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@#AIM: To analyze the association between postnatal weight growth rate(PWGR)and the threshold disease of retinopathy of prematurity(TDROP)in preterm babies with very low birth weight(BW), and investigate the predictive ability of PWGR for the onset of TDROP.<p>METHODS: A retrospective cohort study. Totally 386 preterm infants in the First Affiliated Hospital of Xiamen University from January 2017 to December 2018, whose weight was less than 1 500g were enrolled in this study. The gender, BW, gestational age(GA), delivery mode, history of oxygen, Apgar score in 1-10min, <i>in vitro</i> fertilization infants, embryo number, neonatal pneumonia, PWGR with 4wk after birth, congenital heart disease were analyzed. The patients were divided into two groups: Non-ROP(NROP)group(<i>n</i>=298)and TDROP group(<i>n</i>=88). Multiple Logistic regression and receiver operating characteristic(ROC)curve were used to determine if the PWGR was independently related to TDROP development and if it was capable of predicting TDROP. This study determines the predict value by comparing the area under the ROC curve(AUC)of independent risk factors. <p>RESULTS: BW(<i>t</i>=2.264, <i>P</i>=0.024), GA(<i>t</i>=3.158, <i>P</i>=0.002), PWGR at 2wk(χ2=20.514, <i>P</i><0.001), history of oxygen(χ2=20.514, <i>P</i><0.001), had significant difference between two groups. Multiple Logistic regression analysis revealed that BW(<i>β</i>=0.699, <i>P</i>=0.016), GA(<i>β</i>= -0.631, <i>P</i>=0.039), PWGR at 2wk(<i>β</i>=-0.636, <i>P</i>=0.039), history of oxygen(<i>β</i>=-1.542, <i>P</i><0.001)were correlated to TDROP, and their <i>OR</i> were 2.013 \〖95% <i>CI</i>: 1.140-3.553\〗, 0.532 \〖95% <i>CI</i>: 0.292-0.970\〗, 0.529 \〖95% <i>CI</i>: 0.289-0.969\〗, 0.214, \〖95% <i>CI</i>: 0.113-0.404\〗 respectively. Further study showed that the area of PWGF at 2wk under the ROC was 71%, and its optimal cut-off points was 4.14g/d, its sensitivity and specificity were 70.8%, 65.9% respectively.<p>CONCLUSION: BW and PWGF at 2wk of very low BW preterm babies is an independent risk factor for TDROP, and has certain predictive value for the onset of TDROP.
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Objective To analyze the association of postnatal weight gain proportion of very low birth weight (BW) preterm babies and the onset of severe retinopathy of prematurity,and investigate the optimal cut-off points and predictive ability of postnatal weight gain (WG) proportion for the onset of retinopathy of prematurity (ROP).Methods A retrospective cohort study.257 preterm infants underwent screening whose weight was less than 1500 g were enrolled in this study.Risk factors include BW,gestational age (GA),history of oxygen inhalation,need for blood transfusions,Apgar score in 1 to 10 minutes,embryo number,delivery mode,in vitro fertilization infants,and WG proportion within 6 weeks after birth and other systemic diseases were recorded.Their correlation with severe ROP is analyzed.Clinical outcomes were divided into severe ROP group (patients who suffered from ROP and required treatment) and mild and no ROP group (patients who suffered from ROP but do not require treatment and-patient without ROP).The severe ROP group included 18 patients and mild and no ROP group included 239 patients.Multiple logistic regression and receiver operating characteristic (ROC) curve were used to determine if the WG proportion was independently related to severe ROP development and if it was capable of predicting severe ROP.This study determines the predict value by comparing the area under the ROC curve (AUC) of independent risk factors.Results GA (t=-4.835,P＜0.001),BW(t=-5.192,P＜0.001),history of oxygen inhalation (x2=6.001,P=0.009),proportion of infants who had oxygen inhalation for more than 10 days(x2 =10.019,P=0.002),postnatal WG proportion at 1 week(t =-3.663,P＜ 0.001),postnatal WG proportion at 2 weeks(t=-3.425,P=0.001) had significant difference between two groups.Multiple logistic regression analysis revealed that GA (β =-0.858,P =0.008),BW (β =-0.005,P =0.010),postnatal WG proportion at 2 weeks (β=-8.745,P =0.035) were correlated to severe ROP significantly.And their area under the ROC were 0.836[95％ confidence interval (CI):0.752-0.920],0.826 (95％CI:0.947-0.903),0.744 (95％CI:0.598-0.891) respectively.The optimal cut-off points of GA,BW,and postnatal WG proportion at 2 weeks were 28.41 weeks,1241.96 g,12.80％ respectively.Conclusion Low WG proportion at 2 weeks of very low BW preterm babies is an important and independent risk factor for severe ROP and has certain predictive value of the onset of severe ROP.
