小胎龄早产儿宫外生长发育迟缓的临床分析

Clinical analysis of extrauterine growth restriction in small gestational age preterm infant

目的 了解小胎龄早产儿宫外生长迟缓（EUGR）发生率及高危因素。方法 回顾性分析2012年1月～2013年12月在淮安市妇幼保健院新生儿医学中心住院治疗且存活出院的胎龄≤32周早产儿资料。根据出院时体重是否标低于校正年龄体重的第10百分位（P10）诊断EUGR，分为EUGR组61例和对照组118例。分析EUGR发生情况和相关因素，应用Logistic多元回归分析EUGR的高危因素。结果 ①179例小胎龄早产儿中，宫内发育迟缓（IUGR）发生率为4．5％（8／179），EUGR发生率为34．1％（61／179）。②早产儿随胎龄和出生体重降低IUGR发生率明显增加，各胎龄组的早产儿严重IUGR（χ^2=7．313）和IUGR（χ^2=7．083）发生率及各体重组之间的早产儿严重IUGR（χ^2=15．819）和IUGR（χ^2=37．160）发生率比较，差异均有统计学意义（P〈0．05或P〈0．01）。早产儿随胎龄和出生体重降低EUGR发生率明显增加，各胎龄组早产儿严重EUGR（χ^2=10．265）和EUGR（χ^2=7．320）发生率及各体重组之间早产儿严重EUGR（χ^2=22．959）和EUGR（χ^2=50．264）发生率比较，差异均有统计学意义（P〈0．05或P〈0．01）。③两组胎龄、出生体重、出院体重、出生Z评分、住院天数、首次胃肠喂养时间、达到全胃肠喂养时间、达最大静脉营养时间、女性、感染、IUGR、新生儿呼吸窘迫综合症（NRDS）、动脉导管未闭、支气管肺发育不良、母亲妊娠高血压综合征、插管机械通气和重度贫血等单因素比较，差异均有统计学意义（P〈0．05或P〈0．01）。Logistic回归分析发现低出生体重、低胎龄、NRDS和女性为小胎龄早产儿发生EUGR的高危因素（均P〈0．05）。结论 小胎龄早产儿EUGR发生率较高，其发生的高危因素为低出生体重、低胎龄和NRDS和女性。

Objective To investigate the incidence of extrauterine growth restriction （EUGR） in small gestational age preterm infants and their correlated factors. Methods Data of the infants that gestational age ≤ 32 weeks were collected between January 2012 and December 2013 in Department of Neonatal Medical Center, Huai＇an Maternity and Child Heahhcare Hospital. All preterm infants were divided into EUGR group with 61 cases and non-EUGR group with 118 cases according to the discharged weight and the 10th percent adjusted-age weight. The occurrence of EUGR and the relevant factors were analyzed, high risk factors of EUGR were analyzed by Logistic multiple regression. Results （1）179 infants were involved. The incidence of intrauterine growth restriction （IUGR） and EUGR was 4.5% （8/179） and 34.1% （61/179）. （2）The incidence of IUGR was higher with the decline of the gestational age and birth weight. The differences of incidence of serious IUGR and IUGR in each gestational age group （χ^2= 7.313, 7.083） and each weight group （χ^2= 15.819, 37.160） were all statistically significant （P 〈 0.05 or P 〈 0.01）. The incidence of EUGR was higher with the decline of the gestational age and birth weight. The differences of incidence of serious EUGR and EUGR in each gestational age group （χ^2= 10.265, 7.320） and each weight group （χ^2= 22.959, 50.264） were all statistically significant （P 〈 0.05 or P 〈 0.01）. （3）The differences of gestation age, birth weight, discharge weight, the mean Z scores at birth, days of hospitalization, time of the first enteral feeding, time to reach full entral feeding, the-maximum-venous-nutrition-time, female, infection, IUGR, neonatal respiratory distress syndrome （NRDS）, patent ductus arteriosus, bronchopul- monary dysplasia, pregnancy induced hypertension syndrome, endotracheal intubation and mechanical ventilation, severe anemia between the EUGR group and non-EUGR group were all statistically significant （P 〈 0.05 or P 〈 0.01）. Low gestational age, low birth weight, NRDS and female were the risk factors correlating with EUGR according to the Logistic multiple regression （all P 〈 0.05）. Conclusion The incidence of the EUGR in the small gestational age preterm infants is high, the risk factors are low gestational age, low birth weight, NRDS and female.