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[不同孕周中国新生儿出生体重、身长和头围的生长标准曲线]

[Growth standard curves of birth weight, length and head circumference of Chinese newborns of different gestation].

出版信息

Zhonghua Er Ke Za Zhi. 2020 Sep 2;58(9):738-746. doi: 10.3760/cma.j.cn112140-20200316-00242.

Abstract

To study and formulate the growth standards for birth weight, length and head circumference of Chinese newborns of different gestation. A cross-sectional survey was carried out by the stratified cluster sampling method from June 2015 to November 2018 in 13 cities including Beijing, Harbin, Xi'an, Shanghai, Nanjing, Wuhan, Guangzhou, Fuzhou, Kunming, Tianjin, Shenyang, Changsha and Shenzhen. A total of 24 375 newborns with gestational age between 24 to 42 weeks were included. The standard percentile-curves of birth weight, length and head circumference for newborn boys and girls in gestational weeks 24 to 42 were established by the generalized additive model for location, scale and shape (GAMLSS). The new reference standard developed in this study was compared with the reference values of China in 1988 and the international Fenton 2013. Among the 24 375 newborns (13 197 males (54.1%),11 178 females (45.9%)), 12 264 were preterm infants and 12 111 were full term infants. The 3(rd), 10(th), 25(th), 50(th), 75(th), 90(th) and 97(th) percentile reference values and curves of birth weight, length and head circumference were obtained for male and female newborns from 24 to 42 gestation weeks. The data showed that birth weight, length and head circumference increased rapidly with the gestational age, but the growth velocity decreased slightly from 37 weeks. For example, the median birth weight for males at 28 weeks, 32 weeks, 37 weeks and 40 weeks was 1 154, 1 805, 2 943 and 3 455 g, respectively. The birth weight, length and head circumference of males at all gestational ages were 87-133 g, 0.2-0.9 cm and 0.3-0.6 cm higher than those of females, respectively. Compared with the percentile curves of birth weight of Chinese reference in 1988, there were significant differences regarding the percentile lines of males and females, especially the 10(th), 50(th), and 90(th) percentile values of birth weight were significantly higher than the reference values in 1988 from 37 to 42 gestation weeks. For example, the median birth weight at 40 weeks in the study was 115-242 g higher than that in 1988. Compared with the standard reference of Fenton 2013, the reference curve at 50(th) percentile of birth weight in this study was 13-81 g slightly higher than that of Fenton 2013 before 33 weeks, and then it was gradually lower than that of Fenton 2013 and the difference was 148-367 g at 41 to 42 weeks of gestation. The 10(th) percentile curve of Fenton 2013 was 11-64 g lower than that of this study in both males and females before 40 weeks. This study created a new national growth standard of birth weight, body length and head circumference for Chinese neonates at 24 to 42 weeks of gestation, which can be used for the growth and nutrition evaluation of newborns at birth and preterm infants in the early postnatal period. The 10(th) percentile and the 3(rd) percentile of growth standards could be suggested as the cut-off point for identifying small for gestational age and severe small for gestational age, respectively.

摘要

研究并制定不同孕周中国新生儿出生体重、身长和头围的生长标准。采用分层整群抽样方法,于2015年6月至2018年11月在包括北京、哈尔滨、西安、上海、南京、武汉、广州、福州、昆明、天津、沈阳、长沙和深圳在内的13个城市进行横断面调查。共纳入24375例孕周在24至42周之间的新生儿。通过位置、尺度和形状的广义相加模型(GAMLSS)建立了24至42孕周新生儿男、女出生体重、身长和头围的标准百分位数曲线。将本研究制定的新参考标准与1988年中国的参考值以及国际Fenton 2013标准进行比较。在这24375例新生儿中(男13197例(54.1%),女11178例(45.9%)),早产儿12264例,足月儿12111例。获得了24至42孕周男、女新生儿出生体重、身长和头围的第3、10、25、50、75、90和97百分位数参考值及曲线。数据显示,出生体重、身长和头围随孕周迅速增加,但从37周起生长速度略有下降。例如,28周、32周、37周和40周男性新生儿的出生体重中位数分别为1154、1805、2943和3455 g。各孕周男性的出生体重、身长和头围分别比女性高87 - 133 g、0.2 - 0.9 cm和0.3 - 0.6 cm。与1988年中国出生体重百分位数曲线相比,男、女百分位数线存在显著差异,尤其是37至42孕周时出生体重的第10、50和90百分位数显著高于1988年的参考值。例如,本研究中40周时的出生体重中位数比1988年高115 - 242 g。与Fenton 2013标准参考值相比,本研究中出生体重第50百分位数的参考曲线在33周前比Fenton 2013标准略高13 - 81 g,之后逐渐低于Fenton 2013标准,在41至42孕周时相差148 - 367 g。Fenton 2013标准的第10百分位数曲线在40周前男、女均比本研究低11 - 64 g。本研究建立了24至42孕周中国新生儿出生体重、身长和头围的新的全国生长标准,可用于出生时新生儿及出生后早期早产儿的生长和营养评估。生长标准的第10百分位数和第3百分位数可分别建议作为识别小于胎龄儿和严重小于胎龄儿的切点。

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