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Pregunta de investigación: ¿Permitirán las curvas de crecimiento infantil (T/E) identificar el retardo en el crecimiento lineal en forma previa a la talla baja (<-2 DE) y la edad promedio de alteración del crecimiento en niños de 6 a 24 meses de edad que demandan atención en establecimientos de salud? Objetivo: Optimizar el uso de los datos del Carnet de Salud Infantil para identificar alteraciones en el crecimiento lineal previa a la talla baja (< -2DE) y los tiempos promedio de inicio de la declinación de curva de crecimiento normal hasta llegar por debajo de -2DE, relacionando esta tendencia con la curva de crecimiento ponderal. Material y métodos: Estudio descriptivo, longitudinal y retrospectivo, que incluyo a 71 niños menores de 2 años. Se analizaron datos del Carnet de Salud Infantil e indicadores antropométricos a partir de ellos. El punto de corte de Talla/Edad fue menor a la -2DE para clasificar talla baja. Resultados: La talla baja en uno o varios de los controles fue de 38.08 por ciento, y desde el primer control 48.1 por ciento. Los que presentaron talla baja como inicio en controles posteriores al primero (51.8 por ciento) mostraban una T/E por debajo a la -1 DE al primer control en el 64.2 por ciento; en este último grupo, el tiempo de descenso desde la T/E <-1 DE hasta <-2DE fue en promedio de 3.9 meses. En el 74 por ciento que iniciaban con talla baja no se observo la presencia concomitante de P/E <-2DE. Existe una asociación estadísticamente significativa entre T/E <-1 DE al primer control y talla baja (chi² 14.07; p=0.0001). Conclusiones: El uso adecuado de las curvas de crecimiento lineal infantil permite identificar de forma previa retardo en el crecimiento, con una T/E <-1 DE en el primer control. La talla baja en nuestro medio se caracteriza por presentarse en edad temprana y acompañarse de retardo en el crecimiento ponderal (P/E) solamente en los casos con inicio de esta en el primer control.
Research question: Do curves of children growth (height/age) let us to identify growth delayed in advance to short stature (<-2DS) and average age of abnormal growth on 6 to 24 years old children who are attended in health centers? Background: Chronic malnutrition is one of the nutritional problems with high magnitude in Latin-America and high prevalence in Bolivia. Objetive: To improve the use of children's health cards data to let it identify abnormal growth in advance to short stature (<-2DS) and overage time of declination beginning from a normal growth lineal curve to across the -2DS relating this tendency whit the weight growth curve. Material and method: A descriptive and prospective longitudinal study, including 71 children less than 2 year's old age. The children's health card data were analyzed generating anthropometric indicators of them. Sort stature was classified as a height/age under -2DS. Results: The frequency of short stature in one or several controls was 38,08 percent taking place since the first control in 48,15 percent. Children who has short stature as beginning after the first control (51,85 percent) showed a height/age under -1DS in the first control in 64,29 percent. The Children who have begun short stature without weight/age <-2DE were 74,04 percent. There is a hard association between height/age under -1DS at the first control and short stature (chi2 14,07; p=0,0001). Conclusions: The children 's growth curves used rightly let us identify growth delayed previously with a height/age under-1DS in the first control or 3,92 previous mouths to the diagnostic of short stature. In our environment, the short stature is characterized because of to take place in early age and is accompanied with weight growth delayed (weight/age) just in cases with beginning in the first control.
