Baja ganancia de peso en las seis primeras semanas posnatales como factor predictor de retinopatía de la prematuridad en neonatos con muy bajo peso al nacer
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Date
2012
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Universidad Nacional de Trujillo
Abstract
Estudios recientes sugieren que la baja ganancia de peso posnatal juega un papel predictivo de retinopatía de la prematuridad (ROP).
OBJETIVO: Determinar si la baja ganancia de peso en la seis primeras semanas posnatales es un factor predictor de ROP en recién nacidos con muy bajo peso al nacer (RN MBPN).
MÉTODO: Se realizó un estudio retrospectivo, que incluyó 377 HC de RN con peso ≤ 1.500 g y edad gestacional (EG) ≤ 32 semanas: Se recopiló el diagnóstico (Dx) inicial a la 4ᵗᵃ o 6ᵗᵃ sem posnatal o a las 32 sem. de EG corregida, y el Dx final a las 38-40 sem. La ganancia de peso relativo (IP), se definió como el peso a las 6ᵗᵃ sem. menos el peso al nacer, dividido por el peso al nacer. Cuatro factores de riesgo: edad gestacional, peso al nacer, peso y ganancia a la sexta semana posnatal fueron estudiados mediante un análisis univariado. Se utilizaron la prueba de Chi² y el Odds Ratio (OR) para comparar a los prematuros con y sin ROP. La Curva (ROC) determinó el punto de corte y definió a la baja ganancia de peso; hallando su capacidad predictiva, sensibilidad, especificidad, valor predictivo positivo (VPP) y negativo (VPN) de este punto de corte.
- RESULTADOS: la tasa de RN MBPN es 171 x l O 000 nacimientos. El promedio de la EG, peso al nacer fue: 29.3 sem; 1 198g. Tras la evaluación inicial: 21.2% tuvo Dx ROP; y el 15.4% regresionaron a No ROP. En el Dx final: 65.7% tuvo No ROP; 13.1% ROP I 14.1% ROP II, y 7.1% ROP III; no hubo Dx de ROP IV ni V. Se halló una significativa relación entre ROP y la EG (X²=12.7; OR: 3.45 menores de 28 sem y OR: 2.47 entre 28 y 29 EG), peso al nacer (X²= 7.8; OR: 2.97 para< 1000 g.), ganancia de peso (GP) (X²= 42.57; OR=36.6 para GP < 300 g.) y peso a la sexta semana (X²= 32.34; OR= 14.9 peso< 1 500g ). La curva ROC definió como punto de corte a IP: 8.2 g/kgD; y la baja ganancia a un IP<8.2g/kgD. Se determinó una correlación muy significativa entre el baja ganancia de peso a la sexta sem. posnatal y el Dx de ROP (X²= 38.58; OR= 45.18), con una sensibilidad=94.12%, especificidad= 73. 85%, VPP= 65 .31 % y VPN= 96 %.
CONCLUSIONES: La baja ganancia de peso en las sets primeras semanas posnatales es un factor predictor de ROP en RN MBPN.
