摘要
目的研究极低出生体重儿(VLBWI)住院期间的生长发育状态及相关影响因素。方法回顾性调查广东省珠江三角洲地区9个城市的9家医院新生儿科于2010年7月1日至2011年6月30日,出院的VLBWI的住院资料,根据出生体重,分为宫内生长发育迟缓[IUGR组(n=63)]和非IUGR组(n=120),非IUGR组又根据其出院时是否发展为宫外生长发育迟缓(EUGR)而分为EUGR组(n=71)和非EUGR组(n=49),对比性研究IUGR组和非IUGtl组住院期间的日均体重增长速度和出院时EUGR的发生率,及各组的院内营养摄入情况、生长速度和相关疾病因素的影响。结果(1)出生时IUGR和出院时EUGR的发生率分别为34.4%和72.1%,IUGR组的日均体重增长速度高于非IUGR组[(12.5±2.7)g/k vs(11.3±2.5)g/kg,t=3.068,P=0.002],但IUGt/组发展为EUGR的比例明显高于非IUGR组(96.8%vs59.2%,X^2=29.145,P=0.000)。(2)IUGR组在生后1、2、4周、达完全经口喂养前和住院期间的日均热卡摄入[62(51,69)kcal/kg vs 56(45,64)kcal/kg、83(71,94)keal/kg vs 76(66,88)keal/kg、107(94,120)keal/kg vs 95(85,108)kcal/kg;103(96,110)keal/kg vs 97(89,106)kcal/kg、121(111,131)keal/kg vs 111(101,119)kcal/kg](1kcal=4.1840kJ)。蛋白质摄入[1.7(1.3,2.0)g/kg vs 1.6(1.2,1.8)g/kg、2.6(2.1,2.9)g/kg vs 2.3(1.9,2.7)g/kg、3.3(2.7,3.6)g/kg vs 2.7(2.4,3.2)g/kg、3.1(2.6,3.4)g/kg vs 2.8(2.4,3.3)g/k、3.4(3.1,3.8)g/kg vs 3.1(2.8,3.5)g/k]均高于非IUGR组(P〈0.05)。热卡累积损失[407(360,483)kca]/kg vs 448(393,527)keal/kg、534(369,689)kcal/kgw612(453,758)keal/kg、367(12,724)kcal/kg vs 718(330,996)kcal/kg、381(231,609)kcal/kg vs 656(394,959)keal/kg、0(0,350)kcal/kg vs 387(85,826)kcal/kg]。蛋白质累积损失[12.3(10.2,15.5)g/kgVS13.7(11.7,16.4)g/kg、12.8(7.8,19.4)g/kgw17.5(11.9,22.7)g/kg、6.2(0,22.6)g/kgw21.7(7.3,30.3)g/kg、6.6(1.8,23.0)g/kgvs22.1(7,2,32.5)∥kg、1.9(0,16.7)g/kg vs 20.1(0,32.6)g/kg]则相应低于非IUGR组(P〈0.05)。(3)非EUGR组的日均体重增长速度高于EUGR组[(12.7±2.2)g/kgVS(10.3±2.1)g/kg,t=6.137,P=0.000];开始喂养时间[1.0(1.0,3.0)dVS3.0(2.0,5.0)d]、禁食时间[3.0(1.0,5.5)d vs 4.0(3.0,9.0)d]、最低体重出现时间[4.0(3.0,6.0)d vs 6.0(5.0,8.0)d]、恢复出生体重时间[11.0(9.0,14.0)d vs 13.0(10.0,17.0)d]均短于非EUGR组(P〈0.05);需机械通气治疗者比例(70.4%vs51.0%)低于非EUG11组(P〈0.05)。(4)非EUGR组在生后2周的日均热卡摄入[81(70,91)kcalZkg vs 73(63,85)kcal/kg]和生后1周[1.6(1.4,2.0)g/kg vs 1.4(1.1,1.8)g/kg]、生后2周[2.4(2.1,2.7)g/kg vs 2.1(1.8,2.6)g/kg]、达完全经口喂养前[3.0(2.5,3.4)g/kgvs2.7(2.3,3.1)g/kg]的蛋白质摄入高于EUGR组(P〈0.05),而生后2周的热卡累积损失[546(403,707)kcal/kg vs 655(494,795)kcal/kg]和生后1周[13.1(10.9,15.1)g/kg vs 14.8(12.0,16.6)g/kg]、生后2周[15.5(11.4,19.8)g/kg vs 20.0(12.1,24.0)g/kg]的蛋白质累积损失低于EUGR组(P〈0.05),在其余各阶段的日均热卡、蛋白质摄入量及累积损失量比较差异无统计学意义(P〉0.05)。(5)IUGR组新生儿呼吸窘迫综合征发生率低于非IUGR组(34.9%US56.7%),孕母妊娠期高血压疾病、胎儿窘迫发生率则高于非IUGR组(54.0%vs 24.2%、25.4%vs7.5%),新生儿窒息、坏死性小肠结肠炎、败血症、支气管肺发育不良、缺氧缺血性脑病/颅内出血、胆汁淤积症和孕母胎膜早破、胎盘早剥/前置胎盘的发生率组间比较差异无统计学意义(P〉0.05)。(6)EUGR组新生儿败血症发生率(11.3%vs0%)和孕母妊娠期高血压疾病发生率(31.0%vs 14.3%)高于非EUGR组(P〈0.05),但新生儿呼吸窘迫综合征、窒息、坏死性小肠结肠炎、支气管肺发育不良、缺氧缺血性脑病/颅内出血、胆汁淤积症和孕母胎膜早破、胎盘早剥/前置胎盘、胎儿宫内窘迫的发生率组间比较差异无统计学意义(P〉0.05)。结论IUGR早产儿发生EUGR的风险远高于非IUGR者;导致非IUGR早产儿发生EUGR的危险因素包括:日均体重增长速度、最低体重出现时间、恢复出生体重时间、开始喂养时间、禁食时间、机械通气治疗、营养摄入与累积损失、疾病等因素。
