极低出生体重儿宫外生长发育迟缓危险因素的多中心研究  

Risk factors for extrauterine growth retardation in very low birth weight infants:a multicenter study

作　　者：无 于永慧[2] 

机构地区：[1]山东省多中心极低出生体重儿预后评估协作组 [2]山东大学附属省立医院新生儿科,济南250000

出　　处：《中华儿科杂志》2020年第8期653-660,共8页Chinese Journal of Pediatrics

基　　金：山东省重点研发计划(2018GSF118163);山东省医药卫生科技发展计划(2017WS009)。

摘　　要：目的分析极低出生体重儿(VLBWI)宫外生长发育迟缓(EUGR)的发生现状及危险因素。方法采用多中心前瞻性观察性队列研究,数据来源于协作组所建立的山东新生儿协作网,收集并分析2018年1月1日至12月31日山东省27家新生儿重症监护病房(NICU)收治的1051例VLBWI的临床资料。根据校正胎龄36周或出院时以体重评价是否发生EUGR分为EUGR组和非EUGR组,并采用单因素χ2检验或Fisher确切概率法、秩和检验和多因素Logistic回归模型,分别分析小于胎龄(SGA)和非SGA婴儿EUGR发生的危险因素。结果共纳入符合条件的VLBWI 1051例,其中男543例(51.7%),EUGR的发生率为60.7%(638/1051);超低出生体重儿(ELBWI)及超早产儿EUGR的发生率分别为78.3%(90/115)、46.9%(53/113);SGA、非SGA婴儿EUGR的发生率分别为87.6%(190/217)、53.7%(448/834)。多因素Logistic回归分析显示禁食时间(OR=1.531、1.237,95%CI:1.180~1.987、1.132~1.353,P均<0.01)及达全胃肠道喂养时间(OR=1.090、1.023,95%CI:1.017~1.167、1.002~1.045,P=0.014、0.034)是SGA与非SGA婴儿发生EUGR共同的独立危险因素;对于SGA婴儿,剖宫产出生(OR=8.147,95%CI:2.127~31.212,P=0.002)亦为EUGR发生的独立危险因素;对于非SGA婴儿,母亲妊娠期高血压疾病(OR=2.572,95%CI:1.496~4.421,P=0.001)及有创呼吸支持时间(OR=1.050,95%CI:1.009~1.092,P=0.016)为EUGR的独立危险因素;中重度支气管肺发育不良(OR=2.241,95%CI:1.173~4.281,P=0.015)、坏死性小肠结肠炎(OR=5.633,95%CI:1.333~23.796,P=0.019)及早产儿视网膜病(OR=2.219,95%CI:1.268~3.885,P=0.005)与EUGR的发生密切相关。结论VLBWI以体重评价EUGR的发生率仍较高,生后避免反复或长时间禁食,尽快实现全胃肠内喂养有望降低EUGR的发生风险。Objective To investigate the incidence and risk factors of extrauterine growth retardation(EUGR)in very low birth weight infants(VLBWI).Methods This prospective,multicenter observational cohort study was conducted based on Shandong Neonatal Network(SNN).The clinical data of the VLBWI(n=1051),who were admitted to 27 neonatal intensive care units from January 1,2018 to December 31,2018,were collected and analyzed.According to the weight at discharge or 36 weeks of postmenstrual age,all the enrolled VLBWI were assigned into EUGR group and non-EUGR group.Univariate and multivariate logistic regression analyses were used to detect the risk factors for EUGR in preterm small for gestational age(SGA)and non-SGA infants.Results A total of 1051 VLBWI were enrolled,with 51.7%(543/1051)male.The incidence of EUGR in the whole group was 60.7%(638/1051),and were 78.3%(90/115)and 46.9%(53/113)in extremely low birth weight infant(ELBWI)and extremely preterm infants(EPI),respectively.The incidence of EUGR in SGA and non-SGA infants were 87.6%(190/217)and 53.7%(448/834),respectively.Logistic regression analysis showed that,withholding feeds(OR=1.531,1.237,95%CI:1.180-1.987,1.132-1.353,both P<0.01)and time to achieve full enteral feeding(OR=1.090,1.023,95%CI:1.017-1.167,1.002-1.045,P=0.014,0.034)were independent risk factors of EUGR in both SGA and non-SGA infants.For SGA infants,cesarean delivery was an independent risk factor for EUGR(OR=8.147,95%CI:2.127-31.212,P=0.002);while for non-SGA infants,hypertensive disorders during pregnancy(OR=2.572,95%CI:1.496-4.421,P=0.001)and the duration of invasive ventilation(OR=1.050,95%CI:1.009-1.092,P=0.016)were independent risk factors of EUGR.Besides,moderate and severe bronchopulmonary dysplasia(OR=2.241,95%CI:1.173-4.281,P=0.015),necrotizing enterocolitis(OR=5.633,95%CI:1.333-23.796,P=0.019)and retinopathy of prematurity(OR=2.219,95%CI:1.268-3.885,P=0.005)were associated with EUGR.Conclusions The incidence of weight-defined EUGR is high in VLBWI,especially in preterm SGA infants.Avoiding d

关 键 词：婴儿 极低出生体重 宫外生长发育迟缓 危险因素 

分 类 号：R174[医药卫生—妇幼卫生保健]