早产极低出生体重儿宫外生长迟缓发生状况及其危险因素  

Incidence of extrauterine growth retardation and associated factors in very low birth weight preterm infants

作　　者：杨晓华[1] 黄越芳[1] 庄思齐[1] 张琼琼[2] 李晓瑜[1] 李易娟[1] 

机构地区：[1]中山大学附属第一医院儿科,广州510080 [2]济南市儿童医院新生儿科

出　　处：《中华围产医学杂志》2015年第2期87-93,共7页Chinese Journal of Perinatal Medicine

基　　金：广东省科技计划项目（2008B030301304）

摘　　要：目的 研究早产极低出生体重儿（very low birth weight infant,VLBWI）宫外生长迟缓（extrauterine growth retardation,EUGR）的发生状况,以及营养支持和疾病对EUGR的影响.方法 本研究为回顾性研究.收集2005年1月至2010年12月中山大学附属第一医院新生儿重症监护病房住院、出生胎龄＜34周的VLBWI的临床资料.根据出院时体重是否低于同胎龄胎儿宫内生长速率的第10百分位,分为EUGR组（67例）和非EUGR组（40例）.比较2组新生儿的围产期情况、生长发育和营养摄入情况以及并发症发生情况,分析VLBWI的EUGR发生状况及其影响因素.采用独立样本t检验、秩和检验、x2检验和Logistic多元回归分析进行统计学处理. 结果 共107例早产VLBWI存活至出院,EUGR发生率为62.6％（67/107）.小于胎龄儿EUGR发生率为86.0％（36/42）,明显高于适于胎龄儿的47.7％（31/65）,差异有统计学意义（x2=15.757,P＜0.01）.EUGR组平均出生胎龄小于非EUGR组[（30.0±2.1）周与（30.9±1.1）周,t=2.904,P=0.002],而母亲妊娠期高血压疾病的发生率明显高于非EUGR组[40.3％（27/67）与20.0％（8/40）,x2-4.689,P-0.030].EUGR组出生体重标准差得分（standard deviation score,SDS）、出院时体重SDS和体重增长速度均明显低于非EUGR组[出生体重SDS：（-1.9±0.8）与（-1.1±0.7）,t=5.418,P＜0.01;出院时体重SDS：-2.6（-3.0～-2.0）与-0.5（-0.9～-0.1）,U=30.271,P＜0.01;体重增长速度：（1 2.0±4.4）g/（kg·d）与（16.1±4.0）g/（kg·d）,t=1.879,P=0.036],而体重下降的最大程度和恢复出生体重的日龄均大于非EUGR组[分别为（13.2±1.7）％与（9.0±1.6）％,t=12.832,P＜0.01; （13.4±3.5）与（10.9±4.3）d,t=3.113,P=0.01].EUGR组达到全胃肠喂养日龄、蛋白质摄入量达3 g/（kg·d）口龄和热量达120 kcal/（kg·d）（l kcal=4.184kJ）日龄均大于非EUGR组[分别为（39.7±8.2）与（30.8±6.1）d,t=6.293,P=0.007;（21.4±5.8）与（17.5±1.3Objective To assess the incidence of extrauterine growth retardation （EUGR） in very low birth weight （VLBW） preterm infants and to evaluate the effects of nutritional support and morbidities on EUGR.Methods Data of VLBW preterm infants ＜ 34 weeks of gestation admitted to the Neonatal Intensive Care Unit （NICU） of the First Affiliated Hospital of Sun Yat-Sen University between January 1,2005 and December 31,2010 were reviewed.Those VLBW preterm infants were divided into the EUGR group （n=67） and the non-EUGR group （n=40）.Perinatal data,growth data,nutritional information and morbidities were compared between the two groups.The incidence of EUGR in VLBW preterm infants was assessed and the associated risk factors were analyzed.Independent samples t,Chi-square and rank sum tests and Logistic regression analysis were used for statistical analyses.Results A total of 107 VLBW infants survived to discharge.The average gestational age in the EUGR group was much lower than that in the non-EUGR group [（30.0±2.1） weeks vs （30.9 ± 1.1） weeks,t=2.904,P=0.002].However,the incidences of small for gestational age （SGA） and maternal hypertension in the EUGR group was higher than that in the non-EUGR group [SGA：53.7％ （36/67） vs 15.0％ （6/40）,x2=15.575,P ＜ 0.01; maternal hypertension：40.3％ （27/67） vs 20.0％ （8/40）,x2=4.689,P=0.030].Standard deviation score （SDS） of birth weight and weight at discharge in the EUGR group was lower than that in the non-EUGR group [SDS of birth weight：（--1.9±0.8） vs （--1.1±0.7）,t=5.418; weight at discharge：-2.6 （-3.0--2.0） vs-0.5 （-0.9--0.1）,U=30.271; both P ＜ 0.01].The velocity of weight gain in the EUGR group was lower than that in the non-EUGR group [（12.0±4.4） g/（kg · d） vs （16.1±4.0） g/（kg · d）,t=1.879,P=0.036],while the maximum percentage of weight loss and the age at maximum weight loss in the EUGR group was higher than that in the non-EUGR group [percentage of weight loss：（13.2±

关 键 词：婴儿 早产 婴儿 极低出生体重 婴儿 小于胎龄 营养支持 生长和发育 

分 类 号：R722.6[医药卫生—儿科]