极低出生体重儿宫外生长发育迟缓及营养支持分析

Effects of nutrition support on extrauterine growth retardation in very low birth weight infants

目的评价上海市极低出生体重儿（very low birth weight infant，VLBWI）出生时胎儿生长受限（fetal growth restriction，FGR）和出院时宫外生长发育迟缓（extrauterine growth retardation，EUGR）的发生率并分析营养支持的影响。方法收集上海市5家医院126例VLBWI临床资料，分析FGR和EUGR发生率，比较EUGR和非EUGR患儿间的生长发育和营养支持指标。并采用Logistic回归分析EUGR危险因素。结果以体重评价，FGR与EUGR发生率分别为53．2％和80．2％，以头围评价为55．6％和46．7％；FGR和EUGR的发生率均随体重减少而增加；以体重评价时，FGR和EUGR发生率随胎龄增加而增加。EUGR组出生胎龄为（32．2±1．8）周，脂肪乳剂为（1.4±0．5）g／（kg·d），高于非EUGR组[分别为（30．9±2．7）周和（0．9±0．2）g／（kg·d）]；而出生体重为（1330±156）g，低于非EUGR组[（1380±90）g]。Logistic回归分析发现首次应用EN的日龄（OR=0．264，95％CI0．079-0．876，P=0．04）和PN配方葡萄糖用量（OR=0．029，95％CI0．001-0．861，P=0．048）是EUGR的危险因素。结论出生体重越低，EUGR发生率越高；目前的营养策略仍存在缺陷，不能满足VLBWI生后的营养需求。

Objective To assess the incidences of fetal growth retardation （FGR） and extrauterine growth retardation （EUGR） in very low birth weight infants（VLBWIs） and nutritional effency on EUGR. Methods Data of 126 VLBWIs incharged in 5 hospitals from January 1. 2003 to December 31. 2004 were reviewed. The risk factors for extrauterine growth retardation were estimated with logistic regression model. Results Assessing by weight and head circumference, the incidence of FGR was 53.2% and 55.6%, and the incidence of EUGR was 80.2% and 46.7%, respectively. The birth gestation of EUGR group was （32.2 ± 1.8） weeks and the intake of lipid was （1.4 ± 0.5） g/（kg· d）, higher than those of non-EUGR group [（30.9±2.7） weeks and （0.9±0. 2） g/（kg · d）]. But the birth weight of EUGR group was （1330±156） g, lower than that of non-EUGR group [（1380±90） g]. The age for initial using enteral nutrinion （OR= 0. 264, 95% CI 0. 079-0. 876, P= 0.04）and glucose intake in PN （OR=0.029, 95%CI 0. 001-0. 861,P=0. 048） were the risk factors of EUGR. Conclusions The incidence of EUGR increased with the birth weight decreased. Current nutritional support could not prevent extrauterine growth retardation in VLBWIs.