LOW WEIGHT GAIN AT THE 6TH WEEK OF LIFE AS A RISK FACTOR WEEK OF LIFE AS A RISK FACTOR FOR RETINOPATHY OF PREMATURITY João Borges Fortes Filho MD, Pedro Paulo Bonomo MD, Renato Soibelmann Procianoy MD Departments of Ophthalmology and Pediatrics, Newborn Section, Federal University of Rio Grande do Sul, Porto Alegre, Brazil Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil Objectives: The purpose of the present study is to analyze the low weight gain
Figure 2. The mean weight gain among 257 Non-
Table 1. Baseline characteristics of the study population of 348 infants
by the 6th week of life as an independent risk factor for the development of
grams) and among 91 ROP infants was 462,80
Number (%) Mean (SD)
grams (SD:209.36 grams), p < 0,001.
retinopathy of prematurity (ROP) at any of it’s evolutive stage.
Methods: Prospective cohort study to compare the incidence of ROP and
the perinatal low weight gain in all the newborn admitted at the Institution from
October 2002 to December 2006. Were included all very low birth weight
preterm babies (birth weight 1.500 g or lower or gestational age of 32 weeks or
Table 2. Distribution of the 348 infants by the perinatal w eight gain in groups of 33th and 66th percentiles and according Non-ROP, ROP and ROP severe groups
less). The main variable was the low weight gain by the 6th week of life. The low
of infants Non-ROP with ROP 3+
weight gain was defined as the weight measured by the 6th week of life less the
Low Weight Gain Group (33th percentile) 116 61 55 17 Perinatal weight gain < 520 grams
birth weight. The clinical outcome was the development of ROP at any stage.
Intermediate W eight Gain Group (66th percentile)
Perinatal weight gain from 521 to 710 grams
The incidence of ROP was determined. Qui-Square test was used to compare
the two groups of patients (babies with ROP and babies who did not develop
Table 3. Univariate analysis of the perinatal risk factors for ROP for the whole Total 348 cohort of 348 infants
the disease). The risk relative (incidence ratio) was calculated with 95%
ROP: retinopathy of prematurity; ROP 3+: severe ROP
p value Chi-square
confidence interval (CI). To determine whether the weight gain, as defined, was
Table 4. Relative risk of the Low and the Intermediate Weight Gain groups compared with the High Weight Gain Group after logistic regression *
related to the development of ROP independently to other associated factors,
95% Confidence Interval Relative risk * p value
logistic regression was performed with significance level of 0.05%.
Inferior Superior Low Weight Gain Group (< 520 grams) < 0.001 Results: Were included 348 infants. The overall incidence of ROP was 26.1%.
The relative risk for the low weight gain was 7.40 (95% CI: 2.97–18.44), which
represents a high risk for this variable to participate in the development of ROP.
* Adjusted for Birth Weight, Gestational Age, Use of Oxygen-therapy in Mechanical Ventilation, use of erithropoietin and
Conclusions: The low weight gain measured by the 6th week of life was an THE PERINATAL LOW WEIGHT GAIN AND ROP IN THE INTERNATIONAL SCIENTIFIC LITERATURE
important risk factor for ROP in any evolutive stage in our study.
Holmes JM, Duffner LA. The effect of postnatal growth retardation on abnormal neovascularization in the oxygen exposed neonatal rat. Curr Eye Res 1996;15(4):403-9. EXPERIMENTAL ARTICLE
Ophthalmologists and neonatologists should take special care in the screening
Wallace DK, Kylstra JA, Phillips SJ, Hall JG. Poor postnatal weight gain: a risk factor for severe retinopathy of prematurity. p value JAAPOS 2000;4(6):343-7.
for ROP in this special group of patients. This is a very important conclusion,
Student t-test
RETROSPECTIVE REVIEW OF RECORDS INCLUDING 111 NEONATES FROM THOSE 43 NEONATES HAD SEVERE ROP
mainly for the middle-income countries once the low weight gain is a risk factor
Allegaert K, Vanhole C, Casteels I, Naulaers G, Debeer A, Cossey V, et al. Perinatal growth characteristics and associated risk of developing threshold retinopathy of prematurity. JAAPOS 2003;7(1):34-7. Weight gain * 678,77 + 258,59 462,80 + 209,36 < 0.001
PROSPECTIVE CASE-CONTROL STUDY INCLUDING 31 THRESHOLD ROP INFANTS IN GA MATCHED CONSTROLS
for ROP easily identifiable and also inexpensive for the social assistance in the
Löfqvist C, Andersson E, Sigurdsson J, Engström E, Hard A, Niklasson A, Smith LEH, Hellström A. Longitudinal postnatal weight and insulin-like growth factor I measurements in the prediction of retinopathy of prematurity. Arch Ophthalmol 2006;124(12):1711-18. PROSPECTIVE STUDY INCLUDING 79 INFANTS AT RISK FOR ROP * Mean + SD; S: significance; NS: non-significance
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LOW WEIGHT GAIN AT THE 6TH WEEK OF LIFE AS A RISK FACTOR