Proyecto EURAIL. Estrategias de prevención y tratamiento contra la inmadurez pulmonar en España

Abstract

Objective To determine clinical practice variability in the prevention and postnatal treatment of lung immaturity in Spain Patients and methods Cross-sectional study within a larger study in 13 European countries. Data were obtained from the medical records of all very low birth weight (VLBW) infants born in participating centers, without other instrumentation. Results A questionnaire was sent to 213 centers. Seventy-two (34 %) responded, with 162,157 births (40 % of total births in 1999). Eight percent of infants were of low birth weight, 1.2% (2,015) of very low birth weight and 0.45 % were of extremely low birth weight. A total of 52.2% of VLBW infants received at least one dose of prenatal steroids, 28.8% received a full course and 9.3 % received more than one cycle. All centres used surfactant and 76.8 % had a written protocol. Forty-one percent of VLBW infants were intubated, 47.6% required mechanical ventilation for more than 6 hours, and 5% underwent continuous positive airway pressure. A total of 80.4 % used postnatal steroids, half of them for chronic lung disease prevention, and 83.4 % used steroids to treat this disease. Steroids were most frequently indicated at 7-14 days of life for 3-9 days. The most important causes of neonatal morbidity were chronic lung disease in 14 %, ductus arteriosus in 16.7 %, intraventricular hemorrhage in 8.5 %, and necrotizing enterocolitis in 7.3%. Conclusions Prenatal exposure to steroids was low. Repeat cycles and postnatal steroid use to prevent chronic lung disease was high. Recent scientific evidence on the use of pre- and postnatal steroids should be more widely disseminated.