两种新生儿生长参照值的应用比较

Comparison of two neonatal growth reference

目的比较中国1988与Fenton 2003新生儿生长参照值在实际应用中的差别,为合理选择新生儿生长评价标准提供参考依据。方法以2011年1月-2012年11月期间南、北方2所妇幼保健院出生的活产新生儿为研究对象,分别用中国1988及Fenton 2003参照值评估不同胎龄新生儿的初生状态,比较两种参照值的生长评价结果。结果 1)新生儿出生体重与中国1988参照值相比37周之前较低,之后较高;与Fenton 2003相比32周之前差别不明显,之后略低。出生体重的第10、50百分位(P10,P50)曲线形态与两种参照值曲线一致;而第90百分位(P90)与中国1988参照值曲线存在较大差别,但与Fenton 2003参照曲线基本一致。2)按中国1988、Fenton 2003参照值计算体重Z值分别为0.18(95%CI:0.17~0.20)、-0.16(95%CI:-0.18^-0.15)。3)37周之前采用中国1988参照值和Fenton 2003参照值的小于胎龄儿(small-for-gestational-age,SGA)检出率分别为16.7%、12.4%,而37周后分别为5.9%、7.2%;37周之前两者的大于胎龄儿(large-for-gestational-age,LGA)检出率分别为3.8%、6.1%,37周后分别为17.8%、4.4%。结论两种参照值的评价结果存在明显差别,中国1988参照值会筛检出更多的早产SGA儿、足月LGA儿,而Fenton 2003则筛检出更多的早产LGA儿和足月SGA儿。两种参照值的应用比较结果提示Fenton 2003更为适用。

Objective To compare the difference in practices between Chinese neonatal growth reference in 1988 （Abbreviation for ＂China 1988＂） and the Fenton neonatal growth reference in 2003（Abbreviation for ＂Fenton 2003＂）. Methods Subjects were live newborns in two Maternal and Child Health Hospitals in the northern and southern areas of China during 2011 to 2012. The birth weight of newborns was assessed by using the growth reference of China 1998 and Fenton 2003 and compared the difference of two assessment results. Results 1） The birth weight of newborns were lower before 36 weeks of gestational age and higher after 37 weeks of gestational age （100-157 g） when comparing with the China 1988. The differences of birth weight were not obvious before 32 weeks of gestational age and the birth weight was lower after 32 weeks when comparing with the Fenton 2003. The shapes of P10 and P50 percentile curves in this paper were similar with the two reference charts,while the shapes of P90 percentile curve was different with the China 1988 but similar with the Fenton 2003;2） The BWZ of the China 1988 and Fenton 2003 were respectively 0.18（95%CI：0.17-0.20） and -0. 16（95%CI： -0.18-0.15））3）The relevance ratio of small-for-gestational-age （SGA） using the China 1988 and Fenton 2003 were respectively 16.7% and 12.4% for newborns younger than 37 weeks,5.9% and 7.2% for newborns older than 37 weeks. The relevance ratio of large-for-gestational-age （LGA） using the China 1988 and Fenton 2003 were respectively 3.8% and 6.1% for newborns younger than 37 weeks, 17.8% and 4.4% for newborns older than 37 weeks. Conclusion The assessment results of the two growth reference were different. The relevance ratio of SGA newborns aged younger than 37 weeks and LGA newborns aged older than 37 weeks were higher when using the China 1988 ,while the relevance ratio of LGA for new-borns younger than 37 weeks and SGA for newborns older than 37 weeks were higher when using the Fenton 2003. It had il lustrated that the Fenton 2003 would suitable for the contemporary newborns by comparing the newborns＇ birth weight.Key words; newborns; gestarional age; birth weight; growth reference