieved in 18.6% in language domain and 7.3% in motor function, 4.5% wore glasses and 1.1% auditory prosthesis/cochlear implant. Almost 30% needed intervention, 18.6% occupational therapy, 16.4% physiotherapy and 13.6% speech therapy. Griffiths' Mental Development Scales was performed in 139, with a mean global quotient of 98.3 and hearing/speech as the least quoted scale. Global development delay (GDD) was present in 14.8% and cerebral palsy in 2.8%. Multivariate analysis by logistic regression adjusted to gestational age, birth weight and confounding variables, revealed a statistically significant association between GDD and hydrocephalus with shunt/reservoir (OR:19.01), retinopathy of prematurity stage ≥2 (OR:7.86) and neonatal sepsis (OR:3.34). CONCLUSIONS: Consistent with recent studies, preterm are at increased risk of neurodevelopmental impairment, mainly due to GDD and language delay, rather than cerebral palsy. In this population, hydrocephalus, retinopathy of prematurity and neonatal sepsis were strongly associated with poorer outcomes. Insight into these factors is essential to refer patients for specific early intervention programs.

Thrombocytopenia requiring platelet transfusions is predictive of retinopathy of prematurity in preterm infants.

BACKGROUND: Recent studies suggest that some hematological parameters and ratios provided by blood count collected on the first day of life may be predictors for the development of retinopathy of prematurity (ROP). The aims of this study were to assess whether hematological parameters and ratios in blood count collected on the first day of life are associated with ROP. METHODS: Retrospective data collection from electronic clinical files of inborn preterm infants with a gestational age of less than 30 weeks delivered from January 2008 to December 2022, in a level III Neonatal Intensive Care Unit (NICU). We collected detailed clinical and demographic data on the mother, pregnancy, mode of delivery, resuscitation, in-hospital neonatal morbidity, pathological examination of the placenta, and hematological parameters and ratios provided by blood count collected on the first day of life. We compared neonates with or without ROP and performed a subgroup analysis on patients with ROP≥2. RESULTS: We included 140 preterm infants with ophthalmic examination; 81(57.9%) developed ROP. The need for platelet transfusions (OR=5.28; 95% CI: 1.31-21.21; P=0.019) and bronchopulmonary dysplasia (BPD) (OR=5.12; 95% CI: 1.14-22.98; P=0.033) were independent risk factors for ROP. In the multivariate analysis, no associations were found between any of the hematological parameters or ratios studied and ROP. CONCLUSIONS: In our study, hematological parameters and ratios on the first day of life were not associated with the development of ROP. However, thrombocytopenia that required platelet transfusions was associated with ROP development and severity.

'Space to talk': a Portuguese focus group study of parents' experiences, needs and preferences in parenting support during prenatal and well-child care.

OBJECTIVE: To explore the experiences, needs and preferences of a group of parents regarding the parenting support received during prenatal and well-child care in the Portuguese National Health Service. DESIGN AND SETTING: We undertook descriptive-interpretive qualitative research running multiple focus groups in Porto, Northern Portugal. PARTICIPANTS, DATA COLLECTION AND ANALYSIS: Purposive sampling was used between April and November 2018. Focus groups were conducted with 11 parents of a 0-3 years old with well-child visits done in primary care units. Thematic analysis was performed in a broadly inductive coding strategy and findings are reported in accordance with Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS: Three main themes were identified to describe parents' experience when participating in their children's healthcare: (1) logistics/delivery matter, including accessibility, organisation and provision of healthcare activities, unit setting and available equipment; (2) prenatal and well-child care: a relational place to communicate, with parents valuing a tripartite space for the baby, the family and the parent himself, where an available and caring health provider plays a major role and (3) parenting is challenging and looks for support, based on key points for providers to watch for and ask about, carefully explained and consensual among health providers. CONCLUSION: This study provides insight into parents' needs and healthcare practices that affect the parenting experience. To meet parents' preferences, sensitive health providers should guarantee a relational place to communicate and person-centredness, accounting for the whole family system to support healthy parenting collaboratively. Future studies are warranted to further strengthen the knowledge in the field of a population-based approach for parenting support.

