Department of Epidemiology, University of Iowa, Iowa City, IA, United States of America.
Department of Biostatistics, University of Iowa, Iowa City, IA, United States of America.
PLoS One. 2021 Jan 28;16(1):e0245387. doi: 10.1371/journal.pone.0245387. eCollection 2021.
A growing amount of evidence indicates in utero and early life growth has profound, long-term consequences for an individual's health throughout the life course; however, there is limited data in preterm infants, a vulnerable population at risk for growth abnormalities.
To address the gap in knowledge concerning early growth and its determinants in preterm infants.
A retrospective cohort study was performed using a population of preterm (< 37 weeks gestation) infants obtained from an electronic medical record database. Weight z-scores were acquired from discharge until roughly two years corrected age. Linear mixed effects modeling, with random slopes and intercepts, was employed to estimate growth trajectories.
Thirteen variables, including maternal race, hypertension during pregnancy, preeclampsia, first trimester body mass index, multiple status, gestational age, birth weight, birth length, head circumference, year of birth, length of birth hospitalization stay, total parenteral nutrition, and dextrose treatment, were significantly associated with growth rates of preterm infants in univariate analyses. A small percentage (1.32% - 2.07%) of the variation in the growth of preterm infants can be explained in a joint model of these perinatal factors. In extremely preterm infants, additional variation in growth trajectories can be explained by conditions whose risk differs by degree of prematurity. Specifically, infants with periventricular leukomalacia or retinopathy of prematurity experienced decelerated rates of growth compared to infants without such conditions.
Factors found to influence growth over time in children born at term also affect growth of preterm infants. The strength of association and the magnitude of the effect varied by gestational age, revealing that significant heterogeneity in growth and its determinants exists within the preterm population.
越来越多的证据表明，子宫内和生命早期的生长对个体整个生命过程中的健康有着深远的、长期的影响；然而，在早产儿这一脆弱人群中，与生长异常相关的数据十分有限。
针对早产儿早期生长及其决定因素方面的知识空白进行研究。
本研究采用回顾性队列研究，使用电子病历数据库中的早产儿（<37 孕周）人群数据。从出院到大约两岁的校正年龄，获取体重 z 评分。采用具有随机斜率和截距的线性混合效应模型来估计生长轨迹。
在单变量分析中，13 个变量，包括母亲种族、孕期高血压、子痫前期、孕早期体重指数、多胎妊娠、胎龄、出生体重、出生身长、头围、出生年份、住院分娩时长、全胃肠外营养和葡萄糖治疗，与早产儿的生长速度显著相关。这些围产期因素的联合模型可以解释早产儿生长变异的一小部分（1.32%-2.07%）。在极早产儿中，通过风险程度不同的疾病，可以进一步解释生长轨迹的差异。具体来说，患有脑室周围白质软化或早产儿视网膜病变的婴儿与无此类疾病的婴儿相比，生长速度较慢。
在足月出生的儿童中，随着时间的推移影响生长的因素也会影响早产儿的生长。关联的强度和影响的大小因胎龄而异，这表明早产儿人群的生长及其决定因素存在显著的异质性。
