Estimulación precoz en los recién nacidos con peso al nacer entre 1.000 y 1.500g.¿Es siempre necesaria?

Resumo

Objective To determine whether the currently widespread practice of sending all premature infants with birth weight between 1,000 and 1,500g to early care centres is necessary from a neurological point of view, or if it is possible to establish selection criteria. Material and methods A retrospective study of newborns (NB) at our hospital between January 1998 and December 2004 with birth weight between 1,000 and 1,500g, and followed up for at least two years in a paediatric neurology clinic. We analysed the prognostic significance of the different neurological variables in the neonatal period, and those of greater significance were set at a score for deciding the start of early stimulation treatment on discharge from neonatology. Results A total of 194 infants met the above criteria. The most significant neurological prognostic variables were: gestational age < 28 weeks, male sex, intraventricular haemorrhage grade > I, history of high risk pregnancy, sepsis, anaemia with haemodynamic repercussion and fundamentally abnormal neurological examination at discharge (odds ratio of 16). A prognostic score was developed with a cut-off of 4 points, with an area under the curve of 88.3%. The positive predictive value and negative predictive value were 43.75% and 96.2%, respectively, with 84.8% sensitivity and 78.9% specificity. Conclusions The newborns with birth weight between 1,000 and 1,500g and normal neurological examination at discharge, with a score of less than 4 points, do not require early stimulation treatment from a neurological standpoint, given its predictable good outcome.