Yau K I, Chang M H
Department of Pediatrics, College of Medicine, National Taiwan University, Taipei, ROC.
Early Hum Dev. 1993 Jun;33(2):117-31. doi: 10.1016/0378-3782(93)90207-b.
In order to understand the nutritional status of preterm, small-for-gestational-age (SGA) infants in the early postnatal period, the growth and body composition of preterm, SGA infants was followed prospectively from birth to the postmenstrual age of 37-40 weeks. The infants were stratified into different groups by gestational age, clinical condition and body proportionality. In each subgroup, the growth and changes in body composition of SGA infants were compared with appropriate-for-gestational-age (AGA) infants of a comparable postmenstrual age. At birth, the SGA infants of both the 31-33 and 34-36 week gestational-age groups were smaller than AGA infants in all body measurements, including arm area (AA), arm muscle area (AMA) and arm fat area (AFA). When the preterm SGA infants had grown to the postmenstrual age of 37-40 weeks, the amount of fat they had accumulated was as much as, or more than that in term AGA infants. Yet, they had less muscle mass and their body weight, body length and head circumference were less than those in term AGA infants. This pattern of growth and the changes in body composition had been persistently observed in SGA infants of different gestational-age groups, different clinical status and different body proportionality. Differences between postnatal enteral nutrition and placental nutrition, or different energy utilization, in preterm SGA infants are hypothesized to account for these observations. The growth of less mature (31-33 weeks gestation) SGA infants and those preterm SGA infants with an eventful clinical course was suboptimal as compared with other SGA infants in the same subgroup. In this study, the weight to length ratio (WLR) was used to define the status of nutrition in preterm SGA infants: WLR < or = 2 S.D. or > 2 S.D. off the reference mean. Infants in both groups showed some catch-up growth in body weight. Yet, at near-term their body weight were still more than 2 S.D. below the mean of term AGA. In each gestational-age group, the growth of these two body-proportionality groups did not differ from each other except for the low WLR group of 34-36 weeks gestation which had a significantly lower body weight and skinfold thickness than the group with a normal WLR. Multiple regression analysis revealed that skinfold measurements of preterm SGA infants at birth is the best factor for determining the body weight gain at near-term. After use of the skinfold thickness was set aside, WLR became the most important factor.(ABSTRACT TRUNCATED AT 400 WORDS)
为了解早产、小于胎龄（SGA）婴儿出生后早期的营养状况，对早产SGA婴儿从出生到孕龄37 - 40周的生长及身体成分进行了前瞻性跟踪研究。根据孕龄、临床状况和身体比例将婴儿分为不同组。在每个亚组中，将SGA婴儿的生长及身体成分变化与孕龄相当的适于胎龄（AGA）婴儿进行比较。出生时，孕龄为31 - 33周和34 - 36周组的SGA婴儿在所有身体测量指标上，包括臂围（AA）、臂肌围（AMA）和臂脂围（AFA），均小于AGA婴儿。当早产SGA婴儿生长至孕龄37 - 40周时，他们积累的脂肪量与足月AGA婴儿相当或更多。然而，他们的肌肉量较少，体重、身长和头围均小于足月AGA婴儿。不同孕龄组、不同临床状况和不同身体比例的SGA婴儿均持续观察到这种生长模式及身体成分变化。推测早产SGA婴儿出生后肠内营养与胎盘营养的差异或不同的能量利用可解释这些观察结果。与同一亚组中的其他SGA婴儿相比，孕龄较小（31 - 33周）的SGA婴儿以及临床过程复杂的早产SGA婴儿生长欠佳。在本研究中，体重身长比（WLR）用于定义早产SGA婴儿的营养状况：WLR低于或高于参考均值2个标准差。两组婴儿体重均有一定追赶生长。然而，接近足月时，他们的体重仍比足月AGA婴儿均值低2个标准差以上。在每个孕龄组中，除了孕龄34 - 36周的低WLR组体重和皮褶厚度明显低于正常WLR组外，这两个身体比例组的生长情况并无差异。多元回归分析显示，早产SGA婴儿出生时的皮褶测量值是确定接近足月时体重增加的最佳因素。排除皮褶厚度因素后，WLR成为最重要的因素。（摘要截选至400字）