Recent studies suggest that low postnatal weight gain plays a predictive role of retinopathy of prematurity (ROP). - AIM: To analyze the low weight gain from birth to 6 postnatal weeks to predict the development of retinopathy of prematurity (ROP) among very low birth weight preterm babies (VLBW). -METHODS: We performed a retrospective study that included 377 MH of newborns with birth weight (BW) ≤ 1,500 g and gestational age (GA) ≤ 32 weeks, which compiled the initial ophthalmologic diagnosis to the 4th or 6th postnatal week or 32 weeks corrected GA and the final diagnosis at 38-40 weeks corrected GA. The relative weight gain (IP) was defined as weight at 6 weeks of age minus birth weight divided by the weight at birth. Four risk factors: gestational age, birth weight, weight gain and the sixth postnatal week were studied by univariate analysis. Were used Chi² test and odds ratio (OR) to compare infants with and without ROP. Curve (ROC) determined the cut-off and set to low weight gain, finding predictive ability, sensitivity, specificity, positive predictive value (PPV) and negative (NPV) of this cutoff. - RESULTS: The rate of VLBW newborns is 171 x l O 000. The average GA, BW was: 29.3 wk, 1 198g. Following the initial assessment: 21.2% had a diagnosis of ROP, of whom 15.4% regressed to No-ROP, in the final diagnosis: 65.7% had diagnosis No-ROP, 13.1% ROP stage I, 14.1% ROP II, and 7.1%, ROP III. There wasn't diagnosis ofROP stage IV or V. We found a significant relationship between ROP and GA (X² = 12.7, OR: 3.45 under 28 weeks and OR: 2.47 between 28 and 29 GA), birth weight (X² = 7.8, OR: 2.97 for <l 000 g.), weight gain (X² = 42.57, OR = 36.6 for GP <300 g.) and weight at the sixth week (X² = 32.34, OR = 14.9 weight <l 500 g). The ROC curve cutoff defined as JP < 8.2 g/KgD, and as a low gain: IP <8.2 g/kgD. There is a significant correlation between low weight gain in the sixth week postnatal and Diagnosis of ROP (X² = 38.58, OR = 45 .18), with a sensitivity = 94.12%, specificity = 73.85%, PPV = 65.31% and NPV = 96%. CONCLUSIONS: The low weight gain in the first six postnatal weeks is a predictor ofROP in VLBW newboms.
Recent studies suggest that low postnatal weight gain plays a predictive role of retinopathy of prematurity (ROP). - AIM: To analyze the low weight gain from birth to 6 postnatal weeks to predict the development of retinopathy of prematurity (ROP) among very low birth weight preterm babies (VLBW). -METHODS: We performed a retrospective study that included 377 MH of newborns with birth weight (BW) ≤ 1,500 g and gestational age (GA) ≤ 32 weeks, which compiled the initial ophthalmologic diagnosis to the 4th or 6th postnatal week or 32 weeks corrected GA and the final diagnosis at 38-40 weeks corrected GA. The relative weight gain (IP) was defined as weight at 6 weeks of age minus birth weight divided by the weight at birth. Four risk factors: gestational age, birth weight, weight gain and the sixth postnatal week were studied by univariate analysis. Were used Chi² test and odds ratio (OR) to compare infants with and without ROP. Curve (ROC) determined the cut-off and set to low weight gain, finding predictive ability, sensitivity, specificity, positive predictive value (PPV) and negative (NPV) of this cutoff. - RESULTS: The rate of VLBW newborns is 171 x l O 000. The average GA, BW was: 29.3 wk, 1 198g. Following the initial assessment: 21.2% had a diagnosis of ROP, of whom 15.4% regressed to No-ROP, in the final diagnosis: 65.7% had diagnosis No-ROP, 13.1% ROP stage I, 14.1% ROP II, and 7.1%, ROP III. There wasn't diagnosis ofROP stage IV or V. We found a significant relationship between ROP and GA (X² = 12.7, OR: 3.45 under 28 weeks and OR: 2.47 between 28 and 29 GA), birth weight (X² = 7.8, OR: 2.97 for <l 000 g.), weight gain (X² = 42.57, OR = 36.6 for GP <300 g.) and weight at the sixth week (X² = 32.34, OR = 14.9 weight <l 500 g). The ROC curve cutoff defined as JP < 8.2 g/KgD, and as a low gain: IP <8.2 g/kgD. There is a significant correlation between low weight gain in the sixth week postnatal and Diagnosis of ROP (X² = 38.58, OR = 45 .18), with a sensitivity = 94.12%, specificity = 73.85%, PPV = 65.31% and NPV = 96%. CONCLUSIONS: The low weight gain in the first six postnatal weeks is a predictor ofROP in VLBW newboms.
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Keywords
Retinopatía del prematuro, Recién nacido de muy bajo peso