宫外生长迟缓极早早产儿近远期生长与营养状况研究  

A research on the short-and long-term growth trend and nutritional status of very preterm infants with extrauterine growth restriction

作　　者：徐文英[1] 李敏[1] 陈丹丹 张丽[1] 黄蓓[1] 王悦 殷灏凌 王玉美[1] Xu Wenying;Li Min;Chen Dandan;Zhang Li;Huang Bei;Wang Yue;Yin Haoling;Wang Yumei(Child Care Division,Huaian Maternity and Child Healthcare Hospital Affiliated to Yangzhou University Medical College,Huaian 223002,China)

机构地区：[1]扬州大学医学院附属淮安市妇幼保健院儿童保健科,223002

出　　处：《中华临床营养杂志》2021年第4期218-225,共8页Chinese Journal of Clinical Nutrition

基　　金：江苏省妇幼健康科研项目(201507);江苏省青年医学重点人才培养项目(QNRC2016440)。

摘　　要：目的追踪研究宫外生长迟缓极早早产儿(出生胎龄28~31+周,very preterm infants,VPI)生后至学龄前期(48月龄)的生长趋势及营养状况。方法纳入2015年1月1日至12月31日江苏省淮安市妇幼保健院出生、新生儿科存活出院、儿童保健科多学科协作诊疗管理至学龄前期的VPI,根据新生儿科出院时是否诊断宫外生长迟缓(extrauterine growth restriction,EUGR)进行分组,统计EUGR组和对照组40周龄、纠正月龄1~6个月、纠正月龄24个月、48月龄时体重、身长/身高、头围的Z评分值(weight for age Z score,WAZ;height for age Z score,HAZ;head circumference for age Z score,HCZ),并比较两组早产儿相应生长指标Z评分值的变化趋势以及48月龄时营养代谢指标的组间差异。结果(1)纳入符合标准的VPI共53例,其中男35例,女18例,EUGR组20例,对照组33组。EUGR组早产儿的出生胎龄、出生体质量、极低出生体重儿发生率、呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)发生率、支气管肺发育不良(broncho pulmonary dysplasia,BPD)发生率与对照组比较,差异有统计学意义(χ^(2)=2.306、3.543、10.852、9.515、0.001,P<0.05)。(2)EUGR组各观察时间点的WAZ、HAZ均低于对照组,40周龄WAZ、纠正月龄3个月HAZ的组间比较,差异有统计学意义(P<0.05);40周龄至纠正月龄2个月和纠正月龄6个月至24个月,两组早产儿的WAZ、HAZ、HCZ均呈上升趋势,而纠正月龄24个月至48月龄,EUGR组的WAZ和非EUGR组的WAZ、HAZ均呈下降趋势。(3)EUGR组早产儿不同观察时间点相应体格生长指标的生长迟缓发生率与对照组比较,差异均无统计学意义(P>0.05)。(4)EUGR组早产儿48月龄的各项营养代谢指标水平与对照组比较,差异均无统计学意义(P>0.05)。结论低出生胎龄、低出生体质量、NRDS和BPD是EUGR发生的危险因素。合并EUGR的VPI出院后至纠正月龄24个月整体呈上升的生长趋势,48月龄时的营养代谢状况良好,但纠Objective To monitor and investigate the long-term growth trend and nutritional status of very preterm infants(VPIs,born at gestational age between[28~31+]weeks)with extrauterine growth restriction(EUGR)from birth to preschool period.Methods VPIs who met with the following criteria were enrolled:infants born in Huai'an Maternity and Child Heath Care Hospital from January 1 to December 31,2015;infants admitted to the Neonatal Medical Center and discharged alive;infants who received multi-disciplinary treatment in Child Care Division from discharge to preschool period.All of the VPIs were divided into the EUGR group and the non-EUGR group according to whether the weight at hospital discharge was below the 10th percentile for corrected age in body weight.The weight for age Z score(WAZ),height for age Z score(HAZ),and head circumference for age Z score(HCZ)were calculated at each specified time point(at 40 weeks of age;at 1,2,3,4,5,6 and 24 months of corrected age;and at 48 months of age).The growth trend and the nutritional status at 48 months of age were compared between the two groups.Results 1.A total of 53 VPIs were enrolled,among whom 35 cases were boys and 20 cases were with EUGR.The differences in the gestational age,birth weight,incidence of very low birth weight infants,neonatal respiratory distress syndrome(NRDS)and bronchopulmonary dysplasia(BPD)were all statistically significant between the EUGR group and the control group(χ^(2)=2.306,3.543,10.852,9.515,0.001,respectively;all P<0.05).2.The WAZ and HAZ of the EUGR group were lower at each time point.The WAZ at 40 weeks of age and the HAZ at 3 months of corrected age were significantly different between the two groups.From 40 weeks of age to 2 months of corrected age and from 6 months to 24 months of corrected age,the WAZ,HAZ and HCZ in both groups showed an increasing trend.However,the WAZ in the EUGR group and the WAZ,HAZ and HCZ in the non-EUGR group showed a declining trend from 24 months of corrected age to 48 months of age.3.There was no significant

关 键 词：极早早产儿 宫外生长迟缓 生长趋势 Z评分值 多学科诊疗 

分 类 号：R722.6[医药卫生—儿科]