Qual é a melhor solução de hidratação parenteral a ser utilizada no tratamento pós-operatório de recém-nascidos com gastrosquise?: experiência do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da USP

Objetivos: Recem-nascidos (RN) com gastrosquise apresentam oliguria, anasarca, ileoadinâmico prolongado e infeccao. O objetivo desse estudo foi utilizar nova abordagem para melhora da evolucao pos-operatoria. Metodo: Estudo com 103 RN foi dividido em duas fases: 1a - infusao de grandes volumes de solucao cristaloide, introducao precoce de formulas integrais e colocacao de cateter venoso central com duplo-lumen; 2a - administracao de solucoes cristaloides em menores volumes, com infusao de coloides quando necessario, introducao tardia de dieta semi-elementar e colocacao decateter PICC. Foram estudadas diferentes variaveis e feitas correlacoes com niveis sericos de sodio e albumina, necessidade de expansao com solucao coloide, tempo de nutricao parenteral, periodo de tempo para inicio da dieta enteral e dieta plena, tempo de intubacao oro-traqueal (IOT) e de internacao, necessidade e tipo de cateter venoso central, complicacoes e sobrevida. Resultados: O nivel de natremia da 2a fase foi maior que da 1a. Houve forte correlacao entre hiponatremia e aumento do tempo de IOT. Necessidade de expansao com solucao coloide se associou a maior tempo de IOT, tempo para inicio da dieta e tempo de internacao. Frequenciade infeccoes nos RN com cateter central foi maior na 1a fase. Os indices de sobrevida nas duas fases foram semelhantes (83,4% e 91,8%). Conclusoes: Restricao da infusao de cristaloides com administracao criteriosa de solucoes coloides pode prevenir hiponatremia, a qual se relaciona a periodos de IOT mais prolongados. Cateteres do tipo PICC se associam a menor frequencia de infeccoes. Objectives: Newborns with gastroschisis display oliguria, anasarca, prolonged gastrointestinal dysfunction and infections. We proposed a different approach, aiming to improve postoperative outcome. Methods: The study with 103 newborns was divided in two phases: 1st - infusion of large volumes of crystalloid solution, milk formulae were early introduced and double lumen catheters were inserted; 2nd - maintenance fluids were restricted and colloid solutions were administered when necessary, late introduction of semi elemental formulae and PICCs were precociously inserted. Several data were evaluated and correlated with serum levels of sodium and albumin, necessity of colloid solutions infusion, time of parenteral nutrition, time to fisrt and full feeds, number of ventilation and inhospital days, need and kind of central catheter, complications and survival in both phases. Results: Natremia levels were higher in the 2nd than in the 1st phase. There was a strong correlation between hyponatremia and increased number of days on mechanical ventilation. Need of colloid solution boluses were associated with prolonged intubation periods, time to first feed and hospitalization. Frequency of systemic infections in patients with central catheters was higher in the 1st phase. Survival rates were similar (83.4% and 91.8%). Conclusions: In newborns with gastroschisis, restriction of crystalloid solutions infusion and judicious administration of colloids can prevent hyponatremia, which correlates with prolonged orotracheal intubation periods. Early insertion of PICCs is associated with less systemic infections than venous dissection.