[早产儿宫外生长发育迟缓及其相关因素]

Shan Hong-mei, Cai Wei, Sun Jian-hua, Cao Yun, Shi Ying-ying, Fang Bing-hua

Department of Clinical Nutrition Center, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, China.

Zhonghua Er Ke Za Zhi. 2007 Mar;45(3):183-8.

OBJECTIVE

Poor growth is a common problem in premature neonates. No sufficient attention has been paid to the nutrition deficit and extrauterine growth retardation in premature neonates in China. The present study aimed to assess the incidences of intrauterine growth retardation (IUGR) and extrauterine growth retardation (EUGR) in premature neonates in Shanghai area and their correlated factors.

METHODS

Data of the neonates discharged between January 1, 2003 and December 31, 2004 from 5 hospitals (Xinhua Hospital, Shanghai Children's Medical Center, Shanghai Children's Hospital, Pediatric Hospital Affiliated to Fudan University, and Shanghai International Peace Maternity and Child Health Hospital) were reviewed. The criteria of exclusion were cases who died or had a malformed appearance, the mother had endocrine or metabolic diseases. The criteria for enrollment were (1) gestational age < 37 weeks, (2) admitted less than 24 hours after birth and discharged from the same hospital, (3) duration of hospitalization was > or = 7 days. The growth values on discharge of each patient were compared to the expected values based on the intrauterine growth data and postmenstrual day on discharge. Growth retardation was defined as measured growth values (weight, head circumference) < or = 10th percentile of the values (growth expectation based on estimated postmenstrual age). In each specific group, the number of neonates with < or = 10(th) percentile for each growth parameter was counted and the percentages of patients who had values < or = 10(th) percentile on birth and discharge were calculated. The growth curves used for assessing birth weight and head circumference for different gestational age neonates were those published in 1986. All the data were analyzed using the SPSS statistical software package. The risk factors for extrauterine growth retardation on weight and head circumference were estimated with logistic regression model.

RESULTS

The subjects included 1196 premature neonates in the five hospitals (734 boys and 462 girls). The incidence of IUGR was 22.7% and 19.2% assessed by weight and head circumference, respectively. The incidence of EUGR was 49.7% and 23.1% assessed by weight and head circumference, respectively. Assessment of IUGR in accordance with the birth weight and head circumference in the five hospitals showed no significant correlation between IUGR and non-IUGR by birth weight (chi(2) = 4.944) and head circumference (chi(2) = 0.017) respectively. Whereas the assessment of EUGR in accordance with weight and head circumference showed a significant correlation between EUGR and non-EUGR by weight on discharge (chi(2) = 28.109), but no significant correlation was found between EUGR and non-EUGR by head circumference on discharge (chi(2) = 0.275). In specific birth weight groups, the lower the weight, the higher the incidence of IUGR and EUGR by the weight and head circumference. The incidence of EUGR in VLBWI was 78.9% and 50.0% assessed by weight and head circumference, respectively. Assessed by weight, significant correlation was observed between EUGR and non-EUGR in birth weight (t = 18.674), hospitalization duration (Z = -8.790) and the median number of day for total using EN (Z = -4.650); but by the head circumference, significant correlation was observed in head circumference at birth (t = 9.555), hospitalization duration (Z = -3.930) and the median number of day for total using EN (Z = -3.004). The relationship between EUGR and some risk factors was analyzed with Logistic regression model. Assessed by the weight, the following 4 factors were related to EUGR: sex (chi(2) = 10.351), gestation age at birth (chi(2) = 56.275), birth weight (chi(2) = 102.126) and different hospital (chi(2) = 4.773). Assessed by the head circumference, the following 2 factors were correlated: gestation age at birth (chi(2) = 10.322) and head circumference (chi(2) = 10.620).

CONCLUSIONS

This study showed that the incidence of EUGR in premature neonates was significantly higher than the data reported in other countries. The incidence of EUGR increased with the decreased birth weight. Different nutritional support had influence on EUGR.

目的

生长发育不良是早产儿常见问题。我国对早产儿营养缺乏及宫外生长发育迟缓未给予足够重视。本研究旨在评估上海地区早产儿宫内生长发育迟缓（IUGR）和宫外生长发育迟缓（EUGR）的发生率及其相关因素。

方法

回顾2003年1月1日至2004年12月31日期间5家医院（新华医院、上海儿童医学中心、上海儿童医院、复旦大学附属儿科医院、上海国际和平妇幼保健院）出院新生儿的数据。排除标准为死亡或外观畸形、母亲患有内分泌或代谢疾病的病例。纳入标准为：（1）胎龄<37周；（2）出生后24小时内入院且在同一家医院出院；（3）住院时间≥7天。将每位患者出院时的生长值与基于宫内生长数据和出院时月经后日龄的预期值进行比较。生长发育迟缓定义为测量的生长值（体重、头围）≤基于估计月经后年龄的生长预期值的第10百分位数。在每个特定组中，统计每个生长参数≤第10百分位数的新生儿数量，并计算出生时和出院时生长值≤第10百分位数的患者百分比。用于评估不同胎龄新生儿出生体重和头围的生长曲线是1986年公布的。所有数据均使用SPSS统计软件包进行分析。采用逻辑回归模型估计宫外生长发育迟缓在体重和头围方面的危险因素。

结果

5家医院的研究对象包括1196例早产儿（734例男婴和462例女婴）。根据体重和头围评估，IUGR的发生率分别为22.7%和19.2%。根据体重和头围评估，EUGR的发生率分别为49.7%和23.1%。根据5家医院出生体重和头围评估IUGR，出生体重（χ² = 4.944）和头围（χ² = 0.017）的IUGR与非IUGR之间均无显著相关性。而根据体重和头围评估EUGR，出院时体重的EUGR与非EUGR之间存在显著相关性（χ² = 28.109），但出院时头围的EUGR与非EUGR之间未发现显著相关性（χ² = 0.275）。在特定出生体重组中，体重越低，根据体重和头围评估的IUGR和EUGR发生率越高。极低出生体重儿（VLBWI）根据体重和头围评估的EUGR发生率分别为78.9%和50.0%。根据体重评估，EUGR与出生体重（t = 18.674）、住院时间（Z = -8.790）和肠内营养（EN）总使用天数中位数（Z = -4.650）之间存在显著相关性；但根据头围评估，EUGR与出生时头围（t = 9.555）、住院时间（Z = -3.930）和EN总使用天数中位数（Z = -3.004）之间存在显著相关性。采用逻辑回归模型分析EUGR与一些危险因素的关系。根据体重评估，以下4个因素与EUGR相关：性别（χ² = 10.351）、出生胎龄（χ² = 56.275）、出生体重（χ² = 102.126）和不同医院（χ² = 4.773）。根据头围评估，以下2个因素相关：出生胎龄（χ² = 10.322）和头围（χ² = 10.620）。