van Dommelen Paula, van Wouwe Jacobus P, Breuning-Boers Jacqueline M, van Buuren Stef, Verkerk Paul H
TNO Quality of Life, Leiden, The Netherlands.
Arch Dis Child. 2007 Jun;92(6):490-4. doi: 10.1136/adc.2006.104331. Epub 2006 Jul 31.
The validity of the rule of thumb that infants may have a weight loss of 10% in the first days after birth is unknown. We assessed the validity of this and other rules to detect breast-fed infants with hypernatraemic dehydration.
A reference chart for relative weight change was constructed by the LMS method. The reference group was obtained by a retrospective cohort study.
1544 healthy, exclusively breast-fed infants with 3075 weight measurements born in the Netherlands and 83 cases of breast-fed infants with hypernatraemic dehydration obtained from literature.
The rule of thumb had a sensitivity of 90.4%, a specificity of 98.3% and a positive predictive value of 3.7%. Referring infants if their weight change is below -2.5 SDS (0.6th centile) in the reference chart in the first week of life and using the rule of thumb in the second week had a sensitivity of 85.5%, a specificity of 99.4% and a positive predictive value of 9.2%.
The rule of thumb is likely to produce too many false positive results, assuming that for screening purposes the specificity needs to be high. A chart for relative weight change can be helpful to detect infants with hypernatraemic dehydration.
出生后最初几天婴儿体重可能减轻10%这一经验法则的有效性尚不清楚。我们评估了这一法则及其他法则用于检测母乳喂养婴儿高钠血症性脱水的有效性。
采用LMS法构建相对体重变化参考图表。参考组通过回顾性队列研究获得。
1544名在荷兰出生的健康纯母乳喂养婴儿，共进行了3075次体重测量，以及从文献中获取的83例母乳喂养高钠血症性脱水婴儿病例。
该经验法则的敏感性为90.4%，特异性为98.3%，阳性预测值为3.7%。如果婴儿出生后第一周体重变化低于参考图表中-2.5 SDS（第0.6百分位数）则进行转诊，并在第二周使用该经验法则，其敏感性为85.5%，特异性为99.4%，阳性预测值为9.2%。
假设出于筛查目的特异性需要较高，那么该经验法则可能会产生过多假阳性结果。相对体重变化图表有助于检测高钠血症性脱水婴儿。
