宫外生长迟缓早产儿生后18月的生长模式及影响因素

Growth pattern and perinatal factors in preterm infants with extrauterine growth retardation at 18 months of corrected age

目的 探讨发生宫外生长迟缓（extrauterine growth retardation，EUGR）的早期早产儿（胎龄〈32周）纠正胎龄18月的生长模式及影响因素。方法 选择2010年1月1日至2013年6月30日在中山大学附属第一医院新生儿重症监护病房住院、胎龄〈32周且存活至出院的适于胎龄早产儿，根据出院时是否发生EUGR分为EUGR组（n=49）和非EUGR组（n=87），比较2组早产儿围产期资料、并发症、新生儿期治疗情况、纠正胎龄40周至纠正胎龄18月各项生长指标变化，分析纠正胎龄18月体重及身长的相关影响因素。采用t检验、秩和检验、χ^2检验及Linear多元回归分析进行统计学处理。结果 EUGR组新生儿期体重下降的最大程度及恢复出生体重的日龄均大于非EUGR组[分别为（7.3±1.1）%与（4.1±1.9）%，（9.9±2.5）与（5.7±1.2）d，t值分别为－10.767和－6.328，P值均〈0.05]，而体重增长速度明显慢于非EUGR组[（13.7±3.9）与（19.3±5.7）g/（kg·d），t=1.915，P=0.003]。EUGR组早产儿达完全胃肠喂养日龄、蛋白质达3 g/（kg·d）日龄及能量达120 kcal/（kg·d）（1 kcal=4.184 kJ）日龄、生后2周蛋白质及能量累计损失量均明显大于非EUGR组（P值均〈0.05）。EUGR组支气管肺发育不良、新生儿感染、重要并发症、颅内出血发生率及生后激素和机械通气使用率均明显高于非EUGR组[分别为20.4%（10/49）与6.8%（6/87）、20.4%（10/49）与5.7%（5/87）、16.3%（8/49）与5.7%（5/87）、12.2%（6/49）与3.4%（3/87）、16.3%（8/49）与2.2%（2/87）、42.8%（21/49）与26.4%（23/87），P值均〈0.05]。2组早产儿纠正胎龄40周至纠正胎龄18月各生长指标（体重、头围、身长、体重指数）均呈逐渐增长趋势，但EUGR组早产儿各生长指标标准差得分的均数均明显低于非EUGR组（P值均〈0.05）。EUGR组纠正胎龄18月体重和身长追赶生长发生率均明显高于非EUGR组[67.3%（33/49）与33.3%（29/87）、63.2%（31/49）与33.3%（29/87），χ^2值分别为14.620和11.391，P值均〈0.05]，但体重和身长生长受限发生率仍明显高于非EUGR组[分别为10.2%（5/49）与0.0%（0/87），8.1%（4/49）与0.0%（0/87），χ^2值分别为9.216和7.317，P值均〈0.05]。多元回归分析显示EUGR早产儿纠正胎龄18月体重的影响因素是胎龄（β=0.069，95%CI：0.010-0.128）、支气管肺发育不良（β=－0.541，95%CI：－0.745-－0.337）、生后2周蛋白质累计损失量（β=－0.014，95%CI：－0.028-－0.001）、纠正胎龄3月时体重标准差得分（β=0.147，95%CI：0.033-0.261）；身长的影响因素是胎龄（β=0.078，95%CI：0.011-0.144）、支气管肺发育不良（β=－0.360，95%CI：－0.637-－0.197）、生后2周蛋白质累计损失量（β=－0.017，95%CI：－0.032-－0.003）、纠正胎龄3月时身长标准差得分（β=0.134，95%CI：0.003-0.265）；P值均〈0.05。结论 EUGR早产儿婴幼儿早期各生长指标均明显落后于非EUGR早产儿；胎龄、支气管肺发育不良、生后2周蛋白质累计损失量、纠正胎龄3月体重（身长）均为EUGR早产儿纠正胎龄18月体重（身长）的重要影响因素。

