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极低出生体重早产儿24个月内的生长情况,无论有无宫内或出生后生长受限

[Growth until 24 months in preterm of very low birth weight, with or without intrauterine or postnatal growth restriction].

作者信息

Mena Nannig Patricia, Vernal Silva Patricia, Díaz Gonzalez Alexis, Henríquez Höfter María Teresa, Pittaluga Pierdiluca Enrica, D'Apremont Ormeño Ivonne, Morgues Nudman Mónica, Standen Herliz Jane, de Toro Navarrete Valeria

机构信息

Hospital Sotero del Río, Santiago, Chile.

Hospital San José, Santiago, Chile.

出版信息

Andes Pediatr. 2022 Feb;93(1):27-36. doi: 10.32641/andespediatr.v93i1.3600. Epub 2021 Nov 30.

Abstract

INTRODUCTION

The growth of preterm newborns can be affected during the fetal period, hospitalization, and post discharge.

OBJECTIVE

to describe the anthropometric development of preterm newborns with or without intrauterine and postnatal growth restriction, and with or without recovery at 40 weeks from birth to 24 months of age.

PATIENTS AND METHOD

Retrospective, descriptive study with Z-scores (Fen ton and WHO) of weight, length, head circumference, and weight/length of preterm infants of less than 32 weeks of gestational age at birth up to 24 months of corrected age. 4 groups were defined ac cording to prenatal, postnatal, post-discharge growth as follows: Group AAA: newborns born AGA, with no postnatal growth restriction; Group APA: newborns born AGA, with postnatal growth res triction, weight < p10 at discharge, and weight > p10 at 40 weeks; Group APP: newborns born AGA, with postnatal growth restriction, weight < p10 at discharge and at 40w; and Group PPP: newborns born with intrauterine growth restriction and who maintained postnatal growth restriction (< p10 at birth, at discharge, and at 40w). We used descriptive statistics with ANOVA, Chi-squared, and linear mixed model analysis.

RESULTS

710 preterm newborns were included, birth weight 1272 grams (SD 360) and gestational age 29 weeks (SD 1.9). Group AAA had weight, length, and head circumference Z-scores close to the median until 2 years of age. AGA preterm newborns and with postnatal growth restriction can evolve in two ways: one group presents recovery at 40 weeks (Group APA) while the other group presents weight Z-score < -1 up to 6 months (Group APP). Group PPP (with intraute rine and postnatal growth restriction) presents slow weight and length Z-score recovery, weight Z- score -2.3 at discharge, and slow improvement to < -1 at 2 years of age. All groups had weight/height Z-scores above the median in the first 2 months of corrected age.

CONCLUSION

Preterm newborns with good fetal growth but restricted postnatal growth, may recover at 40 weeks, with subsequent normal development or recover at 6 months.

摘要

引言

早产新生儿的生长在胎儿期、住院期间及出院后都可能受到影响。

目的

描述有或没有宫内及出生后生长受限、出生后40周(从出生到24月龄)有或没有恢复的早产新生儿的人体测量学发育情况。

患者与方法

一项回顾性描述性研究,对出生时胎龄小于32周的早产婴儿,直至矫正年龄24个月时的体重、身长、头围及体重/身长的Z评分(芬顿和世界卫生组织标准)进行分析。根据产前、产后、出院后生长情况定义了4组:AAA组:适于胎龄出生的新生儿,无出生后生长受限;APA组:适于胎龄出生的新生儿,有出生后生长受限,出院时体重<第10百分位数,40周时体重>第10百分位数;APP组:适于胎龄出生的新生儿,有出生后生长受限,出院时及40周时体重均<第10百分位数;PPP组:有宫内生长受限且出生后持续生长受限(出生时、出院时及40周时体重均<第10百分位数)。我们使用描述性统计方法,并进行方差分析、卡方检验及线性混合模型分析。

结果

纳入710名早产新生儿,出生体重1272克(标准差360),胎龄29周(标准差1.9)。AAA组在2岁前体重、身长及头围的Z评分接近中位数。适于胎龄出生且有出生后生长受限的早产新生儿有两种发育方式:一组在40周时恢复(APA组),而另一组在6个月时体重Z评分< -1(APP组)。PPP组(有宫内及出生后生长受限)体重和身长Z评分恢复缓慢,出院时体重Z评分为 -2.3,2岁时缓慢改善至< -1。所有组在矫正年龄的前2个月体重/身高Z评分均高于中位数。

结论

胎儿期生长良好但出生后生长受限的早产新生儿,可能在4周时恢复,随后正常发育,或在6个月时恢复。

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