早产儿出院后追赶生长的随访观察及宫外发育迟缓的影响因素  

Follow-up observation of catch-up growth of preterm infants after discharge and risk factors for extrauterine growth retardation

作　　者：高晓燕[1] 冯琳[1] 许靖[1] 潘新年[1] GAO Xiao- Yan;FENG Lin;XU Jing;PAN Xin-Nian.(Department of Neonatology, Maternal and Child Health Care Hospital of Guangxi Zhuang Autonomous Region, Nanning 530000, Chin)

机构地区：[1]广西壮族自治区妇幼保健院新生儿科,广西南宁530000

出　　处：《中国当代儿科杂志》2018年第6期438-443,共6页Chinese Journal of Contemporary Pediatrics

基　　金：广西壮族自治区卫生与计划生育委员会自筹经费科研课题(Z2016087)

摘　　要：目的研究早产儿纠正月龄6个月内追赶生长的情况,并分析宫外发育迟缓(EUGR)的影响因素。方法选取在新生儿重症监护病房治疗后出院的,并建立序贯化定期随访档案且有完整随访记录的早产儿321例,按2015年"早产儿保健工作规范"出院后分组随访标准分为低危早产儿组(n=69)和高危早产儿组(n=252)。采用Z评分法对体重、身长和头围进行评估,分析早产儿纠正月龄6个月内追赶生长情况。并采用多因素logistic回归分析探讨6月龄EUGR发生的危险因素。结果低危组和高危组两组早产儿体重、身长和头围的Z值<?-2(未达追赶生长)的百分比均随纠正月龄增加而逐渐下降,其中低危组早产儿纠正月龄6个月时体重、身长和头围未达追赶生长的比例分别降为1.4%(1/69)、2.9%(2/69)和?1.4%(1/69),高危组早产儿相应的比例为1.2%(3/252)、1.6%(4/252)和3.6%(9/252)。高危组纠正6月龄EUGR发生率高于低危组(28.2%?vs?15.9%,P=0.039)。多因素logistic回归分析显示,早产儿纠正6月龄EUGR的危险因素包括多胎(OR=2.68,P=0.010)、出生体重较低(<1?000?g:OR=14.84,P<0.001;1?000~1?499?g:OR=2.85,P=0.005)、宫内发育迟缓(OR=11.41,P<0.001),而出生后营养强化可降低EUGR的风险(OR=0.25,P<0.001)。结论早产儿多可在纠正月龄6个月内达追赶生长;高危早产儿6月龄EUGR发生率较高;多胎、低出生体重、宫内发育迟缓为早产儿EUGR的危险因素,而出生后合理营养强化可降低早产儿EUGR的发生。Objective To investigate the catch-up growth of preterm infants within a corrected age of 6 months and the risk factors for extrauterine growth retardation（EUGR）. Methods A total of 321 preterm infants who were discharged after treatment in the neonatal intensive care unit and had regular follow-up documents with complete followup records were enrolled. According to the Prenatal Health Care Norms in 2015, these infants were divided into low-risk group with 69 infants and high-risk group with 252 infants. The Z-score method was used to evaluate body weight, body length, and head circumference, and the catch-up growth of the preterm infants within a corrected age of 6 months was analyzed. A multivariate logistic regression analysis was performed to identify the risk factors for EUGR at the corrected age of 6 months. Results The percentage of preterm infants with Z scores of body weight, body length, and head circumference of 〈-2（not reach the standard for catch-up growth） in both groups decreased gradually with increasing corrected age. At the corrected age of 6 months, the percentages of preterm infants whose body weight, body length, and head circumference did not reach the standard for catch-up growth in the low-risk group were reduced to 1.4%（1/69）, 2.9%（2/69）, and 1.4%（1/69） respectively, while in the high-risk group, these percentages were reduced to 1.2%（3/252）, 1.6%（4/252）, and 3.6%（9/252） respectively. The high-risk group had a significantly higher incidence rate of EUGR atthe corrected age of 6 months than the low-risk group（28.2% vs 15.9%, P=0.039）. The multivariate logistic regression analysis showed that multiple birth（OR=2.68, P=0.010）, low birth weight（〈1 000 g： OR=14.84, P〈0.001; 1 000-1 499 g： OR=2.85, P=0.005）, and intrauterine growth retardation（IUGR）（OR=11.41, P〈0.001） were risk factors for EUGR at the corrected age of 6 months, while nutritional enhancement after birth（OR=0.25, P〈0.001） reduced the risk of EUGR. Conclusions M

关 键 词：追赶生长 Z评分 宫外发育迟缓 危险因素 早产儿 

分 类 号：R722.6[医药卫生—儿科]