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出生体重低于1500克新生儿的宫外生长受限

[Extrauterine growth restriction among neonates with a birthweight less than 1,500grams].

作者信息

Avila-Alvarez Alejandro, Solar Boga Alfonso, Bermúdez-Hormigo Carmen, Fuentes Carballal Jesús

机构信息

Unidad de Neonatología, Servicio de Pediatría. Complexo Hospitalario Universitario de A Coruña, Sergas, A Coruña, España; Departamento de Pediatría, Universidade de Santiago de Compostela, Santiago de Compostela, España.

Unidad de Gastroenterología, Hepatología y Nutrición pediátrica, Servicio de Pediatría, Complexo Hospitalario Universitario de A Coruña, Sergas, A Coruña, España; Departamento de Pediatría, Universidade de Santiago de Compostela, Santiago de Compostela, España.

出版信息

An Pediatr (Engl Ed). 2018 Dec;89(6):325-332. doi: 10.1016/j.anpedi.2018.02.004. Epub 2018 Apr 9.

Abstract

INTRODUCTION

Growth restriction in preterm infants has been related to a poor neurodevelopment outcome.

OBJECTIVES

To define the incidence of postnatal growth restriction in premature babies ≤1,500 grams and to detect related clinical or biochemical markers.

METHODS

Retrospective longitudinal observational study. Multivariate linear regression models were used to determine variables that can predict the change in weight z-score during admission.

RESULTS

The study included 130 patients with a mean birthweight of 1,161±251grams and a gestational age of 29.9±2.5 weeks. At hospital discharge, 59.2% had a weight below P10.During admission, the z-scores of weight and length decreased by -0.85±0.79 and -1.09±0.65, respectively.The largest decrease in z-score occurred during NICU admission, with a weight gain rate of 6.6±8.8g/Kg/day, after which growth acceleration took place (16.7±3.8g/Kg/day), but was insufficient to catch-up.Higher levels of urea were negatively correlated with the change in the z-score of weight (P<.001), and a weight <P10 at birth positively correlated (P=.013).

CONCLUSIONS

More than half of newborns ≤1,500 grams have a weight at discharge of <P10. This growth restriction occurs during NICU admission, and affects low birth weight infants less frequently.Urea levels correlate negatively with weight gain, which requires further study of the relationship between growth and the protein compartment.

摘要

引言

早产儿生长受限与不良的神经发育结局相关。

目的

确定出生体重≤1500克的早产儿出生后生长受限的发生率,并检测相关的临床或生化标志物。

方法

回顾性纵向观察研究。采用多变量线性回归模型确定可预测住院期间体重z评分变化的变量。

结果

该研究纳入了130例患者,平均出生体重为1161±251克,胎龄为29.9±2.5周。出院时,59.2%的患者体重低于第10百分位数。住院期间,体重和身长的z评分分别下降了-0.85±0.79和-1.09±0.65。z评分下降幅度最大发生在新生儿重症监护病房(NICU)住院期间,体重增加率为6.6±8.8克/千克/天,此后生长加速(16.7±3.8克/千克/天),但不足以实现追赶生长。较高的尿素水平与体重z评分的变化呈负相关(P<0.001),出生时体重<第10百分位数呈正相关(P=0.013)。

结论

超过一半的出生体重≤1500克的新生儿出院时体重<第10百分位数。这种生长受限发生在NICU住院期间,对低出生体重儿的影响较小。尿素水平与体重增加呈负相关,这需要进一步研究生长与蛋白质代谢之间的关系。

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