摘要
目的评价上海市早产儿出生时新生儿重症监护病房(NICU)和出院时宫外生长发育迟缓(EUGR)发生率并分析相关因素。方法上海五家医院进行多中心回顾分析研究。入选标准:入院胎龄评分<37周;入院日龄<24 h,出院于同一医院;住院天数≥7 d;排除标准:住院期间死亡及外观有畸形;母亲患有内分泌及代谢性疾病。对宫内外生长迟缓进行描述(≤生长曲线的第10百分位)。计数资料采用卡方检验,正态分布计量资料采用 t 检验,非正态分布计量资料采用秩和检验,疾病危险因素采用 logistic 回归模型。结果 2003年1月至2004年12月,5家医院共计1196例早产儿(男734例,女462例),IUGR 与 EUGR 发生率分别以体重评价为22.7%和49.7%,以头围评价为19.2%和23.1%;各医院间 IUGR 发生率差异均无统计学意义,以出院体重评价的 EUGR 发生率,差异有统计学意义,出院头围评价差异无统计学意义。IUGR 和 EUGR 的发生率均随体重减少而增加;在极低出生体重儿中,EUGR 发生率以体重评价为78.9%,以头围评价为50.0%。住院天数与全肠内营养(EN)日龄在 EUGR 组与非 EUGR 组差异有统计学意义。Logistic 回归中,性别、出生胎龄、出生体重、出生头围、医院间为生长迟缓的危险因素。结论本研究早产儿 EUGR 发生率明显高于国外资料,出生体重越低,EUGR 发生率越高,且不同医院营养支持状况对 EUGR 发生率有影响。
Objective Poor growth is a common problem in premature neonates. No sufficient attention has been paid to the nutrition deficit and extrauterine growth retardation in premature neonates in China. The present study aimed to assess the incidences of intrauterine growth retardation （IUGR） and extrauterine growth retardation （EUGR） in premature neonates in Shanghai area and their correlated factors. Methods Data of the neonates discharged between January 1,2003 and December 31,2004 from 5 hospitals （Xinhua Hospital, Shanghai Children＇s Medical Center, Shanghai Children＇s Hospital, Pediatric Hospital Affiliated to Hehai University, and Shanghai International Peace Maternity and Child Health Hospital） were reviewed. The criteria of exclusion were cases who died or had a malformed appearance, the mother had endocrine or metabolic diseases. The criteria for enrollment were （ 1 ） gestational age 〈 37 weeks, （2） admitted less than 24 hours after birth and discharged from the same hospital, （3） duration of hospitalization was ≥ 7 days. The growth values on discharge of each patient were compared to the expected values based on the intrauterine growth data and postmenstrual day on discharge. Growth retardation was defined as measured growth values （weight, head circumference） ≤ 10th percentile of the values （growth expectation based on estimated postmenstrual age）. In each specific group, the number of neonates with ≤ 10^th percentile for each growth parameter was counted and the percentages of patients who had values ≤ 10^th percentile on birth and discharge were calculated. The growth curves used for assessing birth weight and head circumference for different gestational age neonates were those published in 1986. All the data were analyzed using the SPSS statistical software package. The risk factors for extrauterine growth retardation on weight and head circumference were estimated with logistic regression model. Results The subjects included 1196 premature neonates in the five hospitals （734 boys and 462 girls）. The incidence of IUGR was 22.7% and 19.2% assessed by weight and head circumference, respectively. The incidence of EUGR was 49.7% and 23.1% assessed by weight and head circumference, respectively. Assessment of IUGR in accordance with the birth weight and head circumference in the five hospitals showed no significant correlation between IUGR and non-IUGR by birth weight （ x^2 = 4. 944） and head circumference （x^2 = 0. 017 ） respectively. Whereas the assessment of EUGR in accordance with weight and head circumference showed a significant correlation between EUGR and non-EUGR by weight on discharge （ X^2 = 28. 109）, but no significant correlation was found between EUGR and non-EUGR by head circumference on discharge （ X^2 = 0. 275 ）. In specific birth weight groups, the lower the weight, the higher the incidence of IUGR and EUGR by the weight and head circumference. The incidence of EUGR in VLBWI was 78.9% and 50. 0% assessed by weight and head circumference, respectively. Assessed by weight, significant correlation was observed between EUGR and non-EUGR in birth weight （ t = 18. 674）, hospitalization duration （ Z = - 8.790） and the median number of day for total using EN （Z= -4. 650） ; but by the head circumference, significant correlation was observed in head circumference at birth （ t = 9. 555 ）, hospitalization duration （ Z = - 3.930） and the median number of day for total using EN （ Z = - 3.004 ）. The relationship between EUGR and some risk factors was analyzed with Logistic regression model. Assessed by the weight, the following 4 factors were related to EUGR： sex（ X^2 = 10. 351 ）, gestation age at birth（ X^2 = 56. 275 ）, birth weight（ X^2 = 102. 126） and different hospital（ X^2 = 4.773）. Assessed by the head circumference, the following 2 factors were correlated： gestation age at birth （ X^2 = 10. 322） and head circumference （ X^2 = 10. 620）. Conclusions This study showed that the incidence of EUGR in premature neonates was significantly higher than the data reported in other countries. The incidence of EUGR increased with the decreased birth weight. Different nutritional support had influence on EUGR.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2007年第3期183-188,共6页
Chinese Journal of Pediatrics
关键词
早产儿
宫外生长发育迟缓
相关因素
体重评价
Premature neonates
Extranterine growth retardation
Correlated factors
