Arya Shreyas, Uzoma Amara, Robinson Aimee, Moreira Alvaro G, Jain Sunil K
Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, USA.
Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, USA.
Cureus. 2022 Nov 17;14(11):e31611. doi: 10.7759/cureus.31611. eCollection 2022 Nov.
Introduction The aim of our study was to assess the impact of intrauterine growth restriction (IUGR) and placental insufficiency (PI) on the nutritional outcomes of extremely low birth weight (ELBW) infants. Methods We conducted a six-year retrospective case-control study that included 117 ELBW infants. Of these, 58 infants had IUGR and 59 were born appropriate-for-gestational age (AGA). Infants with IUGR were further divided based on the presence or absence of PI, as determined by umbilical arterial doppler velocimetry on serial ultrasounds. Results IUGR infants with PI had the lowest enteral calorie intake at 28 days of life (DOL) (median intake- IUGR+PI: 32 vs IUGR-PI: 93 vs AGA: 110 kcal/kg/day; p-value 0.011) and at 36 weeks corrected gestational age (CGA) (median intake- IUGR+PI: 102 vs IUGR-PI: 125 vs AGA: 119 kcal/kg/day; p-value 0.012). These infants also trended towards requiring a longer duration of total parenteral nutrition (TPN) (median duration - IUGR+PI: 35 vs IUGR-PI: 25 vs AGA: 21 days; p-value 0.054) and higher incidence of conjugated hyperbilirubinemia (IUGR+PI: 43% IUGR-PI: 29% vs AGA: 16%; p-value 0.058), but these results did not reach statistical significance. Despite challenges with enteral nutrition, IUGR infants with PI showed good catch-up growth and had higher growth velocities over the first month of life, compared to AGA controls. Conclusion IUGR in the presence of PI is associated with significantly poorer enteral nutritional outcomes in ELBW infants. However, with the support of optimal parenteral nutrition these infants showed good catch-up growth.
引言 我们研究的目的是评估宫内生长受限（IUGR）和胎盘功能不全（PI）对极低出生体重（ELBW）婴儿营养结局的影响。方法 我们进行了一项为期六年的回顾性病例对照研究，纳入了117例ELBW婴儿。其中，58例婴儿患有IUGR，59例为适于胎龄（AGA）出生。根据连续超声检查脐动脉多普勒测速确定的PI存在与否，将患有IUGR的婴儿进一步分组。结果 患有PI的IUGR婴儿在出生后28天（DOL）时肠内热量摄入量最低（中位数摄入量 - IUGR+PI：32 vs IUGR-PI：93 vs AGA：110 kcal/kg/天；p值0.011），在矫正胎龄（CGA）36周时也是如此（中位数摄入量 - IUGR+PI：102 vs IUGR-PI：125 vs AGA：119 kcal/kg/天；p值0.012）。这些婴儿也倾向于需要更长时间的全胃肠外营养（TPN）（中位数持续时间 - IUGR+PI：35 vs IUGR-PI：25 vs AGA：21天；p值0.054）以及结合胆红素血症的发生率更高（IUGR+PI：43%，IUGR-PI：29%，vs AGA：16%；p值0.058），但这些结果未达到统计学显著性。尽管肠内营养存在挑战，但与AGA对照组相比，患有PI的IUGR婴儿在出生后的第一个月显示出良好的追赶生长，并且生长速度更快。结论 存在PI的IUGR与ELBW婴儿明显较差的肠内营养结局相关。然而，在最佳肠外营养的支持下，这些婴儿显示出良好的追赶生长。
