Fanaro S
Pediatric Section, University of Ferrara, Italy.
Minerva Pediatr. 2010 Jun;62(3 Suppl 1):77-82.
In the last two decades the improved survival of very low birth weight (VLBW) and extremely low birth weight (ELBW) infants has underscored the problem of postnatal growth failure of these subjects. Notwithstanding the evident improvements in the general management of these infants during the hospital stay, most of them acquire a significant extrauterine growth restriction (EUGR). Frequent illnesses, medical and surgical therapies, feeding intolerance and, most of all, inadequacy of nutrient deliveries are responsible for the great part of this growth failure. However other factors, such as genetics, prenatal environment, hormones and metabolic pathways may contribute to growth impairment, that my persist until adulthood. Most of VLBW infants exhibit some catch-up growth, especially in late childhood and adolescence, but they generally remain smaller than their term peers. However, the most worrying aspect is related to the detrimental effect of growth impairment, especially if involving head circumference, on neurodevelopment outcomes of these infants. The endocrine, metabolic and cardiovascular long term consequences of under- and/or hypernutrition of VLBW infants are still to be elucidated. In the meantime, the efforts of the neonatotolgists should be focused on improving, how much as possible, the early nutrient management of these infants, allowing them to reach an adequate growth rate (at least 18-20 g/kg/d), then avoiding the need of a late unphysiological catch-up growth.
在过去二十年中，极低出生体重（VLBW）和超低出生体重（ELBW）婴儿存活率的提高凸显了这些婴儿出生后生长发育不良的问题。尽管在住院期间对这些婴儿的总体管理有了明显改善，但大多数婴儿仍出现了显著的宫外生长受限（EUGR）。频繁生病、内科和外科治疗、喂养不耐受，最重要的是营养供应不足，在很大程度上导致了这种生长发育不良。然而，其他因素，如遗传学、产前环境、激素和代谢途径，可能导致生长受损，这种情况可能会持续到成年。大多数VLBW婴儿会出现一定程度的追赶生长，尤其是在童年晚期和青春期，但他们通常仍比足月儿矮小。然而，最令人担忧的方面是生长受损，尤其是涉及头围时，对这些婴儿神经发育结局的不利影响。VLBW婴儿营养不足和/或营养过剩的内分泌、代谢和心血管长期后果仍有待阐明。与此同时，新生儿科医生的努力应集中在尽可能改善这些婴儿的早期营养管理，使他们达到足够的生长速度（至少18 - 20克/千克/天），从而避免后期非生理性追赶生长的需要。