Platelet transfusions in preterm infants: current concepts and controversies-a systematic review and meta-analysis.

Platelet transfusions (PTx) are the principal approach for treating neonatal thrombocytopenia, a common hematological abnormality affecting neonates, particularly preterm infants. However, evidence about the outcomes associated with PTx and whether they provide clinical benefit or harm is lacking. The aim of this systematic review and meta-analysis is to assess the association between PTx in preterm infants and mortality, major bleeding, sepsis, and necrotizing enterocolitis (NEC) in comparison to not transfusing or using different platelet count thresholds for transfusion. A broad electronic search in three databases was performed in December 2022. We included randomized controlled trials, and cohort and case control studies of preterm infants with thrombocytopenia that (i) compared treatment with platelet transfusion vs. no platelet transfusion, (ii) assessed the platelet count threshold for PTx, or (iii) compared single to multiple PTx. We conducted a meta-analysis to assess the association between PTx and mortality, intraventricular hemorrhage (IVH), sepsis, and NEC and, in the presence of substantial heterogeneity, leave-one-out sensitivity analysis was performed. We screened 625 abstracts and 50 full texts and identified 18 reports of 13 eligible studies. The qualitative analysis of the included studies revealed controversial results as several studies showed an association between PTx in preterm infants and a higher risk of mortality, major bleeding, sepsis, and NEC, while others did not present a significant relationship. The meta-analysis results suggest a significant association between PTx and mortality (RR 2.4, 95% CI 1.8-3.4; p < 0.0001), as well as sepsis (RR 4.5, 95% CI 3.7-5.6; p < 0.0001), after a leave-one-out sensitivity analysis. There was also found a significant correlation between PTx and NEC (RR 5.2, 95% CI 3.3-8.3; p < 0.0001). As we were not able to reduce heterogeneity in the assessment of the relationship between PTx and IVH, no conclusion could be taken.    Conclusion: Platelet transfusions in preterm infants are associated to a higher risk of death, sepsis, and NEC and, possibly, to a higher incidence of IVH. Further studies are needed to confirm these associations, namely between PTx and IVH, and to define the threshold from which PTx should be given with less harm effect. What is Known: • Platelet transfusions are given to preterm infants with thrombocytopenia either to treat bleeding or to prevent hemorrhage. • Lack of consensual criteria for transfusion. What is New: • A significant association between platelet transfusions and mortality, sepsis, and NEC.

Prevalence, risk factors and predictors of severity of neonatal thrombocytopenia in neonatal Intensive Care Units: a single center study.

BACKGROUND: Thrombocytopenia is a common hematological disorder seen in the neonatal period, especially in newborns admitted to the Neonatal Intensive Care Unit (NICU). The clinical and laboratorial presentation is heterogeneous, with different underlying causes and risk factors. There are still few studies about some possible risk factors and their influence on the newborn's clinical outcome. The aim of this study was to assess the prevalence, risk factors and predictors of severity of thrombocytopenia in a level III NICU. METHODS: The present analysis was the retrospective study of newborns with thrombocytopenia (platelet count less than 150×109/L) admitted from January 1, 2008, to December 31, 2017. Patients included newborns admitted after the first 72 hours of life and those with thrombocytopenia related to surgical intervention were excluded. RESULTS: Out of 187 neonates with thrombocytopenia, a total of 134 neonates were included in the study, corresponding to a prevalence of 3.3%. One hundred fourteen (85%) neonates had an early onset presentation (EOT), and 20 (15%) neonates had a late onset presentation (LOT); 68 (50.7%) neonates had severe and 66 (49.3%) had non-severe thrombocytopenia. Sepsis was identified as an independent predictor of LOT. Sepsis by gram-negative bacteria was identified as an independent predictor for severe thrombocytopenia. CONCLUSIONS: Identification of risk factors, early diagnosis and treatment of the underlying causes are crucial for a better approach of neonatal thrombocytopenia. A strong association between sepsis and sepsis by gram-negative bacteria with LOT and severe thrombocytopenia, respectively, enhances the importance of nosocomial sepsis control in NICU.