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Insuficiencia de CrecimientoRESUMEN
Introducción. Una succión inadecuada puede repercutir en el crecimiento de un neonato, sobre todo si es de bajo peso al nacer. El objetivo de este trabajo fue determinar la relación entre la efectividad de la succión a las 48 horas de vida, con el crecimiento neonatal en lactantes exclusivamente amamantados, con peso adecuado (> 2.5 kg) o peso bajo (≤ 2.5 kg) al nacimiento. Métodos. Se realizó un estudio de cohortes en neonatos sanos e ingresados en alojamiento conjunto con la madre a las 45-48 horas de vida, antes del egreso. Antes del pesaje se evaluó la eficacia de la succión con la escala ECLES mientras eran amamantados. A los 28 días de vida se evaluó el crecimiento ponderal. Se incluyeron solo aquellos que fueron amamantados exclusivamente. Resultados. Se analizaron 80 neonatos, 51 (63.7%) con peso adecuado (PA) y 29 (36.3%) con bajo peso (BP). De estos, 47 (58.7%) presentaron succión normal (ECLES 39-40), 24 (30%) con alteración leve (ECLES 37-38) y 9 (11%) con alteración moderada (ECLES 3236). Hubo un incremento ponderal (IP) con relación a la eficacia de la succión, más notorio en los neonatos de BP [IP para los neonatos: PA succión normal = 1169 ± 222 g, alteración leve = 995 ± 257 g y alteración moderada= 1073 ± 245 g; BP succión normal = 911 ± 229 g, alteración leve = 1010 ± 299 g y alteración moderada= 460 ± 115 g. ANOVA ECLES* peso F = 3.8, p = 0.04, F ECLES = 1.5, p = 0.39 y Fpeso = 4.5, p = 0.12]. No hubo diferencias en paridad, edad gestacional, sexo y condición de los pezones en las madres de los neonatos con y sin succión normal. Conclusiones. Una succión leve o moderadamente alterada a las 48 horas de vida se relacionó con un menor incremento ponderal en la etapa neonatal, sobretodo en neonatos de bajo peso al nacimiento. Se sugiere dar terapias de estimulación oral en estos niños antes de su egreso y vigilancia estrecha.
Background. Inadequate suction may affect newborn (NB) growth, especially in low birth weight (LBW) infants. The aim of this study was to determine the relationship between suckling efficacy at 48 h of life with neonatal weight gain (WG) in infants exclusively breastfed with normal birth weight (NBW > 2.5 kg) and LBW (≤ 2.5 kg). Methods. We carried out a cohort study in healthy NB rooming with their mothers in hospital. At 45-48 h after birth, prior to discharge and after being weighed, suckling efficacy was assessed using the ECLES scale by a previously trained physician. At 28 days of life, WG was assessed. We included only those infants who continued to be exclusively breastfed. Results. There were 80 NB, 51 (63.7%) with NBW and 29 (36.3%) with LBW; 47 (58.7%) NB with normal suckling (ECLES 39-40), 24 (30%) with mild suckling impairment (ECLES 37-38), and nine NB (11%) with moderate suckling impairment (ECLES 32-36). There was a relationship between WG and suckling efficacy, most noticeable in LBW infants [WG for newborns with NBW and normal suckling = 1169 ± 222 g, mild impairment of suckling = 995 ± 257, and moderate impairment of suckling = 1073 ± 245; for LBW infants and normal suckling = 911 ± 229, mild impairment of suckling = 1010 ± 299, and moderate impairment of suckling = 460 ± 115. ANOVA ECLES* weight F = 3.8, p = 0.04, F ECLES = 1.5, p = 0.39 y Fweight = 4.5, p = 0.12]. There were no diferences in parity, gestational age, gender and nipple condition of the mothers among infants, with or without normal suckling. Conclusions. Mild or moderate suckling impairment after 48 h of life was associated with lower weight gain during the neonatal period, especially in LBW infants. Oral stimulation therapy is suggested in these children before discharge and with close follow-up.
