胎龄≤34周的早产儿宫外发育迟缓发生情况及影响因素分析

Occurrence and influencing factors of extrauterine growth retardation in premature infants not older than 34 weeks old

目的分析胎龄≤34周早产儿宫外发育迟缓(EUGR)发生率及其影响因素,为促进早产儿的生长发育提供参考。方法回顾性分析2016年1月-2018年1月于南京市妇幼保健院分娩的315例胎龄≤34周早产儿临床资料,根据是否出现EUGR分为发育迟缓组与发育正常组,采用多因素Logistic回归分析早产儿宫外发育迟缓的影响因素。结果迟缓组的出生体重(<1500 g)、出生时胎龄(<28周)、出生头围(≤33 cm)、体重下降时间(>6 d)、母体妊娠高血压构成比以及最低体重、出院时体重均明显高于正常组(P<0.05),迟缓组的第一次母乳喂养时间、达到全肠道喂养的时间、静脉营养时间、微量喂养持续时间、败血症构成比、呼吸窘迫综合征构成比、喂养不耐受构成比均高于正常组(P<0.05)。多因素Logistic回归分析显示出生体重<1500 g(OR=1.719,95%CI:1.115~2.652)、出生时胎龄<28周(OR=1.587,95%CI:1.052~2.396)、达到全肠道喂养时间≥17 d(OR=1.835,95%CI:1.144~2.943)是早产儿发生EUGR的危险因素(P<0.05)。结论胎龄≤34周早产儿EUGR的影响因素为出生体质量、出生时胎龄以及达到全肠道喂养时间,应尽早采取营养支持,降低EUGR风险。

Objective To explore the incidence and influencing factors of extrauterine growth retardation(EUGR)in premature infants with gestational age≤34 weeks old,in order to provide reference for facilitating the healthy growth and development of preterm infants.Methods The clinical data of 315 premature infants whose gestational age was≤34 weeks and were delivered in Nanjing Maternal and Child Health Hospital from January 2016 to January 2018 were retrospectively collected and analyzed.According to whether infants had EUGR or not,infants were divided into developmental retardation group(retardation group)and typical development group(normal group).The influencing factors of EUGR in preterm infants were analyzed by multivariate Logistic regression analysis.Results The proportions of birth weight<1500 g,gestational age<28 weeks,head circumference at birth≤33 cm,duration of body mass decline>6 d,maternal gestational hypertension,minimum body weight and body mass at discharge indevelopmental retardation group were significantly higher than those in typical development group(P<0.05).And the first breastfeeding time,time for achieving enteral feeding,intravenous nutrition duration,duration of minimal feeding,the proportions of sepsis,respiratory distress syndrome and feeding intolerance were significantly higher than those in typical development group(P<0.05).Multivariate Logistic regression analysis showed that birth weight<1500 g(OR=1.719,95%CI:1.115—2.652),gestational age<28 weeks(OR=1.587,95%CI:1.052—2.396)and time for achieving enteral feeding≥17 d(OR=1.835,95%CI:1.144—2.943)were risk factors of EUGR in premature infants(P<0.05).Conclusions The influencing factors of EUGR in premature infants with gestational age is≤34 weeks include birth weight,gestational age and time for achieving enteral feeding.And nutritional support should be taken as soon as possible to reduce EUGR risk.