Objective To study the postnatal growth of very low birth weight infant (VLBWI) and its relevant influencing factors during hospitalization. Method Clinical data of very low birth weight infants (VLBWI) ,who were discharged from July 1 st ,2010 to June 30th ,2011, were collected retrospectively from 9 NICUs of 9 cities in Pearl River Delta, Guangdong province. A total of 183 cases of VLBW premature infants were enrolled in this research. The incidence of intrauterine growth retardation (IUGR) at birth and extrauterine growth retardation (EUGR) on discharge were assessed. According to IUGR at birth, they were assigned into two groups: IUGR group (n = 63 ) and non-IUGR group (n = 120). And non-IUGR group were further assigned into EUGR group (n = 71 ) and non-EUGR group (n = 49 ). The mean daily growth rate during hospitalization and the incidence of EUGR on discharge were studied comparatively to IUGR group and non-IUGR group. The nutrition intake, mean growth rate and relevant illnesses were studied comparatively to IUGR group and non-IUGR group , EUGR group and non-EUGR group. Result ( 1 ) The incidence of IUGR at birth was 34.4% ,while the incidence of EUGR on discharge was 72. 1%. The mean daily growth rate to body weight of IUGR group was higher than that of non-IUGR groupE ( 12. 5 ± 2. 7 ) g/kg vs ( 11.3 ± 2. 5 ) g/kg, P = 0. 0021. The increasing incidence from IUGR to EUGR, IUGR group was higher than non-IUGR group (96. 8% vs 59. 2% ,P =0. 000). (2) The mean daily energy and protein intake in postnatal time of 1 weekE62(51,69) kcal/kg vs 56(45,64) kcal/kg( 1 kcal -4. 1840 kJ),1.7( 1.3,2. 0) g/kg vs 1.6 ( 1.2,1.8 ) g/kgl, 2 weeks E 83 (71,94) kcal/kg vs 76 ( 66,88 ) kcal/kg, 2. 6 ( 2. 1,2. 9 ) g/kg vs 2. 3 (1.9,2.7) g/kg], 4 weeksI107(94,120) keal/kgvs95(85,108) kcal/kg,3.3(2.7,3.6) g/kgvs 2.7 (2. 4,3.2) g/kg], before total enteral nutritionE 103(96,110) kcal/kg vs 97(89,106) keal/kg,3. 1 (2. 6, 3.4) g/kg vs 2. 8 ( 2.4,3.3 ) g/kg ] and the whole hospitalization E 121 ( 111,131 ) kcal/kg vs 111 ( 101, 119) kcal/kg,3.4(3. 1,3.8) g/kg vs 3.1(2. 8,3.5) g/kg] ,IUGR group were more than non-IUGR group ( P 〈 0. 05 ). While the cumulative losses of energy E 407 ( 360,483 ) kcal/kg vs 448 ( 393,527 ) kcal/kg, 534 (369,689) kcal/kg vs 612(453,758) kcal/kg,367(12,724) kcal/kg vs 718(330,996) kcal/kg,381 (231,609) kcaL/kg vs 656(394,959) kcal/kg,0(0,350) kcal/kg vs 387(85,826) kcal/kg] and protein E12.3(10.2,15.5) g/kgvs 13.7(11.7,16.4) g/kg,12.8(7.8,19.4) g/kgvs 17.5(11.9,22.7) g/kg,6. 2(0, 22.6) g/kgvs 21.7(7.3,30.3) g/kg,6. 6(1. 8,23. 0) g/kgvs 22. 1(7.2,32.5) g/kg,l. 9(0,16. 7) g/kgvs 20. 1 (0,32. 6) g/kg] were lower in IUGR group than in non-IUGR group at the same time (P 〈 0. 05 ). (3) The mean daily growth rate to body weight of non-EUGR group was higher than that of EUGR group E ( 12. 7 ± 2. 2) g/kg vs ( 10. 3 ± 2. 1 ) g/kg, P = 0. 