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A síndrome de aspiração de mecônio: prevenção e tratamento
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Authors
Abstract(s)
A síndrome de aspiração meconial (SAM) é uma condição respiratória que ocorre quando
o recém-nascido aspira mecônio misturado com líquido amniótico antes ou durante o
parto. Essa aspiração pode causar obstrução das vias aéreas, inflamação pulmonar e
dificuldade respiratória grave.
A SAM associa-se a uma importante morbimortalidade fetal a nível mundial sendo, por
isso, essencial a sua prevenção e tratamento atempados. Vários estudos têm sido
realizados com o objetivo de compreender quais as técnicas e os fármacos que poderiam
ser utilizadas com esse intuito.
Esta monografia pretende realizar uma revisão dos estudos publicados e de outra
literatura existente sobre o tema, com o objetivo de explanar quais as técnicas
abandonadas, quais as que atualmente se recomendam e quais as que, apesar de ainda
não serem aconselhadas, se encontram em estudo. Deste modo, foi realizada uma
pesquisa de artigos nas plataformas PubMed e Google Scholar e foram compilados dados
disponibilizados pela Direção Geral de Saúde, pela Sociedade Portuguesa de
Neonatologia e pela plataforma DynaMed.
A SAM está associada a vários factores de risco já identificados, e que poderão ser
modificáveis quando detectados atempadamente no decurso da gravidez e na
monitorização fetal periparto.
A utilização de técnicas com intuito preventivo tem sofrido modificações nos últimos
anos, tendo deixado de ser recomendada por se ter demonstrado ineficaz ou com pouco
valor para o outcome do RN.
A patofisiologia da SAM é complexa e envolve uma série de eventos que resultam em
comprometimento respiratório neonatal. Assim a descoberta de terapias dirigidas para
esta síndrome ainda se encontra numa fase embrionária, e em estudos em animais. Deste
modo, atualmente apenas estão recomendadas e acessíveis à prática clínica as terapias
de suporte ventilatório, que deverão ser iniciadas o mais precocemente possível, o óxido
nítrico e o surfactante. Foram ainda avaliados os papéis de terapêutica adjuvante como a antibioterapia ou a
corticoterapia, contudo não foi identificada, com evidência estatística, vantagem no seu
uso disseminado no tratamento da sintomatologia associada à SAM.
Concluíndo, são necessários mais estudos clínicos randomizados que comprovem a
eficácia de algumas das técnicas mencionadas e devem ser elaboradas recomendações
claras e atualizadas sobre a abordagem dos recém nascidos com SAM ou com fatores de
risco associados à mesma.
Meconium aspiration syndrome (SAM) is a respiratory condition that occurs when the newborn aspirates meconium-stained amniotic fluid before or during birth. This aspiration can cause airway obstruction, lung inflammation and severe breathing difficulties. SAM is associated with significant fetal morbimortality worldwide and, therefore, its timely prevention and treatment is essential. Several studies have been conducted with the goal of understanding which techniques and drugs could be used for this purpose. This monography intends to make a revision of the studies and other literature published on this topic, with the aim of explaining which techniques were abandoned, which are currently recommended and which, although not yet recommended, are being studied. In this way, a search for articles was carried out on the PubMed and Google Scholar platforms and information made available by Direção Geral de Saúde, Sociedade Portuguesa de Neonatologia and DynaMed were compiled. SAM is associated with many already identified risk factors, which may be modifiable when detected early during pregnancy and the peripartum fetal monitoring. The utilization of techniques for preventive purposes has undergone changes in the last years, having ceased to be recommended as they have proven to be ineffective and of little value for the newborn´s outcome. The pathophysiology of SAM is complex and involves a series of events that result in neonatal respiratory compromise. Therefore, the discovery of targeted therapies for this syndrome is still in an embryonic stage, and in animal studies. So, currently only ventilatory support therapies, which should be started as early as possible, nitric oxide and surfactant are recommended and accessible to clinical practice. The roles of adjuvant therapies such as antibiotic therapy and corticosteroid therapy were also evaluated, however no advantage was identified, with statistical evidence, in their widespread use in the treatment of symptoms associated with SAM. In conclusion, more randomized clinical studies are needed to prove the effectiveness of some of the techniques mentioned previously and clear and updated recommendations must be developed on the approach to newborns with SAM or with risk factors associated with it.
Meconium aspiration syndrome (SAM) is a respiratory condition that occurs when the newborn aspirates meconium-stained amniotic fluid before or during birth. This aspiration can cause airway obstruction, lung inflammation and severe breathing difficulties. SAM is associated with significant fetal morbimortality worldwide and, therefore, its timely prevention and treatment is essential. Several studies have been conducted with the goal of understanding which techniques and drugs could be used for this purpose. This monography intends to make a revision of the studies and other literature published on this topic, with the aim of explaining which techniques were abandoned, which are currently recommended and which, although not yet recommended, are being studied. In this way, a search for articles was carried out on the PubMed and Google Scholar platforms and information made available by Direção Geral de Saúde, Sociedade Portuguesa de Neonatologia and DynaMed were compiled. SAM is associated with many already identified risk factors, which may be modifiable when detected early during pregnancy and the peripartum fetal monitoring. The utilization of techniques for preventive purposes has undergone changes in the last years, having ceased to be recommended as they have proven to be ineffective and of little value for the newborn´s outcome. The pathophysiology of SAM is complex and involves a series of events that result in neonatal respiratory compromise. Therefore, the discovery of targeted therapies for this syndrome is still in an embryonic stage, and in animal studies. So, currently only ventilatory support therapies, which should be started as early as possible, nitric oxide and surfactant are recommended and accessible to clinical practice. The roles of adjuvant therapies such as antibiotic therapy and corticosteroid therapy were also evaluated, however no advantage was identified, with statistical evidence, in their widespread use in the treatment of symptoms associated with SAM. In conclusion, more randomized clinical studies are needed to prove the effectiveness of some of the techniques mentioned previously and clear and updated recommendations must be developed on the approach to newborns with SAM or with risk factors associated with it.
Description
Keywords
Prevenção Amnioinfusão Esteróides Líquido Amniótico Meconial Monitorização Fetal Intraparto Oxigenação por Membrana Extra-Corpórea Síndrome de Aspiração de Mecônio Sucção Endotraqueal Surfactante Tratamento