中晚期早产儿宫外生长发育迟缓的危险因素分析  

Risk factors for extranterine growth retardation in moderate and late preterm infants

作　　者：王恋 林新祝 

机构地区：[1]厦门市妇幼保健院新生儿科,361000

出　　处：《中国小儿急救医学》2017年第12期912-915,920,共5页Chinese Pediatric Emergency Medicine

基　　金：2017年厦门市科技计划重大专项立案（3502220171006）

摘　　要：目的探讨中晚期早产儿出院时宫外生长发育迟缓（EUGR）的发生率及相关危险因素，为其预后及临床干预提供预警指标。方法单中心回顾性分析2016年1月1日至2016年12月31日入住我院NICU的607例中晚期早产儿（32周≤胎龄≤35^＋6周）的临床资料，根据出院时体重分为EUGR组（n=159）与非EUGR组（n=448），应用Logistic多因素回归分析EUGR发生的危险因素。结果出院时EUGR发生率为26．2％（159／607）。EUGR组发生宫内生长发育迟缓的比例明显高于非EUGR组（35．2％比1．1％，P〈0．001）；极低出生体重儿发生EUGR比例明显高于非极低出生体重儿（P〈0．001）。EUGR组早产儿禁食时间、达全肠内营养日龄、辅助通气时间、用氧时间、住院时间均明显大于非EUGR组（P〈0．001）。EUGR组早产儿的剖宫产、多胎、妊娠期高血压综合征、妊娠期肝内胆汁淤积、胎儿脐带异常的比例均显著高于非EUGR组（P〈0．05）。EUGR组早产儿的脓毒症、低白蛋白血症、贫血、早产儿视网膜疾病、早产儿脑损伤、辅助通气需求等发生率均显著高于非EUGR组（P〈0．05）。Logisitc回归分析显示，低出生体重（1500～2500g：OR=10．398，95％CI=2．459～43．972；〈1500g：OR=29．010，95％CI=2．873—292．944）、宫内生长发育迟缓（OR=35．952，95％CI=13．239—97．621）、多胎（OR=1．722，95％CI=1．005—2．952）、脐带异常（OR=2．038，95％CI=1．033—4．020）及住院时间长（2～3周：OR=1．934，95％CI=1．025～3．649；≥3周：OR=2．558，95％CI=1．209—5．411）均是EUGR发生的独立危险因素。结论中晚期早产儿EUGR的发生与多方面因素有关，加强围生保健工作，积极合理的营养支持，积极防治生后各种并发症，是降低中晚期早产儿EUGR发生的重要措施。Objective To study the incidence and risk factors for extrauterine growth retardation （EUGR） at discharge in moderate and late preterm infants. Methods A retrospective analysis was performed on 607 premature infants who were admitted to the neonatal intensive care unit between January lst,2016 and December 31st, 2016. These subjects were classified into EUGR （n = 159 ） and non-EUGR groups （ n = 448 ） based on the body weight at discharge. The risk factors for the occurrence of EUGR were studied by multivariate logistic regression analysis. Results Based on the body weight, the incidence of EUGR at discharge was 26. 2% （159/607）. The incidence of EUGR in intrauterine growth restriction （IUGR） infants was significantly higher than in non-IUGR infants （P 〈 0. 001 ）. The very low birth weight （VLBW） infants had a higher incidence of EUGR than non-VLBW infants （P 〈 0. 05 ）. Compared with the non-EUGR group, the fasting time, the age to achieve full enteral feeds, the length of mechanical ventilation, oxygen therapy and the length of hospital stays were significantly greater in the EUGR group （ P 〈 0. 05 ）. The percentages of caesarean section, multiple gestation, pregnancy-induced hypertension, intrahepatic chole- stasis of pregnancy and umbilical cord abnormality in the EUGR group were higher than in the non-EUGR group （ P 〈 0. 05 ）. The incidences of septicemia, hypoalbuminemia, anemia, retinopathy of premamrity, brain injury in premature infants and mechanical ventilation in the EUGR group were higher than in the non-EUGR group（ P 〈 0. 05 ）. The logistic regression analysis showed that birth weight, IUGR, multiple gestation, abnor- mality of umbilical cord and the length of hospital stays were the independent risk factors for EUGR. Conclu- sion The causes of EUGR are multi-factorial. To strengthen pregnancy care, aggressive and reasonable nutri- tional strategy, prevention and treatment of complications may facilitate to reduce the occurrence of EUGR.

关 键 词：早产儿 宫外生长发育迟缓 宫内生长发育迟缓 早产儿视网膜疾病 

分 类 号：R722.6[医药卫生—儿科]