早产适于胎龄儿婴儿期追赶生长特点和2至3岁生长偏离的队列研究

Characteristics of the catch-up growth among preterm infants appropriate for gestational age and the growth deviation of them after two years of age——a longitudinal study

目的分析早产适于胎龄儿婴儿期追赶生长特点和2-3岁生长偏离情况。方法以队列研究设计实验方案。选择成都市妇女儿童中心医院（我院）出生的无明显疾病状态的早产儿,生后行单纯早产儿出院后配方粉喂养至达到WHO儿童生长发育标准身长别体重的P50水平后,转换为足月儿配方粉喂养至12月龄;9月龄前每月和12月龄行体格测量和喂养指导。随访至2-3岁并行体格测量,与2006年WHO（简称WHO）和2005年中国九市城区（简称中国九市城区）标准的足月儿增长x珋值比较。结果符合本文纳入标准早产儿165例,达到WHO儿童生长发育标准P50水平后转换为任意品牌足月儿配方粉喂养,并于2-3岁均来我院随访,其中122例早产儿规律地完成了1-9月龄和12月龄的体格测量和喂养指导,43例未规律随访和接受喂养指导。早产儿男婴体重和身长与WHO标准差异有统计学意义,与中国九市城区标准头围差异有统计学意义。早产儿女婴体重与WHO标准差异有统计学意义。早产儿女婴头围与中国九市城区标准差异有统计学意义。早产儿男女婴儿各月龄体重、身长和头围的增长值差异无统计学意义。早产儿男女婴儿每月体重、身长和头围增长不符合足月儿生长规律。规律随访的婴儿至2-3岁均无生长偏离,未规律随访和接受喂养指导的婴儿至2-3岁,基于WHO标准出现生长偏离为54%（23/43）,基于中国九市城区标准出现生长偏离为98%（42/43）,均以超重危险和超重为主。结论早产儿的追赶生长不遵从足月儿规律,早产儿追赶生长现象贯穿于0-12月龄,婴儿期个体化喂养指导是幼儿期生长偏离的影响因素。与WHO标准相比采用中国九市城区BMI标准将升高超重危险和超重儿童的筛出率。

Objective To analyze the characteristics of catch-up growth among premature infants appropriate for gestational age（ AGA） and the growth deviation of them after 2 years of age. Methods Cohort study was used to design experimental program. The preterm infants without disease born in Chengdu Women ＇s and Children ＇s Central Hospital were involved. They were fed on premature formulas（ 74 Kcal·100 mL-（-1）） until their weight for height reached the WHO P50 level. Their weight,length and head circumference were measured every month during the first year. After 2 years of age they were asked to measure weight and length.All the data were compared with the WHO and Nine-Chinese-City criteria. Results The 165 preterm infants were involved in this study. All of them could be fed with any brand of formula when their weight for height reached the WHO P50 level,and were followed-up after the age of 2 years. 122 cases of premature infants had regularly completed 1 - 9 months and 12 months of physical measurement and feeding guidance,43 cases without regular follow-up when their weight for height reached the WHO P50 level. The weight and length of the premature male infants were statistically significant different with the WHO standards,and the head circumference was statistically significantly different with nine-Chinese- city criteria. For females,the weight and the head circumference were individually different with the WHO standards and the nine-Chinese- city criteria. There was no significant sex difference in physical measurement of growth of the premature infants appropriate for gestational age. There was no growth deviation in infants who were regularly followed-up. For those who were not regularly followed-up,54% infants（ 23 /43） were found growth deviation according to WHO standards,98% infants（ 42 /43） had growth deviation according to the nine-Chinese- city criteria.The growth deviates were mainly thin,risk of overweight and overweight. Conclusion The regularity of the premature infants growthis different from that of the full term infants. Catch-up growth can be seen through the first year in the premature infants. The regular clinical health care is the influencing factor of the growth deviation in children. The Nine-Chinese-City criteria will raise the screening rate of the wasting,overweight and obesity.