Per citar aquest document: http://ddd.uab.cat/record/99212
Tratamiento de la retinopatía del prematuro con láser de diodo : correlación de la retinopatía grave y la presencia de enfermedad plus con factores clínicos de riesgo predictivo / María Nieves Martín Begué ; directores: José García-Arumí, Félix Castillo Salinas
Martín Begué, Nieves
García Arumí, José, dir. (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Castillo Salinas, Félix, dir. (Universitat Autònoma de Barcelona. Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva)
Universitat Autònoma de Barcelona. Departament de Cirurgia

Publicació: Bellaterra : Universitat Autònoma de Barcelona, 2011
Resum: Retinopathy of prematurity is a peripheral proliferative vitreoretinopathy seen in premature infants, which has a multifactorial aetiology. The incidence and severity of retinopathy of prematurity is influenced by the increasing survival of the more premature infants thanks to the advances in their care and management in the peri- and post-natal periods. It is a prevalent pathology with an associated high morbidity, as illustrated by the fact that it remains the second cause of blindness in children within the developed world. This study analyses the characteristics of the premature infants who developed retinopathy of prematurity that required treatment and their structural outcome after photocoagulation at nine-months postnatal age in Vall d'Hebron Hospital. A comparative analysis was made between the premature infants that developed retinopathy and those that did not in order to identify possible prognostic factors that could identify infants at risk of developing severe retinopathy or plus disease. As a secondary objective we compared our results with data from other national and international centres within the developed world. Lastly, the frequency and severity of retinopathy was compared before and after 2005 when continued positive airway pressure (CPAP) became widely used, and the treatment criteria for retinopathy of prematurity was broadened. The study includes all infants of less than 31 weeks gestational age and / or less than 1251g birth weight either born at or referred within the first 24 hours of life to the Vall d'Hebron Hospital between December 2001 and December 2007. The results of this thesis show that premature infants have a high comorbidity, and need a multidisciplinary approach to their management. The main risk factors for developing retinopathy in our population were gestational age, birth weight, anemia, intraventricular haemorrhage and mechanical ventilation. However, the risk factors for developing severe retinopathy (stage ≥3) and plus disease were gestational age and hypotension. The premature infants that developed retinopathy were correctly identified using these variables, however not the infants that progressed to stage 3 ROP or developed plus disease. Postmenstrual age rather than neonatal history determines both the timing of presentation of retinopathy and its further progression, so that the first eye examination should be established according to the postmenstrual age. Equally, the critical period in which a retinopathy develops to treatment levels is between 34 and 44 weeks postmenstrual age, illustrating that retinopathy of prematurity is a late complication. The location of the retinopathy and the time to resolution of plus disease following laser photocoagulation are the sole factors for an unfavourable structural outcome. The observed reduction in an unfavourable structural outcome over the years of the study is probably a reflection of the broadening of the treatment indications and the learning curve for the treatment with laser in these patients. Nor the incidence nor the severity of retinopathy has varied over the years of this study and is similar to populations with like characteristics within developed countries, however our structural results were better. In conclusion, this study has shown the incidence and morbidity of retinal pathology associated with prematurity in our population. It has enabled us to modify our screening protocol for premature infants and establish when to retreat a patient in order to further improve the structural results.
Nota: Bibliografia
Nota: Descripció del recurs: 7 setembre 2011
Nota: Tesi doctoral - Universitat Autònoma de Barcelona, Facultat de Medicina, Departament de Cirurgia, 2010
Drets: ADVERTIMENT. L'accés als continguts d'aquesta tesi doctoral i la seva utilització ha de respectar els drets de la persona autora. Pot ser utilitzada per a consulta o estudi personal, així com en activitats o materials d'investigació i docència en els termes establerts a l'art. 32 del Text Refós de la Llei de Propietat Intel·lectual (RDL 1/1996). Per altres utilitzacions es requereix l'autorització prèvia i expressa de la persona autora. En qualsevol cas, en la utilització dels seus continguts caldrà indicar de forma clara el nom i cognoms de la persona autora i el títol de la tesi doctoral. No s'autoritza la seva reproducció o altres formes d'explotació efectuades amb finalitats de lucre ni la seva comunicació pública des d'un lloc aliè al servei TDX. Tampoc s'autoritza la presentació del seu contingut en una finestra o marc aliè a TDX (framing). Aquesta reserva de drets afecta tant als continguts de la tesi com als seus resums i índexs.
Llengua: Castellà.
Document: Tesis i dissertacions electròniques ; doctoralThesis
Matèria: Infants prematurs ; Malalties ; Fibroplàsia retrolenticular
ISBN: 9788469418642

Adreça alternativa: http://hdl.handle.net/10803/32091


136 p, 1.0 MB

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