Zaw Win, Gagnon Robert, da Silva Orlando
Department of Child Health, University of Aberdeen, Aberdeen, United Kingdom.
Pediatrics. 2003 Jun;111(6 Pt 1):1273-7. doi: 10.1542/peds.111.6.1273.
To evaluate neonatal and fetal growth standards in determining the impact of small for gestational age (SGA) on neonatal mortality and morbidity.
A hospital-based cohort study of infants born in a regional tertiary care center and admitted to the neonatal intensive care unit.
A total of 1267 singleton neonates of <34 weeks gestational age, without any congenital anomalies, born between January 1, 1993 and December 31, 2001.
Each outcome variable including mortality, respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage (IVH), periventricular leukomalacia, and necrotizing enterocolitis was related to growth status as defined by fetal and neonatal growth standards after adjustment for potential confounders.
The number of SGA infants was 11.6% (n = 147) of the study population according to neonatal growth standards, but it was increased to 23.3% (n = 295) when fetal growth standards were used. According to fetal growth standards, when SGA was compared with appropriate for gestational age infants, it was associated with an increased risk of respiratory distress syndrome (odds ratio [OR] 1.40; 95% confidence interval [CI] 1.00-1.95), bronchopulmonary dysplasia (OR 2.18; 95% CI 1.33-3.59), IVH (OR 1.67; 95% CI 1.13-2.45), and retinopathy of prematurity (OR 3.88; 95% CI 2.33-6.48). However, only neonatal mortality (OR 3.64; 95% CI 1.64-8.09), retinopathy of prematurity (OR 5.38; 95% CI 2.87-10.90), and necrotizing enterocolitis (OR 2.47; 95% CI 1.21-5.07) were positively associated with SGA when using neonatal growth standards.
Compared with the neonatal growth standards, the fetal growth standards are better in identifying increased risk of respiratory morbidity and IVH among preterm SGA infants.
评估新生儿和胎儿生长标准在确定小于胎龄儿（SGA）对新生儿死亡率和发病率影响方面的作用。
一项基于医院的队列研究，研究对象为在某地区三级医疗中心出生并入住新生儿重症监护病房的婴儿。
共1267名单胎新生儿，孕周小于34周，无任何先天性异常，于1993年1月1日至2001年12月31日期间出生。
在对潜在混杂因素进行调整后，将包括死亡率、呼吸窘迫综合征、支气管肺发育不良、脑室内出血（IVH）、脑室周围白质软化和坏死性小肠结肠炎在内的每个观察变量与根据胎儿和新生儿生长标准定义的生长状况相关联。
根据新生儿生长标准，SGA婴儿数量占研究人群的11.6%（n = 147），但使用胎儿生长标准时，该比例增至23.3%（n = 295）。根据胎儿生长标准，将SGA与适于胎龄儿进行比较时，SGA与呼吸窘迫综合征风险增加相关（优势比[OR] 1.40；95%置信区间[CI] 1.00 - 1.95）、支气管肺发育不良（OR 2.18；95% CI 1.33 - 3.59）、IVH（OR 1.67；95% CI 1.13 - 2.45）和早产儿视网膜病变（OR 3.88；95% CI 2.33 - 6.48）相关。然而，使用新生儿生长标准时，仅新生儿死亡率（OR 3.64；95% CI 1.64 - 8.09）、早产儿视网膜病变（OR 5.38；95% CI 2.87 - 10.90）和坏死性小肠结肠炎（OR 2.47；95% CI 1.21 - 5.07）与SGA呈正相关。
与新生儿生长标准相比，胎儿生长标准在识别早产SGA婴儿呼吸疾病和IVH风险增加方面表现更佳。
