Clark Reese H, Thomas Pam, Peabody Joyce
The Pediatrix-Obstetrix Center for Research and Education, Pediatrix Medical Group, Inc, Sunrise, Florida 33323-2825, USA.
Pediatrics. 2003 May;111(5 Pt 1):986-90. doi: 10.1542/peds.111.5.986.
Poor growth is a common problem in premature neonates and may be associated with neurodevelopmental delay.
To evaluate the incidence of extrauterine growth restriction (growth values < or =10th percentile of intrauterine growth expectation based on estimated postmenstrual age in premature (23-34 weeks' estimated gestational age) neonates at the time they are discharged from the hospital.
DESIGN/METHODS: Using a database formed from a computer-assisted tool that generates clinical progress notes and discharge summaries on neonatal intensive care unit admissions, we reviewed data on neonates discharged from 124 neonatal intensive care units between January 1, 1997, and December 31, 2000. We evaluated neonates who were born between 23 and 34 weeks' estimated gestational age without congenital anomalies and who were cared for at and discharged from the same hospital. For each patient, we compared the discharge growth values to the expected values based on our intrauterine growth data and postmenstrual age on the day of discharge. We defined extrauterine growth restriction as having a measured growth value (weight, length or head circumference) that was < or =10th percentile of the predicted value. In each specific birth weight and estimated gestational age group, we counted the number of neonates < or =10th percentile for each growth parameter and calculated the percentage of patients who had values < or =10th percentile at discharge. Using logistic regression, we evaluated the factors associated with extrauterine growth restriction for weight, length, and head circumference.
Our sample included 24 371 premature neonates. Data on discharge weight, length, and head circumference was available on 23 970, 17 203, and 20 885 neonates, respectively. The incidence of extrauterine growth restriction was common (28%, 34%, and 16% for weight, length, and head circumference, respectively). For each growth parameter, the incidence of extrauterine growth restriction increased with decreasing estimated gestational age and birth weight. Factors independently associated with extrauterine growth restriction were male gender, need for assisted ventilation on day 1 of life, a history of necrotizing enterocolitis, need for respiratory support at 28 days of age, and exposure to steroids during the hospital course.
Extrauterine growth restriction remains a serious problem in premature neonates especially for neonates who are small, immature, and critically ill.
生长发育迟缓是早产儿常见问题，可能与神经发育延迟有关。
评估宫外生长受限（基于早产（估计胎龄23 - 34周）新生儿出院时的估计月经龄，生长值<或=宫内生长预期的第10百分位数）的发生率。
设计/方法：利用一个由计算机辅助工具形成的数据库，该工具可生成新生儿重症监护病房入院患者的临床病程记录和出院小结，我们回顾了1997年1月1日至2000年12月31日期间从124个新生儿重症监护病房出院的新生儿数据。我们评估了胎龄估计在23至34周之间、无先天性异常且在同一家医院接受治疗并出院的新生儿。对于每位患者，我们将出院时的生长值与基于我们的宫内生长数据和出院当天的月经龄计算出的预期值进行比较。我们将宫外生长受限定义为测量的生长值（体重、身长或头围）<或=预测值的第10百分位数。在每个特定出生体重和估计胎龄组中，我们统计了每个生长参数<或=第10百分位数的新生儿数量，并计算出院时生长值<或=第10百分位数的患者百分比。使用逻辑回归，我们评估了与体重、身长和头围宫外生长受限相关的因素。
我们的样本包括24371名早产儿。分别有23970名、17203名和20885名新生儿有出院体重、身长和头围的数据。宫外生长受限的发生率很常见（体重、身长和头围分别为28%、34%和16%）。对于每个生长参数，宫外生长受限的发生率随着估计胎龄和出生体重的降低而增加。与宫外生长受限独立相关的因素包括男性性别、出生第1天需要辅助通气、坏死性小肠结肠炎病史、28日龄时需要呼吸支持以及住院期间接触类固醇。
宫外生长受限在早产儿中仍然是一个严重问题，尤其是对于体型小、不成熟和危重症的新生儿。