A maternal age of 35 years and over may increase the risk for cystic periventricular leukomalacia in very preterm infants.

BACKGROUND: Some studies have shown increased risk for neonatal morbidity and mortality with increasing maternal age. The aim of this study was to assess the influence of a maternal age of 35 years, and older, on the neonatal morbidities and mortality of very preterm infants. METHODS: Obstetrical and neonatal data on mothers and preterm infants with gestational age 24 to 30 weeks, born during 2015 and 2016 after a surveilled pregnancy at 11 Portuguese level III centers were analyzed according to a mother's age <35 years versus ≥35. Statistical analysis was performed using IBM SPSS statistics 23 (IBM, Armonk, NY, USA) and a P value <0.05 was considered significant. RESULTS: A total of 415 mothers and 499 infants were included; 340 (68.1%) infants were delivered to mothers <35 years old and 159 (31.9%) to mothers ≥35. There were no differences in birthweight, gestational age and gender in both groups of preterm infants. Rupture of membranes over 18 hours and chronic hypertension with superimposed preeclampsia were significantly more frequent in mothers ≥35 years. Cystic periventricular leukomalacia (cPVL) assessed by cranial ultrasound was significantly more prevalent in infants delivered to mothers ≥35 years. The multivariate analysis by logistic regression revealed an association between cPVL and a maternal age ≥35 years (OR=2.34, 95% CI: 1.20-4.54; P=0.012). CONCLUSIONS: Our study revealed a significant association between a maternal age ≥35 years and echographic cPVL in preterm infants below 30 weeks of gestational age.

Neonatal outcomes of multiple versus single very preterm infants.

BACKGROUND: Neonatal morbidity and mortality differ between very preterm infants that result from single and those that result from a multiple order pregnancy. The aim of our study was to assess and compare the neonatal morbidity and mortality of multiple versus single very preterm infants. METHODS: Obstetrical and neonatal data on mothers and preterm infants with gestational ages between 24 and 30 weeks, born during 2015 and 2016 at 11 level III perinatal centers after a surveilled pregnancy, were analyzed and compared. Statistical analysis was performed using IBM SPSS® statistics 25 and a p-value < 0.05 was considered statistically significant. RESULTS: A total of 494 infants delivered from 410 women were enrolled in the study; 320 (64.8%) infants resulted from single gestation and 174 (35.2%) resulted from multiple order gestation (153 double, 21 triple). Multiples were associated with a higher maternal age, a greater use of medically assisted reproduction techniques, higher C-section rates, more frequent full cycle use of antenatal corticosteroids, higher gestational age with adequate birth weight, spent less days on oxygen therapy, presented less prevalence of BPD and cPVL, needed less surgical closure of PDA and had a lower length of stay in NICU. Abruptio placenta, hypertensive disorders of pregnancy and preeclampsia were more frequent in single pregnancies. The multivariate analysis by logistic regression adjusted to gestational age and confounding variables did not show any significant difference on the outcomes of multiples compared to singles. CONCLUSIONS: The results of our study support the scientific evidence that, with the current practices, the neonatal morbidity and mortality of very premature infants are not different between those resulting from single and multiple gestations.

Perforación de la córnea: una complicación poco común del traumatismo del nacimiento / Corneal perforation: A rare complication of birth trauma

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Extrauterine growth restriction at discharge in very-low-birth weight infants: a retrospective study in a level III neonatal intensive care unit.

