低出生体重早产儿宫外发育迟缓的相关因素分析

Related factors of extrauterine growth restriction in low birth weight preterm children

目的探讨胎龄≤32周低出生体重早产儿宫外发育迟缓（EUGR）发生率及其相关影响因素。方法纳入126例胎龄≤32周低出生体重早产儿,记录胎龄（超声或出生时成熟度分析数据）、出生时体重、身长、头围、性别、是否低于胎龄儿、是否存在呼吸窘迫综合征、最大生理性体重减少率、恢复出生体重的天数、起始肠内喂养时间、完全肠内喂养时间（每天奶量〉100 ml/kg·d）,37～42周时测定早产儿体重、身长、头围,以体重、身长和头围计,分析EUGR发生率、其危险因素以及适于胎龄儿（AGA）和低于胎龄儿（SGA）EUGR发生率。结果 EUGR组胎龄、出生体重、出生身长、出生头围均低于非EUGR组（均P〈0.01）,而体重下降率（%）、恢复出生体重时间、起始肠内喂养时间以及完全肠内喂养时间均大于非EUGR组（均P〈0.01）,SGA比例明显大于非EUGR组（均P〈0.05）。以体重、身长、头围计,所有新生儿EUGR发生率分别为47.6%、39.7%和4.8%。总体上SGA宫外发育迟缓率明显高于AGA（均P〈0.01）。胎龄、恢复出生体重时间、完全肠内喂养时间与EUGR发生密切相关。结论胎龄、宫内发育迟缓、营养摄入差及呼吸窘迫综合症仍是胎龄≤32周早产儿EUGR发生的危险因素。

Objective To investigate the incidence and related factors of extrauterine growth retardation（EUGR） in low birth weight preterm children. Methods A total of 126 cases of low birth weight premature children with gestational age≤32 week were enrolled, and gestational age（ultrasound or birth maturity analysis of data）, birth weight, length, head circumference, gender, the existence of respiratory distress syndrome, the maximum physiological weight reduction rate, the number of days to regain birth weight, the time for starting enteral feeding and full enteral feeding（daily milk100 ml/kg·d） were recorded. During 37～42 weeks, weight, length, head circumference, body weight, length and head circumference of premature children were measured. Incidence of EUGR and risk factors, and incidences of EUGR in appropriate for gestational age children（AGA） and small for gestational age children（SGA）were analyzed. Results The gestational age, birth weight, birth length, and head circumference at birth of EUGR group were lower than those of the non-EUGR group（all P〈0.01）, while the rate of weight loss（%）, time to regain birth weight, time for starting enteral feeding and giving full enteral feeding were greater than those of non-EUGR group（all P〈0.01）. The proportion of SGA was significantly greater than that of non-EUGR group（all P〈0.05）. Based on weight, length, head circumference, incidences of EUGR in all newborns were 47.6%, 39.7% and 4.8%. Toatally,extrauterine growth retardation rate of SGA was significantly higher than that of AGA（all P〈0.01）.Gestational age,birth weight, recovery time, and time for full enteral feeding were closely related with EUGR. Conclusion Gestational age, intrauterine growth retardation, poor nutritional intake and RDS are still the risk factors of EUGR in premature children with gestational age≤ 32 week.