Evaluación de la severidad, proporcionalidad y riesgo de muerte de recién nacidos de muy bajo peso con restricción del crecimiento fetal: análisis multicéntrico sudamericano

Abstract

Suggested citation: Grandi C, Tapia JL, Marshall G, Grupo Colaborativo NEOCOSUR. An assessment of the severity, proportionality and risk of mortality of very low birth weight infants with fetal growth restriction. A multicenter South American analysis. J Pediatr (Rio J). 2005;81:198-204. AbstractObjectives: To evaluate the clinical severity and proportionality of small for gestational age, very low birth weight neonates (< 1,500 g) and to estimate the neonatal mortality risk associated with the condition of being small for gestational age according to the degree of severity and proportionality.Methods: Observational design. All of the NEOCOSUR Collaborative Group s very low birth weight infants (25-36 weeks gestation) were included (n = 1,518). Anthropometric indices: birth weight < 3rd and 10th percentile. Severity (fetal growth ratio = observed weight/mean birth weight for gestational age); no growth restriction: fetal growth ratio 0.90-1.10, mild: fetal growth ratio 0.80-0.89, moderate: fetal growth ratio 0.75-0.79 and severe: fetal growth ratio < 0.75. Proportionality: coefficient of bimodality and z score for ponderal index (PI = g/cm 3 x 100). Neonatal mortality until discharge.Results: < 3rd percentile: 13.5% (p < 0.001); < 10th percentile: 31% (p < 0.001); fetal growth ratio: 0.90±0.21 (p < 0.001), mild restriction: 20.8%, moderate restriction: 8.7% and severe restriction: 32.6%. Coefficient of bimodality: 0.53; PI z score < -1: 8%. Maternal hypertensive disease was systematically associated with being small for gestational age (aOR 1.20, 95% CI 0.86-1.67), fetal growth ratio < 0.89 (aOR 1.71, 1.24-2.36) and PI z score < -1 (aOR 1.60, 1.03-2.41). Adjusted odds ratios for neonatal mortality were: 2.64 (95% CI 1.71-3.92) for being small for gestational age, 2.76 (95% CI 1.85-4.10) for fetal growth ratio < 0.89, and 1.37 (95% CI 0.80-2.32) for z score PI < -1.Conclusions: Small for gestational age, mostly symmetric and severe restriction is a frequent condition in < 1,500 g neonates and is associated with higher mortality rates.

Pequenos para a idade gestacional: gravidade, proporcionalidade e mortalidade

“…3 The group of preterm infants born with weights of less than 1,500 g and small for gestational age without doubt require evaluation of physical characteristics that may identify possible subgroups and their clinical importance. This is what Grandi et al are doing in their article published in this issue, 4 performing a detailed study of the prevalence, severity and proportionality of newborn infants weighing less than 1,500 g and small for gestational age, according to different degrees of prematurity. They also investigate the risk of mortality according to the condition of small for age and the degree of growth restriction and proportionality.…”

Editorial

“…Un estudio encuentra entre 6 y 8% en América Latina (18) , asociándose en especial con la preeclampsia e hipertensión materna (19) . La Encuesta Demográfica y de Salud Familiar en el Perú (Endes III) encontró que los recién nacidos de peso bajo representaron el 8,9% de los nacimientos, siendo 7% en la costa, 11,3% en la sierra y 12,4% en la selva (20) , promedio que disminuyó levemente a 8% el año 2010 (21) .…”

Small for gestational age: severity, proportionality and risk of mortality

“…Seria a distribuição das idades dessas mães mais próxima dos 18 anos? O trabalho de Grandi et al 4 e do grupo multicêntrico traz um conjunto de resultados que fazia falta e contribui efetivamente em áreas relativamente carentes de estudo. O desenho desse trabalho certamente será referência para futuros estudos no mesmo campo.…”

“…É o que fazem Grandi et al no artigo publicado neste número 4 , partindo para minucioso estudo da prevalência, gravidade e proporcionalidade dos recém-nascidos de menos de 1.500 g pequenos para a idade gestacional, para diferentes graus de prematuridade. Estudam, ainda, o risco de mortalidade segundo a condição de pequeno para a idade, o grau de gravidade da restrição de crescimento e a proporcionalidade.…”

“…Os resultados de Grandi et al 4 mostram elevado índice de pequenos para a idade gestacional no grupo estudado (30,1% abaixo do percentil 10 e 13,1% abaixo do percentil 3), com elevada mortalidade quando a condição de pequeno é grave (segundo a razão de crescimento fetal (FGR)) e, vale acentuar, independentemente da etiologia.…”