000 1. The date beginning to feed E 1.0 (1.0,3.0) d vs 3.0(2.0,5.0) d], the total fastingtimeE3.0(1.0,5.5) dvs4.0(3.0,9.0) d], the time to reach the lowest body weight [ 4. 0 ( 3.0,6. 0) d vs 6.0 (5.0,8.0) d ], and the time to restoring birth weight [ 11.0 (9.0, 14.0) d vs 13.0(10.0, 17.0) d], non-EUGR group were shorter than that of EUGR group ( P 〈 0. 05 ). The percentage of the infants who needed ventilator therapy was lower in non-EUGR group than in EUGR group(70. 4% vs 51.0%, P = 0. 031 ). (4) The mean daily energy intake in postnatal time of 2 weeksE81 (70,91) keal/kg vs 73(63,85) keal/kg] and the mean protein intake daily in postnatal time of 1 weekE1. 6(1. 4,2. 0) g/kgvs 1.4(1.1,1.8) g/kg], 2 weeksE2.4(2. 1,2.7) g/kg vs 2. 1(1.8,2.6) g/kg] and before total enteral nutritionS3.0(2. 5,3.4) g/kg vs 2. 7(2. 3,3. 1 ) g/kg~ were higher in non-EUGR group than in EUGR group(P 〈0. 05). While the cumulative losses of energy in postnatal time of 2 weeks[ 546 (403,707) kcal/kg vs 655 (494,795) kcal/kg ] and the cumulative losses of protein in postnatal time ofl week[13.1(10.9,15.1) g/kgvs 14.8(12.0,16.6) g,/kgl and2 weeks[15.5(11.4,19.8) g/kgvs 20.0(12. 1,24.0) g/kg] were lower in non-EUGR group than in EUGR group(P 〈0.05). (5)The incidence of neonatal respiratory distress syndrome was lower in IUGR group than in non-IUGR group (34. 9% vs 56. 7% ,P =0. 005) ; the incidence of hypertensive disorders in pregnancy(54. 0% vs 24. 2% , P = 0. 000 ) and fetal distress in uterus (25.4% vs 7.5 % , P = 0. 001 )of the pregnant women were higher in IUGR group than in non-IUGR group. (6)The incidence of septicemia of the newborn( 11.3% vs 0% ,P = 0. 020 ) and the incidence of hypertensive disorders in pregnancy of the pregnant women( 31.0% vs 14. 3 % , P = 0. 036) in EUGR group were higher than in non-EUGR group. Conclusion EUGR was still a serious problem in VLBWI. The risk of EUGR in the VLBWI with IUGR was much higher than those of non-IUGR. The relevant influencing factors of EUGR included mean daily growth rate to body weight, the date beginning to feed, the total fasting time, the time to reach the lowest body weight, the time to restoring birth weight, ventilator therapy, the daily nutrition intake, the cumulative nutrition losses, and illnesses of infants or their mother.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2013年第1期4-11,共8页
Chinese Journal of Pediatrics
基金
2011年广东省第三批科技计划项目(2011-97)
广州市医药卫生科技项目(201102A213149)
广州市科技计划项目应用基础研究专项重点项目(2011J4100046)
关键词
极低出生体重
婴儿
早产
营养疗法
胎儿生长迟缓
生长障碍
宫内生长发育迟缓
宫外生长发育迟缓
Infant, very low birth weight
Infant, premature
Nutrition therapy
Fetal growthretardation
Growth disorders
Intrauterine growth retardation
Extrauterine growth retardation