根据不同生长图表评估极低出生体重儿宫外生长受限：一项回顾性 10 年观察研究。
Extrauterine growth restriction in very low birth weight infants according to different growth charts: A retrospective 10 years observational study.
机构信息
Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Neonatal Intensive Care Unit, Trieste, Italy.
Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Clinical Epidemiology and Public Health Research Unit, Trieste, Italy.
出版信息
PLoS One. 2023 Apr 20;18(4):e0283367. doi: 10.1371/journal.pone.0283367. eCollection 2023.
BACKGROUND
Extrauterine growth restriction (EUGR) is common among very low birth weight (VLBW) infants and associated with poor neurodevelopmental outcomes. There are two types of EUGR definitions (cross-sectional and longitudinal) and many growth charts for monitoring postnatal growth. Aims of our study were 1) to compare the rate of small for gestational rate (SGA) and EUGR in a population of VLBW infants, both according to different growth charts (Fenton, INeS charts and Intergrowth-21) and different definitions; 2) to identify risk factors for EUGR.
METHODS
This is a single centre retrospective observational study, including all VLBW infants born between January 2009 and December 2018. Anthropometric measures were obtained at birth and at discharge and presented as z-scores according to three growth charts (Fenton, INeS charts, Intergrowth-21). Maternal, clinical and nutritional data were retrieved from clinical records.
RESULTS
228 VLBW were included. Percentage of SGA did not change significantly according to the three different growth charts (Fenton 22.4%, INeS charts 22.8%, Intergrowth 28.2%, p 0.27). Prevalence of EUGR was significantly higher when INeS and Fenton charts were used, compared to Intergrowth charts regardless of EUGR-definition (cross sectional-EUGR: Fenton 33.5%, INeS charts 40.9%, Intergrowth-21 23.8%, p 0.001; longitudinal-EUGR (loss of 1SDS): Fenton 15%, INeS charts 20.4%, Intergrowth 4%, p <0.001). In our population a longer time to reach 100 ml/kg/day of enteral feeding increased of 18% the risk of longitudinal EUGR. Late onset sepsis and retinopathy of prematurity were associated with an increased risk of longitudinal EUGR, although not significantly, while having a preeclamptic mother was associated with a reduced risk.
CONCLUSIONS
We confirmed a wide variability of EUGR rates when using different charts and definitions, highlighting that Intergrowth-21 charts identify less EUGR when compared to INeS and Fenton charts. Standardized criteria for defining EUGR are warranted in order to facilitate comparisons between studies and to improve the nutritional management of VLBW infants.
背景
宫外生长受限（EUGR）在极低出生体重（VLBW）婴儿中很常见，与神经发育不良结局有关。EUGR 有两种定义（横断面和纵向）和许多监测产后生长的生长图表。我们研究的目的是 1）比较根据不同的生长图表（Fenton、INeS 图表和 Intergrowth-21）和不同的定义，VLBW 婴儿中 SGA 和 EUGR 的发生率；2）确定 EUGR 的危险因素。
方法
这是一项单中心回顾性观察研究，包括 2009 年 1 月至 2018 年 12 月期间出生的所有 VLBW 婴儿。在出生时和出院时获得人体测量指标，并根据三种生长图表（Fenton、INeS 图表、Intergrowth-21）以 z 分数表示。从临床记录中检索了母亲、临床和营养数据。
结果
共纳入 228 例 VLBW。根据三种不同的生长图表，SGA 的百分比没有明显变化（Fenton 22.4%、INeS 图表 22.8%、Intergrowth 28.2%，p 0.27）。当使用 INeS 和 Fenton 图表时，EUGR 的患病率明显高于 Intergrowth 图表，无论使用哪种 EUGR 定义（横断面 EUGR：Fenton 33.5%、INeS 图表 40.9%、Intergrowth-21 23.8%，p 0.001；纵向 EUGR（丢失 1SDS）：Fenton 15%、INeS 图表 20.4%、Intergrowth 4%，p <0.001）。在我们的人群中，达到 100ml/kg/天肠内喂养的时间延长增加了 18%发生纵向 EUGR 的风险。晚发性败血症和早产儿视网膜病变与纵向 EUGR 风险增加相关，但无统计学意义，而母亲患有子痫前期与 EUGR 风险降低相关。
结论
我们证实，使用不同的图表和定义时，EUGR 的发生率存在很大差异，这表明与 INeS 和 Fenton 图表相比，Intergrowth-21 图表可识别出较少的 EUGR。需要标准化的 EUGR 定义标准，以便于研究之间的比较，并改善 VLBW 婴儿的营养管理。
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