Frondas-Chauty A, Simon L, Branger B, Gascoin G, Flamant C, Ancel P Y, Darmaun D, Rozé J C
Department of Neonatal Medicine, University Hospital of Nantes, Nantes, France INRA UMR 1280, Physiologie des Adaptations Nutritionnelles, IMAD, CRNH Ouest, Nantes, France.
Department of Neonatal Medicine, University Hospital of Nantes, Nantes, France.
Arch Dis Child Fetal Neonatal Ed. 2014 Sep;99(5):F366-72. doi: 10.1136/archdischild-2013-305464. Epub 2014 Jun 10.
Nutrition in the neonatal unit may impact the neurological outcome of very preterm infants, and male preterms are more likely to suffer neonatal morbidity and adverse neurological outcomes. We hypothesised that growth during hospitalisation would impact neurological outcome differently, depending on infant gender.
Surviving infants born between 1 January 2003 and 31 December 2009 with a gestational age <33 weeks, and enrolled in Loire Infant Follow-up Team, a regional cohort in western France, qualified for the study. Growth during neonatal hospitalisation was assessed by the change in weight z-score between birth and discharge, and infants where ranked into 5 classes, depending on their change in z-score (<-2, -2 to -1.01, -1 to -0.51, -0.50 to 0.01 and ≥0), the last class being the reference. The main outcome criterion was neurodevelopmental outcome at 2 years of corrected age. For each class of changes in weight z-score, crude or adjusted OR for non-optimal outcome was calculated for each gender, and compared between genders.
1221 boys and 1056 girls were included. Gender and early growth interact, (p=0.02). Moreover when change in weight z-score varied from <-2 to (-0.50 to -0.01), adjusted OR for non-optimal outcome varied from 3.2 (1.5-6.8) to 2.2 (1.2-4.1) in boys versus 1.8 (0.7-4.2) to 0.95 (0.4-1.9) in girls. For each class, the OR was significantly higher in boys.
In very preterm infants, male neurodevelopment appears to be much more sensitive than female to poor postnatal growth.
新生儿重症监护病房的营养状况可能会影响极早产儿的神经发育结局，并且男性早产儿更易出现新生儿发病及不良神经发育结局。我们推测住院期间的生长情况对神经发育结局的影响因婴儿性别而异。
2003年1月1日至2009年12月31日期间出生、胎龄<33周且纳入法国西部一个地区队列卢瓦尔河婴儿随访团队的存活婴儿符合本研究条件。通过出生至出院期间体重z评分的变化评估新生儿住院期间的生长情况，根据z评分变化（<-2、-2至-1.01、-1至-0.51、-0.50至0.01及≥0）将婴儿分为5组，最后一组为参照组。主要结局指标为矫正年龄2岁时的神经发育结局。对于每组体重z评分变化，计算每种性别的非最佳结局的粗比值比或调整比值比，并在不同性别间进行比较。
共纳入1221名男婴和1056名女婴。性别与早期生长存在交互作用（p=0.02）。此外，当体重z评分变化从<-2至（-0.50至-0.01）时，男婴非最佳结局的调整比值比从3.2（1.5-6.8）至2.2（1.2-4.1），而女婴从1.8（0.7-4.2）至0.95（0.4-1.9）。对于每组，男婴的比值比显著更高。
在极早产儿中，男性神经发育似乎比女性对出生后生长不良更为敏感。
