住院极早产儿宫外生长迟缓及相关因素的多中心前瞻性研究  

Incidence of extrauterine growth retardation and its risk factors in very preterm infants during hospitalization:a multicenter prospective study

作　　者：沈蔚 郑直 林新祝 吴繁[2] 田倩欣 崔其亮[2] 袁媛[3] 任玲 毛健[3] 石碧珍 王玉梅 刘玲[4] 张京慧 常艳美[5] 童笑梅[5] 朱燕[6] 张蓉[6] 叶秀桢[7] 邹静静[7] 李怀玉[8] 赵宝银 邱银萍[8] 刘淑华[9] 马莉[9] 徐颖[10] 程锐[10] 周文莉[11] 武辉[11] 刘志勇 陈冬梅 高金枝 刘晶[13] 陈玲[13] 李丛[14] 杨春燕[14] 许平[14] 张亚昱[15] 呼斯乐 梅花[15] 杨祖铭[16] 冯宗太[16] 王三南[16] 孟二艳 尚利宏[17] 徐发林[17] 欧少苹 巨容 中国医师协会新生儿科医师分会营养专业委员会全国多中心EUGR协作组 SHEN Wei;ZHENG Zhi;LIN Xin-Zhu;WU Fan;TIAN Qian-Xin;CUI Qi-Liang;YUAN Yuan;REN Ling;MAO Jian;SHI Bi-Zhen;WANG Yu-Mei;LIU Ling;ZHANG Jing-Hui;CHANG Yan-Mei;TONG Xiao-Mei;ZHU Yan;ZHANG Rong;YE Xiu-Zhen;ZOU Jing-Jing;LI Huai-Yu;ZHAO Bao-Yin;QIU Yin-Ping;LIU Shu-Hua;MA Li;XU Ying;CHENG Rui;ZHOU Wen-Li;WU Hui;LIU Zhi-Yong;CHEN Dong-Mei;GAO Jin-Zhi;LIU Jing;CHEN Ling;LI Cong;YANG Chun-Yan;XU Ping;ZHANG Ya-Yu;HU Si-Le;MEI Hua;YANG Zu-Ming;FENG Zong-Tai;WANG San-Nan;MENG Er-Yan;SHANG Li-Hong;XU Fa-Lin;OU Shao-Ping;JU Rong;Nutritional Committee of Neonatology Branch of Chinese Medical Doctor Association,National Multicenter EUGR Collaborative Group(Department of Neonatology,Women's and Children's Hospital Affiliated to Xiamen University/Xiamen Maternal and Child Health Hospital,Xiamen,Fujian 361003,China;不详)

机构地区：[1]厦门大学附属妇女儿童医院/厦门市妇幼保健院,福建厦门361003 [2]广州医科大学附属第三医院儿科,广东广州510150 [3]中国医科大学附属盛京医院,辽宁沈阳110000 [4]贵阳市妇幼保健院·贵阳市儿童医院,贵州贵阳550002 [5]北京大学第三医院,北京100191 [6]复旦大学附属儿科医院,上海201102 [7]广东省妇幼保健院,广东广州510030 [8]宁夏医科大学总医院,宁夏银川750001 [9]河北省儿童医院,河北石家庄050031 [10]南京医科大学附属儿童医院,江苏南京210000 [11]吉林大学第一医院,吉林长春130000 [12]泉州市妇幼保健院·儿童医院,福建泉州362000 [13]华中科技大学同济医学院附属同济医院,湖北武汉430000 [14]山东省聊城市人民医院,山东聊城252000 [15]内蒙古医科大学附属医院,内蒙古呼和浩特010010 [16]苏州市立医院,江苏苏州215002 [17]郑州大学第三附属医院(河南省妇幼保健院),河南郑州450052 [18]电子科技大学医学院附属妇女儿童医院·成都市妇女儿童中心医院,四川成都611731 [19]不详

出　　处：《中国当代儿科杂志》2022年第2期132-140,共9页Chinese Journal of Contemporary Pediatrics

摘　　要：目的了解我国住院极早产儿(very preterm infant,VPI)宫外生长迟缓(extrauterine growth restriction,EUGR)的发生率及影响因素。方法采用多中心前瞻性调查研究方法,纳入2019年9月至2020年12月我国7个地区28家医院新生儿科的2514例VPI临床资料,根据纠正胎龄36周或出院时的体重评估是否发生EUGR,分成EUGR组(n=1189)和非EUGR组(n=1325)。比较两组VPI的临床特征,探讨EUGR的发生情况及相关因素。结果以体重评价,EUGR的发生率为47.30%(1189/2514)。多因素logistic结果显示,恢复出生体重后平均体重增长速率快和住院第1周累计热卡高是EUGR的保护因素(P<0.05),小于胎龄儿、达全肠内营养所需时间长、累计禁食时间长、开始添加母乳强化剂时的母乳量少及达到全强化的所需时间长、中-重度支气管肺发育不良是EUGR发生的危险因素(P<0.05)。结论尽早达全肠内营养,及时强化母乳喂养,增加生后第1周的热卡摄入,提高体重增长速率,以及防治中-重度支气管肺发育不良对降低VPI EUGR的发生率至关重要。Objective To investigate the incidence of extrauterine growth retardation(EUGR)and its risk factors in very preterm infants(VPIs)during hospitalization in China.Methods A prospective multicenter study was performed on the medical data of 2514 VPIs who were hospitalized in the department of neonatology in 28 hospitals from 7 areas of China between September 2019 and December 2020.According to the presence or absence of EUGR based on the evaluation of body weight at the corrected gestational age of 36 weeks or at discharge,the VPIs were classified to two groups:EUGR group(n=1189)and non-EUGR(n=1325).The clinical features were compared between the two groups,and the incidence of EUGR and risk factors for EUGR were examined.Results The incidence of EUGR was 47.30%(1189/2514)evaluated by weight.The multivariate logistic regression analysis showed that higher weight growth velocity after regaining birth weight and higher cumulative calorie intake during the first week of hospitalization were protective factors against EUGR(P<0.05),while small-for-gestational-age birth,prolonged time to the initiation of total enteral feeding,prolonged cumulative fasting time,lower breast milk intake before starting human milk fortifiers,prolonged time to the initiation of full fortified feeding,and moderate-to-severe bronchopulmonary dysplasia were risk factors for EUGR(P<0.05).Conclusions It is crucial to reduce the incidence of EUGR by achieving total enteral feeding as early as possible,strengthening breastfeeding,increasing calorie intake in the first week after birth,improving the velocity of weight gain,and preventing moderate-severe bronchopulmonary dysplasia in VPIs.

关 键 词：宫外生长迟缓 营养 危险因素 极早产儿 

分 类 号：R722.6[医药卫生—儿科]