Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361003, Fujian, China.
Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, 361003, Fujian, China.
BMC Pediatr. 2023 Aug 31;23(1):437. doi: 10.1186/s12887-023-04245-1.
To analyze the real-world growth pattern of very premature infants (VPI) with small for gestational age (SGA) after birth by using the ΔZ value of weight at discharge.
The clinical data were collected from 28 hospitals in China from September 2019 to December 2020. They were divided into the EUGR(Extrauterine Growth Restriction) and the non-EUGR group according to the criterion of ΔZ value of weight at discharge < -1.28.
This study included 133 eligible VPI with SGA. Following the criterion of ΔZ value, the incidence of EUGR was 36.84% (49/133). The birth weight, the 5-min Apgar score, and the proportion of male infants in the EUGR group were lower (P < 0.05). The average invasive ventilation time, cumulative duration of the administration of antibiotics, blood transfusion time, blood transfusion ratio, and total days of hospitalization were significantly higher in the EUGR group (P < 0.05). In the EUGR group, several factors exhibited higher values (P < 0.05), including the initiation of enteral feeding, the volume of milk supplemented with human milk fortifier (HMF), the duration to achieve complete fortification, the cumulative duration of fasting, the duration to achieve full enteral feeding, the length of parenteral nutrition (PN), the number of days required to attain the desired total calorie intake and oral calorie intake, as well as the age at which birth weight was regained. The average weight growth velocity (GV) was significantly lower in the EUGR group (P < 0.001). The incidences of patent ductus arteriosus with hemodynamic changes (hsPDA), neonatal necrotizing enterocolitis (NEC) stage≥ 2, late-onset sepsis (LOS), and feeding intolerance (FI) in the EUGR group were higher (P < 0.05). Multivariate logistic regression analysis showed that birth weight, male, and GV were the protective factors, while a long time to achieve full-dose fortification, slow recovery of birth weight, and NEC stage ≥2 were the independent risk factors.
SGA in VPI can reflect the occurrence of EUGR more accurately by using the ΔZ value of weight at discharge. Enhancing enteral nutrition support, achieving prompt and complete fortification of breast milk, promoting greater GV, reducing the duration of birth weight recovery, and minimizing the risk of NEC can contribute to a decreased occurrence of EUGR.
CHICTR, ChiCTR1900023418. Registered 26/05/2019, http://www.chictr.org.cn .
通过使用出院时体重的 ΔZ 值分析小于胎龄儿（SGA）极早产儿（VPI）的真实生长模式。
本研究收集了 2019 年 9 月至 2020 年 12 月中国 28 家医院的临床数据，根据出院时体重的 ΔZ 值< -1.28 将其分为宫外生长受限（EUGR）组和非 EUGR 组。
本研究纳入 133 例符合条件的 SGA 极早产儿。根据 ΔZ 值，EUGR 的发生率为 36.84%（49/133）。EUGR 组的出生体重、5 分钟 Apgar 评分和男婴比例较低（P<0.05）。EUGR 组的有创通气时间、抗生素累计使用时间、输血时间、输血比例和总住院天数均明显较高（P<0.05）。EUGR 组中，开始肠内喂养、添加人乳强化剂（HMF）的奶量、达到完全强化的时间、禁食时间、达到完全肠内喂养的时间、肠外营养（PN）时间、达到目标总热量和口服热量的天数、恢复出生体重的年龄等因素均较高（P<0.05）。EUGR 组的平均体重增长速度（GV）明显较低（P<0.001）。EUGR 组中，有创动脉导管未闭伴血流动力学改变（hsPDA）、新生儿坏死性小肠结肠炎（NEC）≥2 期、晚发性败血症（LOS）和喂养不耐受（FI）的发生率较高（P<0.05）。多因素 logistic 回归分析显示，出生体重、男性和 GV 是保护因素，而完全强化时间长、出生体重恢复缓慢、NEC 期≥2 是独立危险因素。
使用出院时体重的 ΔZ 值可以更准确地反映 VPI 中 SGA 的 EUGR 发生情况。加强肠内营养支持，尽快完成母乳强化，促进更大的 GV，减少出生体重恢复时间，降低 NEC 风险，有助于降低 EUGR 的发生。
CHICTR，ChiCTR1900023418。注册于 2019 年 5 月 26 日，网址：www.chictr.org.cn。
