极低出生体重儿神经系统发育与早期营养的关系

A study on the relationship between neurodevelopment and early nutritional status of very low birth weight infants

目的探讨新生儿重症监护病房（NICU）极低出生体重儿早期营养状况与后期神经系统发育的关系。方法回顾性选择2013年1月至2014年12月在我院NICU住院且出院后定期在我院高危儿门诊随访的极低出生体重儿,均在校正年龄3个月时评估发育商（DQ）,DQ≥130分为优秀,115~129分为中上,85~114分为中等,70~84分为中下,≤69分为智能低下。根据DQ得分将患儿分为神经发育正常组（DQ≥85分）及神经发育异常组（DQ〈85分）,比较两组患儿住院期间营养状况。结果共纳入125例极低出生体重儿。校正年龄3个月时DQ优秀2例（1.6%）,中上3例（2.4%）,中等63例（50.4%）,中下57例（45.6%）;神经发育正常组68例（54.4%）,神经发育异常组57例（45.6%）。神经发育正常组生后4、7、14天平均总热卡摄入量[（44.3±8.0）比（37.7±6.8）kcal/kg、（60.4±5.0）比（55.2±6.7）kcal/kg、（92.3±8.0）比（83.1±9.9）kcal/kg]、平均肠内能量所占比例[（9.0±1.8）%比（4.8±1.5）%、（18.6±2.9）%比（10.4±2.6）%、（38.0±2.5）%比（30.4±2.0）%]及生后4、7天平均氨基酸供给量[（1.2±0.2）比（0.9±0.1）g/kg、（1.8±0.1）比（1.6±0.1）g/kg]均高于神经发育异常组,差异有统计学意义（P〈0.05）。神经发育正常组体重下降程度较神经发育异常组轻,恢复出生体重时间及达到全肠道喂养时间较神经发育异常组早,两组差异有统计学意义（P〈0.05）。结论极低出生体重儿生后早期营养状况与神经系统发育结局相关。

Objective To study the relationship between neurodevelopment and early nutritional status of very low birth weight（ VLBW） infants in NICU. Methods VLBW infants admitted to NICU of our hospital from January 2013 to December 2014 and received regular follow-up management at our high-risk infant outpatient clinic were retrospectively studied. All infants＇ developmental quotient（ DQ）were evaluated at 3 months of corrected gestational age（ c GA）. DQ ≥130 was defined as excellent,115- 129 above medium,85- 114 medium,70- 84 below medium and ≤69 abnormal. According to their DQ scores,infants were assigned into two groups,normal neurodevelopment group（ DQ≥85） and abnormal neurodevelopment group（ DQ 85）. Nutritional status during hospitalization between the two groups were compared. Results A total of 125 VLBW infants were recruited. At three months of c GA,2 cases（ 1. 6%） had excellent DQ score; 3（ 2. 4%） above medium; 63（ 50. 4%） medium;57（ 45. 6%） below medium. 68 cases（ 54. 4%） in the normal development group and 57（ 45. 6%） in the abnormal group. The total energy intake,the proportion of enteral energy supply on 4 d,7 d,14 d after birth and amino acid supply on 4 d,7 d were significantly higher in the normal neurodevelopment group than the abnormal group（ P〈0. 05）. Comparing with the abnormal group,weight loss of VLBW infants in the normal neurodevelopment group was less; the time needed to reach birth weight and exclusive enteral nutrition in the normal neurodevelopment group was shorter. The differences were statistically significant between the two groups（ P〈0. 05）. Conclusions VLBW infants＇ early nutritional status may influence their neurodevelopmental outcome.