晚期早产儿是儿童早期生长发育迟缓的一个危险因素：一项队列研究。
Late preterm birth is a risk factor for growth faltering in early childhood: a cohort study.
机构信息
Postgraduate Program in Epidemiology, Department of Social Medicine, Federal University of Pelotas, Pelotas, Brazil.
出版信息
BMC Pediatr. 2009 Nov 16;9:71. doi: 10.1186/1471-2431-9-71.
BACKGROUND
Rates of preterm birth are increasing worldwide and this increase is mostly due to infants born between 34 and 36 weeks of gestational age, the so-called "late preterm" births. The aim of this study was to assess the effect of late preterm birth over growth outcomes, assessed when children were 12 and 24 months old.
METHODS
In 2004, all births taking place in Pelotas (Southern Brazil) were recruited for a cohort study. Late preterm (34/0-36/6 weeks of gestational age) and term children (37/0-42/6 weeks) were compared in terms of weight-for-age, length-for-age and weight-for-length z-scores. Weight-for-age, length-for-age and weight-for-length z-scores below -2 were considered, respectively, underweight, stunting and wasting. Singleton newborns with adequate weight for gestational age at birth, successfully followed-up either at 12 or 24 months of age were analyzed and adjusted odds ratios with 95% confidence intervals calculated through logistic regression.
RESULTS
3285 births were included, 371 of whom were late preterm births (11.3%). At 12 months, prevalence of underweight, stunting and wasting were, respectively, 3.4, 8.7 and 1.1% among late preterm children, against 1.0, 3.4 and 0.3% among term children. At 24 months, correspondent values were 3.0, 7.2 and 0.8% against 0.8, 2.9 and 0.4%. Comparing with the term children, adjusted odds of being underweighted among late preterm children was 2.57 times higher (1.27; 5.23) at 12 months and 3.36 times higher (1.56; 7.23) at 24; of being stunted, 2.35 (1.49; 3.70) and 2.30 (1.40; 3.77); and of being wasted, 3.98 (1.07; 14.85) and 1.87 (0.50; 7.01). Weight gain from birth to 12 and 24 months was similar in late preterm and term children, whereas length gain was higher in the former group in both periods.
CONCLUSION
Late preterm children grow faster than children born at term, but they are at increased risk of underweight and stunting in the first two years of life. Failure to thrive in the first two years may put them at increased risk of future occurrences of serious morbidity in late childhood and of chronic disease development in adult life.
背景
全世界早产儿的比例正在上升，而这种上升主要归因于 34 至 36 孕周之间出生的婴儿，即所谓的“晚期早产儿”。本研究的目的是评估晚期早产儿出生对生长结局的影响，这些影响是在儿童 12 个月和 24 个月时评估的。
方法
2004 年，在巴西南部的佩洛塔斯（Pelotas），所有的分娩都被招募进行队列研究。将晚期早产儿（34/0-36/6 孕周）和足月产儿（37/0-42/6 孕周）在体重与年龄、身长与年龄和体重与身长的 z 评分方面进行比较。体重低于年龄、身长低于年龄和体重低于身长的 z 评分分别被认为是体重不足、生长迟缓或消瘦。对出生时具有适当胎龄体重、在 12 或 24 个月时成功随访的单胎新生儿进行分析，并通过逻辑回归计算调整后的比值比及其 95%置信区间。
结果
共纳入 3285 例分娩，其中 371 例为晚期早产儿（11.3%）。在 12 个月时，晚期早产儿的体重不足、生长迟缓、消瘦的患病率分别为 3.4%、8.7%和 1.1%，而足月产儿的患病率分别为 1.0%、3.4%和 0.3%。在 24 个月时，相应的值分别为 3.0%、7.2%和 0.8%，足月产儿的相应值为 0.8%、2.9%和 0.4%。与足月产儿相比，晚期早产儿在 12 个月时体重不足的调整比值比为 2.57（1.27；5.23），24 个月时为 3.36（1.56；7.23）；在生长迟缓方面，12 个月时为 2.35（1.49；3.70），24 个月时为 2.30（1.40；3.77）；消瘦方面，12 个月时为 3.98（1.07；14.85），24 个月时为 1.87（0.50；7.01）。从出生到 12 个月和 24 个月的体重增长在晚期早产儿和足月产儿中相似，而在这两个时期，前者的身长增长更快。在前 2 年体重增长不良可能会使他们在以后的儿童期发生严重疾病的风险增加，并在成年期发展为慢性疾病。
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