早产儿的产后生长标准：INTERGROWTH-21(st) 项目的早产儿产后随访研究。

Postnatal growth standards for preterm infants: the Preterm Postnatal Follow-up Study of the INTERGROWTH-21(st) Project.

机构信息

Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK.

Dipartimento di Scienze della Sanita Pubblica e Pediatriche, Struttura Complessa di Neonatologia Universitaria, Universiti degli Studi di Torino, Turin, Italy.

出版信息

Lancet Glob Health. 2015 Nov;3(11):e681-91. doi: 10.1016/S2214-109X(15)00163-1.

DOI:10.1016/S2214-109X(15)00163-1

PMID:26475015

Abstract

BACKGROUND

Charts of size at birth are used to assess the postnatal growth of preterm babies on the assumption that extrauterine growth should mimic that in the uterus.

METHODS

The INTERGROWTH-21(st) Project assessed fetal, newborn, and postnatal growth in eight geographically defined populations, in which maternal health care and nutritional needs were met. From these populations, the Fetal Growth Longitudinal Study selected low-risk women starting antenatal care before 14 weeks' gestation and monitored fetal growth by ultrasonography. All preterm births from this cohort were eligible for the Preterm Postnatal Follow-up Study, which included standardised anthropometric measurements, feeding practices based on breastfeeding, and data on morbidity, treatments, and development. To construct the preterm postnatal growth standards, we selected all live singletons born between 26 and before 37 weeks' gestation without congenital malformations, fetal growth restriction, or severe postnatal morbidity. We did analyses with second-degree fractional polynomial regression models in a multilevel framework accounting for repeated measures. Fetal and neonatal data were pooled from study sites and stratified by postmenstrual age. For neonates, boys and girls were assessed separately.

FINDINGS

From 4607 women enrolled in the study, there were 224 preterm singleton births, of which 201 (90%) were enrolled in the Preterm Postnatal Follow-up Study. Variance component analysis showed that only 0·2% and 4·0% of the total variability in postnatal length and head circumference, respectively, could be attributed to between-site differences, justifying pooling the data from all study sites. Preterm growth patterns differed from those for babies in the INTERGROWTH-21(st) Newborn Size Standards. They overlapped with the WHO Child Growth Standards for term babies by 64 weeks' postmenstrual age.

INTERPRETATION

Our data have yielded standards for postnatal growth in preterm infants. These standards should be used for the assessment of preterm infants until 64 weeks' postmenstrual age, after which the WHO Child Growth Standards are appropriate. Size-at-birth charts should not be used to measure postnatal growth of preterm infants.

FUNDING

Bill & Melinda Gates Foundation.

摘要

背景

出生体重图表用于评估早产儿的产后生长，假设宫外生长应与子宫内生长相似。

方法

INTERGROWTH-21st 项目评估了八个地理定义的人群中的胎儿、新生儿和产后生长，这些人群的母婴保健和营养需求得到满足。从这些人群中，胎儿生长纵向研究选择了在 14 周妊娠前开始产前保健的低风险妇女，并通过超声监测胎儿生长。该队列中的所有早产儿都有资格参加早产儿产后随访研究，该研究包括标准化的人体测量、基于母乳喂养的喂养实践以及发病率、治疗和发育数据。为了构建早产儿产后生长标准，我们选择了所有在 26 至 37 周妊娠之间出生且无先天性畸形、胎儿生长受限或严重产后发病率的活单胎。我们使用二阶分数多项式回归模型在多层次框架中进行了分析，考虑了重复测量。胎儿和新生儿数据来自研究地点，并按胎龄分层。对于新生儿，男孩和女孩分别进行评估。

结果

在 4607 名参加该研究的妇女中，有 224 名早产儿单胎分娩，其中 201 名（90%）参加了早产儿产后随访研究。方差分量分析表明，出生后长度和头围的总变异性中只有 0.2%和 4.0%可归因于地点间差异，因此可以合并所有研究地点的数据。早产儿的生长模式与 INTERGROWTH-21st 新生儿大小标准中的婴儿不同。在胎龄 64 周后，它们与世界卫生组织儿童生长标准中的足月婴儿重叠。