Objective To assess the growth pattern and perinatal factors in preterm infants （〈32 weeksof gestation） with extrauterine growth retardation （EUGR） at 18 months of corrected age.Methods Data on appropriate for gestational age preterm infants with gestational age〈32 weeks admitted to the Neonatal Intensive Care Unit of the First Affiliated Hospital of Sun Yat-Sen University between January 1, 2010 and June 30, 2013 were reviewed retrospectively. The infants were divided into EUGR group （n=49） and non-EUGR group （n=87） according to the EUGR diagnosis at discharge. The perinatal information, complication, early nutritional supplementation and medical treatment, and growth data were compared between the two groups. Two independentttest, rank-sum test,Chi-square test and multiple linear regression analysis were used for statistical analysis.Results Compared with non-EUGR group, EUGR group had a significantly higher percentage of weight loss during neonatal period [（7.3±1.1）% vs （4.1±1.9）%,t=-10.767,P〈0.05]. The age to regain birth weight was significantly higher in EUGR group than in non-EUGR group [（9.9±2.5） vs （5.7±1.2） d,t=-6.328,P〈0.05]. The speed of weight gain was significantly slower in EUGR group than in non-EUGR group [（13.7±3.9） vs （19.3±5.7） g/（kg·d）,t=1.915,P=0.003]. EUGR group also had significantly more cumulative protein and energy loss in the first two weeks of life （bothP〈0.05）. The age to achieve full enteral feeding, protein 3 g/（kg·d）, and energy 120 kcal/（kg·d） （1 kcal=4.184 kJ） was significantly higher in EUGR group than in non-EUGR group （allP〈0.05）. The incidences of bronchopulmonary dysplasia, neonatal infection, major complications, intraventricular hemorrhage, and the rates of postnatal steroid use and mechanical ventilation were significantly higher in EUGR group than in non-EUGR group [20.4%（10/49） vs 6.8%（6/87）, 20.4%（10/49） vs 5.7%（5/87）, 16.3%（8/49） vs 5.7%（5/87）, 12.2%（6/49） vs 3.4%（3/87）, 16.3%（8/49） vs 2.2%（2/87）, 42.8%（21/49） vs 26.4%（23/87） , respectively, allP〈0.05]. The weight, head circumference, length and body mass index showed increasing trend in both groups, but were significantly lower in EUGR group than in non-EUGR group between 40 weeks and 18 months of corrected age （allP〈0.05）. EUGR group had significantly higher rates of catch-up growth in both weight and length than non-EUGR group [67.3%（33/49） vs 33.3%（29/87）, 63.2%（31/49） vs 33.3%（29/87）, respectively,χ^2=14.620 and 11.391, bothP〈0.05]. However, the EUGR group still had significantly higher rates of growth restraint than the non-EUGR group [weight： 10.2% （5/49） vs 0.0%（0/87）, length： 8.1%（4/49） vs 0.0%（0/87）;χ^2=9.216 and 7.317, bothP〈0.05]. Linear regression analysis showed that gestational age （β=0.069, 95%CI： 0.010 to 0.128）, bronchopulmonary dysplasia （β=-0.541, 95%CI：-0.745 to-0.337）, cumulative protein loss in the first two weeks of life （β=-0.014, 95%CI：-0.028 to-0.001）, and weight at 3 months of corrected age （β=0.147, 95%CI： 0.033 to 0.261） were risk factors for weight of preterm infants with EUGR at 18 months of corrected age. The risk factors for length of preterm infants with EUGR at 18 months of corrected age were gestational age （β=0.078, 95%CI： 0.011 to 0.144）, bronchopulmonary dysplasia （β=-0.360, 95%CI：-0.637 to-0.197）, cumulative protein loss in the first two weeks of life （β=-0.017, 95%CI：-0.032 to-0.003）, and length at 3 months of corrected age （β=0.134, 95%CI： 0.003 to 0.265）; allP〈0.05.Conclusions All growth parameters of preterm infants with EUGR fall behind those without EUGR during early infancy. Gestational age, bronchopulmonary dysplasia, cumulative protein loss in the first two weeks of life, and weight （length） at 3 months of corrected age are important factors for weight （length） of preterm infants with EUGR at 18 months of corrected age.