Prevalence and factors associated with surfactant use in Brazilian Neonatal Intensive Care Units: A multilevel analysis.

Ceane Cunha Rios Lessa,Maria Auxiliadora De Souza Mendes Gomes,Maria Elizabeth Lopes Moreira,Fernando Lamy Filho,Antônio Augusto Moura Da Silva,Zeni Carvalho Lamy

doi:10.1590/1413-81232018239.22192016

Ceane Cunha Rios Lessa, Maria Auxiliadora De Souza Mendes Gomes + Show 4 more

Open Access

https://doi.org/10.1590/1413-81232018239.22192016

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Abstract

The treatment with exogenous surfactant reduces mortality and the risk of complications in preterm newborns with Respiratory Distress Syndrome. Higher usage levels have been associated with individual and institutional factors. The study aimed to identify these factors associated with use of this technology in 16 public Brazilian Neonatal Units using logistic multilevel analysis. In a sample of 630 newborns the use at some time was 82.6%. Only 24.7% made use of this technology up to two hours after birth. An intraclass correlation of 0.30 showed that 30% of the variance in the use of exogenous surfactant could be assigned to the contextual level. In the final model, a greater severity score (SNAPPE-II) was associated with increased surfactant use (OR = 2.64), whereas being small for gestational age (SGA) (OR = 0.59) was associated with lower use of this technology. At the contextual level the number of beds in the unit >15 (OR = 5.86), units with higher complexity (OR = 1.73) or units with implemented Kangaroo Mother Care (OR = 2.91), especially units in Rio de Janeiro state (OR = 16.17) were associated with greater surfactant use. Although individual clinical features explained most of the variation in the use of this technology, factors linked to the institution were also of utmost importance.

Highlights

In Brazil, the neonatal component of the infant mortality rate remains higher than the post-neonatal one and most of deaths occur in the first seven days of life
Variables related to the institutions, to the neonatal units, were important to explain the use of exogenous surfactant in the first two hours of life in infants with respiratory distress syndrome (RDS) in sixteen Brazilian Neonatal Intensive Care Units (NICU)
We found a contextual effect, estimated by the intraclass correlation coefficient of 0.30, which means that 30% of the variance in the use of exogenous surfactant can be attributed to the contextual level

Summary

Introduction

In Brazil, the neonatal component of the infant mortality rate remains higher than the post-neonatal one and most of deaths occur in the first seven days of life (early neonatal period). At that stage breathing problems are a major cause of death especially among preterm newborns. In these newborns, lung immaturity determines deficiency of surfactant, a substance responsible for reducing the surface tension within the alveoli that prevents collapse at low lung volumes[1]. The use of exogenous surfactant is indicated for preterm newborns with established or presumed diagnosis of respiratory distress syndrome (RDS)[2,3] because it reduces mortality, disease severity and complications due to RDS. Advantages related to the use of this technology are well established in the literature. It is known that newborns with RDS receiving treatment with surfactant have reduced risk of pneumothorax, pulmonary interstitial emphysema, death and bronchopulmonary dysplasia or death (in combination) in comparison to those who do not receive this treatment[4]

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