BACKGROUND: Extrauterine growth restriction (EUGR) remains a serious problem among very low birth weight (VLBW) infants and is a marker of severe nutritional deficit during the first weeks of life. It can lead to a higher risk of growth impairment during childhood and long-term medical problems. The aim of this study is to determine the prevalence and risk factors of EUGR in preterm infants below 1500 grams. METHODS: Descriptive retrospective study of all preterm infants with birth weight below 1500 grams who were born at and discharged from our center, from January 1st, 2012 to December 31st, 2016. Those with major congenital malformations, congenital TORCH infections, death before 36 weeks of postmenstrual age and those transferred during hospitalization were excluded. RESULTS: A total of 101 VLBW newborns were studied, 35 (34.7%) had EUGR. Fifty-four (52.9%) newborns were male. The median gestational age was 29 weeks (25-35) and the median birth weight was 1205 grams (580-1500). Fetal growth restriction, moderate-severe bronchopulmonary dysplasia, invasive mechanical ventilation, patent ductus arteriosus and its surgical treatment, retinopathy of prematurity, cystic periventricular leukomalacia, anemia requiring red blood cells transfusions, as well as duration of parenteral nutrition, day of start of enteral nutrition (EN), day of achievement of full EN and a longer duration of hospitalization were identified as independent risk factors for EUGR. CONCLUSIONS: EUGR is a serious concern in neonatal intensive care. Some of its potential long-term consequences include a higher risk of growth impairment during childhood, poorer neurodevelopment and motor outcomes, as well as cardiovascular disease and type II diabetes later in life. Therefore, it is necessary to carefully assess the nutritional status of VLBW infants, as well as to increase the knowledge of the risk factors for EUGR, which will be crucial for its prevention.

Patent ductus arteriosus in preterm newborns: A tertiary hospital experience.

INTRODUCTION: Patent ductus arteriosus (PDA) in preterm infants has been associated with increased mortality and comorbidities. This study aimed to characterize the population of preterm infants diagnosed with PDA and to identify predictive factors of response to medical treatment of PDA. METHODS: An eight-year retrospective observational study was carried out, which included all preterm infants with a gestational age (GA) between 23 and 32 weeks diagnosed with PDA, admitted to the Neonatal Unit of the CHUSJ. Univariate comparative analysis was performed, and models for predicting the effectiveness of PDA treatment with ibuprofen were explored by multivariate logistic regression analysis. RESULTS: 115 cases were included and 34 were excluded, with a final sample of 81 preterm infants with PDA. The univariate analysis revealed significant differences in the closure efficacy via medical treatment with ibuprofen in several variables, and a multivariate logistic regression model was obtained (discriminative capacity 72.2%, sensitivity 98.1%, specificity 57.1%), taking into account the effect of GA, type of delivery, need for diuretics treatment and platelet transfusion. CONCLUSION: This study enabled the population of preterm infants diagnosed with PDA to be characterized and the identification of a predictive model that can help predict the efficacy of medical treatment and thus contribute to optimizing the medical approach to the non-responders.

Nephrotoxicity in Neonates.

Acute kidney injury (AKI) is classified based on prerenal, intrinsic, and postrenal causes. In the newborn, AKI can occur after an insult during the prenatal, perinatal, or postnatal period. AKI is usually an underrecognized condition and its true incidence is unknown. AKI may result from the administration of a number of different nephrotoxic medications, which are often used concurrently in critically ill neonates, exponentially increasing the risk of renal injury. Drug toxicity may also compromise the formation and development of nephrons, and this is particularly important in preterm infants, who have incomplete nephrogenesis. Little is known about the pharmacokinetics and pharmacodynamics of different medications used in neonates, especially for the most immature infant, and the use of most medications in this population is off label. Strategies to prevent AKI include the avoidance of hypotension, hypovolemia, fluid imbalances, hypoxia, and sepsis as well as judicious use of nephrotoxic medications. Treatment strategies aim to maintain fluids and electrolytic and acid-base homeostasis, along with an adequate nutritional status. Neonates are especially prone to long-term sequelae of AKI and benefit from long-term follow-up. This review summarizes the most relevant aspects of nephrotoxicity in neonates and describes the prevention, treatment, and follow-up of AKI in neonates.