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O peso de nascimento insuficiente é decorrente, principalmente em países em desenvolvimento, da restrição de crescimento intrauterino. Embora as crianças nascidas com peso insuficiente correspondam a 30% dos nascimentos, o seu crescimento até a idade escolar tem sido pouco estudado. Não há informações sobre as diferenças existentes entre o crescimento das crianças nascidas com peso insuficiente e as nascidas com peso adequado. Neste estudo, foi avaliado o crescimento alcançado na idade pré-escolar por 323 crianças nascidas com peso insuficiente, comparado-o com o crescimento de 886 crianças nascidas com peso adequado, tendo como referencial os valores do NCHS 2000. Foi analisada a influência do sexo, idade, idade materna ao nascimento da criança, tempo de aleitamento materno, morbidade, escolaridade materna, número de pessoas na casa e há quanto tempo freqüentava a creche no crescimento alcançado pelas crianças nascidas com peso insuficiente na idade pré-escolar. No conjunto, o crescimento alcançado pelas crianças com peso de nascimento insuficiente foi menor que o observado para as crianças com peso de nascimento adequado, tanto em peso quanto em estatura. O tempo que a criança freqüenta a creche e o número de pessoas na casa foram fatores de risco associados ao menor crescimento entre as crianças com peso de nascimento insuficiente. A idade da criança foi associada também, porém, como fator de proteção. O crescimento ponderal deficiente teve o tempo que a criança freqüenta a creche como fator de risco e a idade da criança e a escolaridade materna como fatores de proteção. Se comparados com crianças de condição sócio-econômica semelhante que apresentaram peso de nascimento adequado, as crianças com peso de nascimento insuficiente são de risco para retardo de crescimento até a idade pré-escolar, evidenciando a necessidade de receber uma atenção diferenciada nos programas de atenção à saúde, incluindo a monitorização do crescimento.
The insufficient birth weight is decurrent, mainly in developing countries, of the intrauterine growth restriction. Although they mean 30% of the births, the growth of insufficient birth weight children has been little described, also until the scholar age. The influence of the demographic and socioeconomic variables in the growth of this group, until the scholar age, also needs to be established. There are not informations on the existing differences between the growth of the insufficient birth weight children and that observed for the adequate birth weight ones. In this study, the growth reached until the preschool age of 323 insufficient birth weight children was evaluated, compared with referential NCHS 2000 and to the growth of 886 adequate birth weight children. It was analyzed the influence of the sex, age, maternal age at the birth of the child, breast feeding duration, diseases, maternal literacy, number of people in the house and time of frequency to the day-care center on the growth reached for the insufficient birth weight children, until the scholar age. The reached linear growth until the scholar age for the insufficient birth weight children was inferior to the expected values of the NCHS 2000 referential. The growth reached by the insufficient birth weight children was inferior to the observed for the adequate birth weight children, in weight, stature and body mass index. The time that the child attends the day-care center and the number of people in the house were risk factors associated to growth retardation, among the insufficient birth weight children. The age of the child was also associated, however, as protection factor. The deficient weight evolution had the time that the child attends the day-care center as risk factor and the age and maternal literacy as protection ones...
