中山地区早产儿出院时宫外生长迟缓调查

Extrauterine growth retardation of preterm infants in Zhongshan city

目的:评价早产儿出生时宫内生长受限(IUGR)和出院时宫外生长迟缓(EUGR)的发生情况。方法:以中山市博爱医院新生儿科2009年1月～2012年5月出生的早产儿为研究对象,分别以出生时、出院时生长发育指标在相应宫内生长速率期望值的第10百分位水平以下定义为IUGR、EUGR,分别计算各胎龄组及体重组IUGR、EUGR发生率及总的发生率,并计算各胎龄组及各体重组EUGR发生率比IUGR发生率增加的比例。结果:1 954例早产儿,IUGR与EUGR发生率以体重评价分别为10.64%和29.32%,以身长评价分别为10.18%和20.83%,以头围评价分别为5.63%和13.46%。其中极低出生体重儿占14.99%,发生体重、身长和头围EUGR者分别为51.54%,47.10%和29.69%。不同出生胎龄(<28周、28～32周、32～35周、≥35周)出院时EUGR发生率较出生时IUGR发生率变化的情况:以头围为指标的≤P10、≤P3和以身长为指标≤P3的EUGR较IUGR增加率呈倒"U"型趋势,组间差异有统计学意义(P<0.05)。不同出生体重组(<1 500 g、1 500～2 500 g、≥2 500 g)以体重、身长、头围为指标EUGR较IUGR的发生率增加的比例均随出生体重的降低而升高,各组以体重为指标,EUGR发生率分别增加25.60%、21.28%、1.55%;以身长为指标,EUGR发生率分别增加16.72%、11.43%、1.86%;以头围为指标,EUGR发生率分别增加10.92%、8.74%、1.24%,组间比较差异有统计学意义(P<0.001)。结论:早产儿IUGR发生率较高,出院时EUGR发生率较IUGR发生率增高,且出院时EUGR发生率较出生时IUGR发生率的增加随出生体重的降低而升高。

Objective：To assess the incidences of intrauterine growth retardation（IUGR） and extrauterine growth retardation（EUGR） in preterm infants in Zhongshan city.Methods：The preterm infants born from January 2009 to May 2012 in Boai hospital of Zhongshan city were selected.The growth values at birth and on discharge of each infant 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（body weight,body length and head circumference） ≤10th percentile of the values（growth expectation based on estimated postmenstrual age）.In each specific group,the number of infants with ≤10th percentile for each growth parameter was counted and the percentages of patients who had values ≤10th percentile at birth and on discharge were calculated.And the increasing incidence from IUGR to EUGR in each specific group was also calculated.Results：A total of 1 954 preterm infants were chosen.The incidences of IUGR and EUGR were 10.64% and 29.32% assessed by body weight,and 10.18% and 20.83% assessed by body length,and 5.63% and 13.46% assessed by head circumference,respectively.The proportion of very low birth weight infants（VLBWI） was 14.99%,the incidences of EUGR were 51.54% assessed by body weight,47.10% assessed by body length,and 29.69% assessed by head circumference,respectively.In each group assigned by gestational age（＆lt;28 w,28~32 w,32~35 w,≥35 w）,the increasing incidence from IUGR to EUGR from up to down was ＆lt;28 w,≥35 w,28-32 w,32-35 w assessed by ≤3th percentile for body length and ≤10th and ≤3th percentile for head circumference.It showed the trend of inverted ＂U＂.In each group assigned by birth weight（＆lt;1 500 g,1 500~2 500 g,≥2 500 g）,the increasing incidence from IUGR to EUGR was 25.60%,21.28% and 1.55% assessed by body weight;16.72%,16.43% and 1.86% assessed by body length;10.92%,8.74% and 1.24% assessed by head circumference.Assessment of the increasing incidence from IUGR to EUGR by each specific group and each growth parameter showed a significant correction（P＆lt;0.001）.Conclusion：The incidences of IUGR in preterm infants are still high.The incidence of EUGR is more than that of IUGR upon discharge.There is an increasing in incidence from IUGR to EUGR with the decrease in birth weight.