Ventilação não invasiva em recém-nascidos prematuros de baixo peso e estratégia de enfrentamento das suas mães

Abstract

According to the World Health Organization (WHO) a baby is considered premature infant if the newborn infant is less than 37 weeks of gestation. The neonatal prematurity may be directly related to the incidence of Hyaline Membrane Disease (HMD) or Respiratory Distress Syndrome (RDS), which requires a non-invasive ventilatory support, as well as positive coping ways of their caregivers. Objectives: Characterize low birth weight premature newborns in Non-invasive Ventilation and Coping Strategies of their mothers at the Neonatal ICU of a teaching hospital in a medium-sized city in the inland of São Paulo State. Identify and analyze sociodemographic and clinical aspects; ventilometry, hemodynamic data, coping strategies using by mothers of preterm infants involved in the study, and compare the study variables with each other and with data from the literature. Method: The study included a random sample consisting of six mothers and their eight male and female premature children with birth weight between 500 g and 2,500 g, gestational age less than 37 weeks of pregnancy requiring mechanical ventilation and extubated for non-invasive ventilation. Material: We used as a research instrument a Sociodemographic and Clinical Identification Form developed by the researchers composed of characterization data of the participants and their respective legal guardians (mothers). We used also the Ways of Coping Scale - WOCS, which was initially developed for the Brazilian population by Gimenes and Queiroz in 1997 and validated by Seidl, Trócoli and Zannon in 2001. Data Collection Procedure and Ethical Issues: Data regarding newborns and their respective mothers were collected by the researcher himself and recorded in a Sociodemographic and Clinical Identification Form, based on information from the electronic medical records provided by the Service. The answers about coping strategies were collected by a psychologist who is an expert in the field. She used a semi-structured interview and the Ways of Coping Scale. The instruments were individually applied in an appropriate place in the unit. Data Analysis: The study is a survey of variables defined through initial baseline measurements, compared with each other, and with literature results. Data were tabulated and grouped by categories into modules (sociodemographic and clinical, ventilation and hemodynamic, and coping). We analyzed data using descriptive statistics, and the results were expressed by frequencies and percentages. Qualitative data was categorized by answers according to the indicated instruments. Results and Discussion: The main results showed that of the six mothers evaluated, two had twin pregnancy, they are mostly from the city of São José do Rio Preto. One of the mother came from a surrounding town and one came from the inland of São Paulo State. The ages ranged from 23 to 36 years old, and they attended from elementary school to higher education. Most of them were housewives; four were single, and two held common-law marriage. Regarding religion, most were Catholics followed by Evangelicals, and Spiritists are the most frequent religions. The primary ethnic group were predominantly Caucasians. Most of the births were through caesarean section, with six male newborns. Gestational age ranged from 25 + 1 to 32 + 2 weeks, birth weight ranged from 518 g to 1,360 g, with Apgar score from 2 to 9; two mothers received antenatal corticosteroids; seven premature infants were administered surfactant, and six premature infants were administered aminophylline and caffeine. Six premature infants were successfully extubated; five remained on nasal intermittent positive-pressure ventilation for up to 72 hours, and one was transposed to continuous positive airways pressure within 48 hours. The maximum respiratory rate used was 30 and the lowest one was 20; inspiratory positive airway pressure ranged from 15 to 20 cm H2O; positive end-expiratory pressure between 5 and 7; FiO2 ranging from 50 to 21%; Inspiratory time ranged from 0.35 to 0.45; extubation weight from 590 g to 1,360 g and reintubation weight from 586 g to 698 g. Regarding hemodynamic data, respiratory rate ranged from 94 to 189; SpO2 ranged from 66 to 100%. Two of the premature infants, both males, had extubation failures and were put on nasal intermittent positive-pressure ventilation. The causes of reintubation were apnea and respiratory distress, respectively. Results of coping presented by mothers showed variations of means and scores: F1 = 3.63; F2 = 2.60; F3 = 3.73, and F4 = 3.52, indicating greater strategy focused on religious practices / wishful thinking, followed by focus problems, search for social support, and emotion-focused strategies. Specifically, for mothers of infants who experienced extubation failures, the greatest coping strategy was F3 - religious practices / wishful thinking, and the lowest one was F2 - emotion. Conclusion: Sociodemographic and clinical results demonstrated a high rate of cesarean c sections; Sex, birth weight, Apgar, aminophylline, and caffeine presented results in accordance with the literature. Low antenatal corticosteroid administration rate and high surfactant rate were observed; extubation success / failure rate was consistent throughout the literature. The forms of non-invasive ventilation used were nasal intermittent positive-pressure ventilation and nasal intermittent positive-pressure ventilation, which were easy to apply and presented clinical efficacy. This provided a reduced need for reintubation, which was also in accordance with the relevant literature. Coping strategies were considered positive for a significant portion of the sample. However, interventions aimed at mothers during hospitalization are necessary to reduce the negative emotional impact on prematurity that may compromise the establishment of the initial attachment of the dyad. Further studies in a larger sample are needed to evaluate and identify premature infant therapies during hospitalization and coping to support this type of intervention.