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Humanos , Recién Nacido , Preescolar , Niño , Preescolar , Crecimiento , Recién Nacido de Bajo Peso/crecimiento & desarrollo , Factores Socioeconómicos , Estatura por EdadRESUMEN
Introducción: las prácticas corrientes de manejo perinatal han resultado en un incremento en la sobrevida de los niños con muy bajo peso al nacer, no obstante estos niños están en riesgo de desarrollar morbilidad a corto y largo plazo debido a su prematurez, así como a complicaciones secundarias al manejo asistencial. Objetivo: estudiar la morbimortalidad y el crecimiento de los niños con muy bajo peso al nacer de dos unidades de cuidados intensivos neonatales. Material y método: se realizó un estudio retrospectivo, descriptivo y analítico de todos los recién nacidos con peso al nacer menor o igual a 1.500 gramos del Hospital de Clínicas en el período comprendido entre enero de 2001 a diciembre de 2003, y de la Asociación Española Primera de Socorros Mutuos en el período comprendido entre enero de 2002 y diciembre de 2004. Se estudiaron un total de 130 neonatos. Se obtuvieron las historias completas de 118 niños, que fueron analizadas en su totalidad. Resultados: el porcentaje de sobrevida total para todo el grupo fue de 82% (106 de 130 neonatos). Hubo un 100% de letalidad para los neonatos con 23 semanas o menos de edad gestacional al nacer, luego la sobrevida aumenta progresivamente a partir de las 24 semanas, llegando a un 100% a las 30 semanas de edad gestacional. Estos datos son comparables a partir de las 24 semanas a los de la red Vermont Oxford (362 instituciones de EE.UU.). Para el estudio de la morbilidad se identificaron las enfermedades más salientes. El 78% de los niños requirió la administración de surfactante pulmonar. El 28% de los niños tuvo diagnóstico de broncodisplasia pulmonar. Presentó sepsis tardía el 26%, ductus arterioso permeable el 22%, retinopatía del prematuro el 10%, hemorragia intracraneana grado III-IV el 3% y enterocolitis necrotizante el 1%. Hasta las 26 semanas el 100% de los niños presentó alguna morbilidad definida, a partir de las 27 semanas aumentó progresivamente el número de niños sin ninguna morbilidad, siendo este porcentaje mayor al 90% para los niños con más de 30 semanas de edad gestacional al nacer. En cuanto al crecimiento, todos los grupos de diferente edad gestacional tuvieron una pérdida de peso inicial de aproximadamente dos desvíos de puntaje z; una vez que se recuperó el peso al nacer todos crecieron a una velocidad de crecimiento semejante a la intrauterina pero por debajo del percentil 10 del feto de referencia. La mayor velocidad de crecimiento se observó con aportes calóricos entre 100-125 calorías/kg/día. Conclusión: la morbimortalidad fue inversamente proporcional a la edad gestacional y al peso al nacer. La mayor morbilidad estuvo determinada por la presencia de broncodisplasia pulmonar y las enfermedades asociadas a ésta, principalmente la sepsis tardía. Serán necesarios futuros estudios en los que se optimice el manejo respiratorio, el crecimiento posnatal y se disminuya la morbimortalidad.
Background: due to the combined efforts of obstetricians and neonatologists in optimizing perinatal and neonatal care, survival of infants with extremely low birth weight (ELBW) has improved remarkably in the last decade. However, improved survival of premature infants has been accompanied by increasing recognition of log-term neurological deficits, chronic lung complications and other morbidities. Objective: to evaluate the mortality, morbidity and growth in weight of infants with ELBW in two level III neonatal intensive care units (NICUs). Methods: a 3-year retrospective review of 130 infants <= 1500 g birth weights who were admitted in two level III neonatal intensive care units (Hospital de Clinics and AEPSM). Results: of 130 infants, 106 (82%) were discharged from the hospital. The survival rates for all infants admitted to a NICU were, respectively, 0% for <= 23 weeks, 43% for 24 weeks, 83% for 25 weeks, 70% for 26 weeks, 80% for 27 weeks, 93% for 28 weeks, 81% for 29 weeks and 100% for > or = 30 weeks. 78% of the infants received treatment with surfactant, 28% have chronic lung disease, 26% late sepsis, 22% patent ducts arteriosus, 10% retinopathy of prematurity, 3% intraventricular hemorrhage grade III-IV, and 1% necrotizing enterocolitis. 100% of the infants with 26 weeks have some morbidity, however only 10% of the infants with = 30 weeks have some morbidity. Most ELBW infants did nor achieve catch-up growth during the neonatal intensive care unit hospitalization when compared with the median birth weight of a reference fetus of the same postmenstrual age. Average daily weight gain (g/kg body weight/d) after regaining birth weight was similar to the reported intrauterine weight gain. The factor significantly associated with a higher growth velocity was a caloric intake = 100 to 125 cal/Kg/d. Conclusions: the mortality and morbidity decreased dramatically with the increment of the gestational age. The morbidity most significative was chronic lung disease and their pathology associated: the late sepsis. Studies using calories closer to the upper ranges of the recommendations and designed to reduce the incidence of/or severity of chronic lung disease need to be conducted in the extremely premature population.