极低出生体重儿住院期间营养状况及体重关系的多因素回归分析

Nutrition and weight gain in very low birth weight infants during hospitalization

目的观察极低出生体重儿住院期间的营养支持情况和生长状况关系,探讨影响其体重增长的因素。方法收集2006年1月～2010年12月住院的极低出生体重儿,回顾性分析患儿的营养状况和体重增长状况,logistic回归分析宫外生长发迟缓的危险因素。结果共有180例极低出生体重儿符合条件入选,出生胎龄(224.9±15.2)d,平均体重(1342.4±140.8)g,开始喂养时间2 d。肠外营养中应用氨基酸占53.9%,开始使用时间(4.2±2.7)d,平均使用时间(8.7±6.2)d,起始剂量为(0.92±0.39)g.kg-1;应用脂肪乳剂占36.7%,开始使用时间(4.2±2.2)d,平均使用时间(10.4±7.4)d,起始剂量为(0.84±0.19)g.kg-1。总热卡达到推荐热卡摄入标准120 kcal.kg-1.d-1的日龄为(13.2±5.4)d,口服热卡达到推荐热卡摄入标准100kcal.kg-1.d-1的日龄为(14.5±5.4)d,平均体重增长速度为(15.1±4.0)g.kg-1.d-1。118例单胎患儿中以体重计算,出生出现宫内生长发育迟缓(IUGR)的占63.6%,至出院时出现宫外生长发育迟缓(EUGR)的73.7%,较出生时明显增加。其中出生胎龄、出生体重,喂养不耐受,以及IUGR是导致EUGR的因素(P<0.05)。结论大多数极低出生体重儿在住院期间存在营养和生长问题,不能达到正常胎儿在宫内的生长发育速度。应当尽早胃肠内营养,并积极合理的应用胃肠外营养。

Aim To analyze the nutrition state and weight gain in very low birth weight infants（VLBWI）during hospitalization.Methods 180 VLBWIs were admitted in NICU of authors＇hospitals from Jan 2006 to Dec 2010.The clinical data were retrospectively analyzed.The risk factors which can lead to growth retardation of VLBWIs were assessed with logistic regression.P0.05 was considered as significant.Results Mean gestational age was（224.9±15.2）d.Mean birth weight was（1 342.4±140.8）g.The time of initial enteral feeding was 2 d.For parenteral nutrion,amino acid was administered in 53.9% of patients.The time to begin was（4.2±2.7）d.The duration of administration was（8.7±6.2）d.The initial dose was（0.92±0.39）g·kg-1.Lipid emulsions was administered in 53.9% patients.The time to begin was（4.2±2.2）d.The duration of administration was（10.4±7.4）d.The initial dose was（0.84±0.19）g·kg-1.Total energy intake of 120 kcal·kg·d-1 was achieved at（13.2±5.4）d.Enteral feeding of 100 kcal·kg·d-1 was achieved at（14.5±5.4）d.The average growth rate after regaining birth weight was（15.1±4.0）g·kg-1d-1.Of 118 singletons,63.6% patients had growth retardation by weight at birth,while 73.7% at discharge.Gastational age,birth weight,feeding intolerance and intrauterine growth restriction were risk factors of extrauterine growth restriction.Conclusions Most VLBWIs had problems with nutrition and growth during hospitalization and failed to reach growth rate as desired for normal intrauterine growth rate.It is very important to begin parenteral nutrition as early as possible and parenteral nutrition should be admitted as supplement to parenteral nutrition.