Beneficial and detrimental effects of choline chloride-oxalic acid deep eutectic solvent on biogas production.

Deep eutectic solvents (DES), a new class of alternative solvents, have recently been used in the pre-treatment of lignocellulosic biomass. Due to the ability to dissolve phenolic compounds, they have been efficiently applied as delignification agents. However, to extend DES application to bioprocesses, such as Anaerobic Digestion (AD), their toxicity to microbial consortia must be evaluated. In this work, an effective delignifying DES, composed of choline chloride (ChCl) and oxalic acid (OA) (1:1) was prepared and its effect evaluated, for the first time, in biogas production. Results show that the presence of DES had both beneficial and detrimental effects on the anaerobic consortium, depending on its concentration. In the concentration range of 0.3-12.5 g/L, the presence of DES led to a lag-phase of 1 to 8 d as the DES concentration increased. However, after the lag-phase has been surpassed, DES up to a concentration of 12.5 g/L improved the biogas production, reaching an accumulated biogas volume three times higher than the control assay for the concentration of 12.5 g/L. For the highest DES concentrations (19.8-78.1 g/L), the biogas production was inhibited. The assays performed with DES components alone have indicated that OA at 3.2 g/L was the main responsible for the inhibition of biogas production (50% less biogas produced than the control). ChCl at 4.9 g/L has not presented a lag-phase and produced an accumulated biogas volume like the control assay (1200 mL for 30 d incubation). This work points out that ChCl:OA DES may be used in the delignification of biomass further submitted to AD, provided the inhibitory concentrations of OA are not achieved.

Renal Dysplasia and Progressive Renal Failure in a Newborn with Interstitial Chromosome 4 Deletion 4q25-28.3: A New Phenotype?

The deletion of the long arm of chromosome 4 is rare, presenting with a variable phenotype depending on the chromosomic area affected. A term newborn with prenatal diagnosis of anhydramnios, dysplastic cystic kidneys, and cardiomegaly was born with generalized subcutaneous edema, several dysmorphic features, and progressive renal failure requiring dialysis. The infant continued to deteriorate and died at 52 days of age. Autopsy confirmed bilateral renal dysplasia with cysts. Array-comparative genomic hybridization (CGH) identified a large deletion on 4q25-q28.3, which is not yet described in association with renal disease. The clinical progression could be expected due to the severity of the perinatal clinical presentation.

The impact of intrauterine growth restriction on respiratory outcomes.

BACKGROUND: Intrauterine growth restriction (IUGR) is caused by fetal growth below what is normal for its genetic potential. Recent studies have shown a distinct association between changes in umbilical artery flow in IUGR subjects and an increased risk of respiratory morbidity and consequently, higher mortality. The aim of this study was to find the impact of IUGR on the respiratory outcomes of premature neonates born with less than 32 weeks gestational age. METHODS: This retrospective cohort study targeted infants born with less than 32 weeks of gestation, admitted at NCIU, between January 2010 and December 2016. Each selected IUGR case was matched according to gestational age and sex with an appropriate birthweight newborn at a 1:2 ratio, within a 12-month period. RESULTS: The study involved 126 neonates, 42 with IUGR, and 84 control subjects. IUGR was not identified as a predictor of Bronchopulmonary Dysplasia (BDP) (OR 4.80, 95% CI: 1.14-20.21, P=0.033). Abnormal umbilical artery flow (OR 4.80, 95% CI: 1.14-20.21, P=0.033) and late onset sepsis (OR 3.31, 95% CI: 1.04-10.56, P=0.044) were significantly associated with BDP. CONCLUSIONS: It is essential to recognize changes in the umbilical artery flow, especially in high-risk pregnancies such as IUGR, since these represent an a priori risk marker for the development of BDP. The individual and combined effect of IUGR, alterations on umbilical artery flow and extreme prematurity has not yet been completely clarified on the impact on lung morbidity, requiring a larger number of studies.