小胎龄儿对极早产儿中单胎儿和足月儿结局的影响：一项日本队列研究。
Small for Gestational Age Affects Outcomes on Singletons and Inborn Births in Extremely Preterm Infants: A Japanese Cohort Study.
机构信息
Department of pediatrics, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan.
Department of Advanced Medicine, Research and Development Center for New Medical Frontiers, Kanagawa, Japan.
出版信息
Am J Perinatol. 2024 May;41(S 01):e780-e787. doi: 10.1055/a-1933-4627. Epub 2022 Aug 30.
OBJECTIVE
This study aimed to compare the short- and long-term outcomes of extremely preterm small for gestational age (SGA) infants and appropriate for gestational age (AGA) infants in Japan.
STUDY DESIGN
We retrospectively assessed 434 SGA and 1,716 AGA infants born at 22 to 27 weeks of gestational age (GA) and examined their outcomes on singletons and inborn births between 2003 and 2012. Infants were followed-up for 3 years, and the clinical characteristics and outcomes were compared. Fisher's exact and Student's -tests were used for independent sample comparison. Logistic regression was used to identify associated factors.
RESULTS
The prevalence of intraventricular hemorrhage ≥ grade 3 was significantly lower (adjusted odds ratio [aOR]: 0.28; 95% confidence interval [CI]: 0.11 - 0.72), and the prevalence of bronchopulmonary dysplasia at 36 weeks of GA and the need for home oxygen therapy were significantly higher (aOR: 2.20; 95% CI: 1.66 - 2.91 and aOR: 2.46; 95% CI: 1.75-3.47, respectively) in SGA infants than in AGA infants. SGA infants born at 24 to 25 weeks of GA had a significantly higher prevalence of developmental quotient (DQ) < 70 (aOR: 1.73; 95% CI: 1.08 - 2.77). Those born at 26 to 27 weeks of GA showed a significantly higher prevalence of cerebral palsy (CP) and visual impairment (aOR: 2.31; 95% CI: 1.22 - 4.40 and aOR: 2.61; 95% CI: 1.21 - 5.61, respectively).
CONCLUSION
In SGA infants, birth at 24 to 25 weeks of GA is an independent risk factor for DQ < 70, and birth at 26 to 27 weeks of GA is an independent risk factor for CP and visual impairment. However, we did not consider nutritional and developmental factors, and a longer follow-up would help assess neurodevelopmental outcomes.
KEY POINTS
· SGA is a risk factor for poor outcomes.. · In SGA infants, birth at 25 to 26 weeks is a risk factor for low a DQ.. · In SGA infants, birth at 26 to 27 weeks is a risk factor for CP..
目的
本研究旨在比较日本极低出生体重儿（SGA）和适于胎龄儿（AGA）的短期和长期结局。
研究设计
我们回顾性评估了 2003 年至 2012 年间出生于 22 至 27 周胎龄的 434 例 SGA 和 1716 例 AGA 婴儿，并检查了单胎和内源性出生的结局。婴儿随访 3 年，比较临床特征和结局。采用 Fisher 确切概率法和学生 t 检验进行独立样本比较。采用 logistic 回归分析确定相关因素。
结果
SGA 组的脑室周围出血≥3 级的发生率显著降低（校正优势比[aOR]：0.28；95%置信区间[CI]：0.11-0.72），而 36 周 GA 支气管肺发育不良和家庭氧疗的发生率显著升高（aOR：2.20；95%CI：1.66-2.91 和 aOR：2.46；95%CI：1.75-3.47）。24 至 25 周 GA 出生的 SGA 婴儿的发育商（DQ）<70 的发生率显著升高（aOR：1.73；95%CI：1.08-2.77）。26 至 27 周 GA 出生的 SGA 婴儿脑瘫（CP）和视力障碍的发生率显著升高（aOR：2.31；95%CI：1.22-4.40 和 aOR：2.61；95%CI：1.21-5.61）。
结论
在 SGA 婴儿中，24 至 25 周 GA 出生是 DQ<70 的独立危险因素，而 26 至 27 周 GA 出生是 CP 和视力障碍的独立危险因素。然而，我们没有考虑营养和发育因素，更长时间的随访将有助于评估神经发育结局。
关键点
· SGA 是不良结局的危险因素。
· 在 SGA 婴儿中，25 至 26 周 GA 出生是 DQ 较低的危险因素。
· 在 SGA 婴儿中，26 至 27 周 GA 出生是 CP 的危险因素。
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