超低／极低出生体重儿出院后早期的生长发育情况

Early growth and development of extremely / very low birth weight infants after discharge

目的对超/极低出生体重儿（extremely low birth weight infant/ very low birth weight infant，ELBWI/VLBWI）出院后进行定期追踪随访，评估其生长发育情况。方法研究对象为2013年1月至2014年6月湖南省儿童医院新生儿重症监护病房（neonatal intensive care unit，NICU）收治并存活出院的ELBWI/VLBWI病例。在纠正胎龄40周及纠正年龄1、3、6、12和18个月分别进行定期随访，通过测量这些患儿的生长发育指标，评估其生长发育情况。采用t检验、秩和检验、χ2检验（或Fisher精确概率法）对数据进行统计学分析。结果（1）研究期间出院的ELBWI/VLBWI共285例，其中，存活并且随访资料完整者145例（50.9%），37例（13.0%）死亡，103例（36.1%）失访。失访与完成随访的ELBWI/VLBWI的临床资料比较，差异均无统计学意义（P值均〉0.05）。（2）参照头围和体重生长曲线，ELBWI和VLBWI的发育迟缓发生率（≤第10百分位数）在纠正年龄3个月时达到最高[分别为42.8%（62/145）和40.0%（58/145）]，此后随年龄增长呈下降趋势。在纠正年龄18个月时，按体重和头围计算的宫外生长迟缓（extrauterine growth retardation，EUGR）发生率分别为14.5%（21/145）和31.7%（46/145）。（3）发生和未发生EUGR的患儿的性别、胎龄、出生体重、住院时间、氧疗时间及并发症发生率差异均无统计学意义（P值均〉0.05）。（4）发生EUGR的新生儿使用肺表面活性物质的比例低于未发生EUGR的新生儿[27.8%（15/54）与53.8%（49/91），χ2=9.340，P〈0.05]，而纠正年龄12和18个月的智力及精神运动发育指数，以及18个月的头围和体重与未发生EUGR的患儿相比，差异均无统计学意义（P值均〉0.05）。（5）纠正年龄18个月时，31.7%（46/145）的婴儿的头围、14.5%（21/145）的体重≤第10百分位。头围≤第10百分位的患儿的神经损害的发生率高于头围〉第10百分位者[67.4%（31/46）与40.4%（40/99），χ2=9.154]；头围或体重之一≤第10百分位的患儿的神经损害发生率高于头围和体重均〉第10百分位的患儿[65.5%（36/55）与38.9%（35/90），χ2=9.641]（P值均〈0.05）。结论ELBWI/VLBWI生后早期EUGR发生率较高。生长迟缓随年龄增长有所减轻。

ObjectiveTo investigate the early growth and development of extremely low birth weight infants （ELBWI） and very low birth weight infants （VLBWI） through a follow-up study from hospital discharge until 18 months of corrected age.MethodsELBWI and VLBWI who were hospitalized and discharged alive from the Neonatal Intensive Care Unit of Hunan Children＇s Hospital from January 2013 to June 2014 were recruited. Follow-ups were performed at the corrected age of 40 weeks, as well as at one, three, six, 12 and 18 months of corrected age. Several parameters indicating the growth and development of those infants were monitored and assessed. Extrauterine growth retardation （EUGR） was defined as head circumference （HC） or weight≤10th percentile for gestational age at discharge. T-, rank-sum, or Chi-square （or Fisher＇s exact） test was performed for statistical analysis.Results（1） A total of 285 ELBWI and VLBWI were recruited. Among them, 145 （50.9%） were alive at last follow-up, 37 （13.0%） died, and 103 （36.1%） were lost. No significant differences in clinical data were observed between the infants who completed the follow-up and those who did not （all P〉0.05）. （2） Based on HC and weight, the incidences of EUGR in the 145 infants reached the peak at the corrected age of three months [42.8% （62/145） and 40.0% （58/145）], and then declined with increasing age. At 18 months of corrected age, the incidences of EUGR dropped to 31.7% （46/145） and 14.5% （21/145）, respectively. （3） There were no significant differences in gender, gestational age, birth weight, length of hospital stay, duration of oxygen therapy, and incidences of complications between the infants with and without EUGR （all P〉0.05）. （4） The rate of pulmonary surfactant therapy in neonates with EUGR was lower than in those without [27.8% （15/54） vs 53.8% （49/91）, χ2=9.340, P〈0.05]. There were no significant differences in mental development index and psycho-motor development index at 12 and 18 months of corrected age between the neonates with and without EUGR （all P〉0.05）. Neither HC nor weight at the corrected age of 18 months showed significant differences between the two groups （both P〉0.05）. （5） At 18 months of corrected age, 31.7% （46/145） of the infants had their HC≤10th percentile, and 14.5% （21/145） had their weight≤10th percentile. Infants with HC≤10th percentile were at higher risk of abnormal neurodevelopment than those with HC 〉10th percentile [67.4% （31/45） vs 40.4% （40/99）, χ2=9.154]. Infants with either HC or weight ≤10th percentile had higher risk of abnormal neurodevelopment that those with both HC and weight 〉10th percentile [65.5% （36/55） vs 38.9% （35/90）, χ2=9.641] （both P〉0.05）.ConclusionsELBWI/VLBWI are at high risk of growth retardation. Incidence of growth restriction declines with age.