Clinical and Nutritional Conditio ns as Predictors of Retinopathy of Prematurity
Ricardo M. Nieto, Alicia M. Benitez, Nestor A. Dine rstein, Gaston P. Perez, Mario Carrara, Claudio L. S olana. Neonatology, Hospital Ramon Sarda, Buenos Ai res, Argentina; Fresenius Kabi Argentina, Buenos Aires, Argentina
icardo M. Nieto, Alicia M. Benitez, Nestor A. Dine
rstein, Gaston P. Perez, Mario Carrara, Claudio L. Solana. Neonatology, Hospital Ramon Sarda, Buenos Aires,Argentina; Fresenius Kabi Argentina, Buenos Aires,
Retinopathy of Prematurity (ROP) is the main cause of childhood blindness in Argentina. Recent stu dies suggest than postnatal growth and related factor s as ILGF levels can play an important role in the develop ment of retinopathy of prematurity (ROP).
To evaluate clinical and nutritional factors associated with the development of ROP (any stage) an d severe ROP (stage III and IV).
Cohort study. Inclusion criteria: inb orn infants between 08/2003 to 11/2005 with gestation al age (GA) <32 weeks and birth weight (BW) <1500 g. Clinical conditions and daily growth in g/kg/day were recorded f rom BW recovery up to day 28. Statistical analysis: Two predictive models of logistical regression were constru cted.
152 patients met the inclusion criteria, 8 were transferred and 3 died before day 28. Data fro m the remaining 141 patients were analyzed. Fifty fi ve patients developed ROP (39%), they had less GA and BW: 28.3 w vs. 29.6 w (p<0.001) and BW 1090 g vs.1190 g (p=0.0 07). Higher prevalence of late onset sepsis: 44% vs 22 % (p=0.012); more days in oxygen: 55 vs 28 (p< 0.001), more days in mechanical ventilation: 21 vs 10 (p= 0.02) , higher prevalence of bronchopulmonary dysplasia: 51% v s 31% (p=0.02), higher caloric and protein deficit at day 2 8: -695 cal/k and -22 g/k vs. -466 g/k and -15 g/k ( p=0.003 and 0.004 respectively), and lower daily grow th: 16 g/k/d vs. 22g/k/d (p=0.038). Multivariate analysis showed that for each week of lower GA the chances of any grade of R OP increased 60% (95% CI 55-81). Patients who had an increase in body weight higher than 20 g/k/d had 58% (95% CI 7-80) less chances of developìng ROP. Sixteen pa tients had a diagnosis of severe ROP (III and IV stage s) and was associated to late onset sepsis (aOR 0.2, CI 95% 0.0 5-0.75), this model represents a negative predective va lue of 94%. Lower GA and less than 20 g/k/d of body weight in crease up to day 28 were associeted independently with R OP. ROP stages III and IV were associated with late onse t sepsis and lower GA.
GA and postnatal growth failure can be associated independently with ROP development. The imp act of new nutritional interventions for decreasing p ostnatal growth restriction should be evaluated. This study confi rms the relevance of GA as a major guide for ROP screen ing in our clinical setting.