89例早产儿矫正月龄2岁内体格发育纵向研究

Longitudinal study on physical development of 89 preterm infants within 2 years of corrected age

目的了解早产儿0~2岁纵向生长发育特点,为早产儿生长发育监测和营养指导提供参考依据。方法选取2012年7月至2013年6月在四川省妇幼保健院出生,在儿保科随访的89例早产儿为研究对象,并按照出生时胎龄和体重将其分为小于胎龄早产儿组(SGA,29例)和适于胎龄早产儿组(AGA,60例)。进行0~24月龄生长发育监测,包括体重、身长、头围测量和喂养咨询指导,共完成12次随访。结果 (1)SGA组早产儿在大部分矫正月龄身长、体重、头围值和年龄别体重Z值(WAZ)、年龄别身长Z值(HAZ)、年龄别头围Z值(HCZ)均低于AGA组早产儿,且差异有统计学意义(体重:t=-5.24^-3.15,均P<0.05;身长:t=-5.23^-2.95,均P<0.05;头围:t=-2.91^-2.01,均P<0.05;WAZ:t=-5.93^-3.07,均P<0.05;HAZ:t=-5.51^-4.01,均P<0.05;HCZ:t=-3.52^-2.36,均P<0.05)。(2)SGA组在绝大多数矫正月龄,WAZ、HAZ和HCZ均为负值。AGA组早产儿WAZ和HCZ在大多数矫正月龄为正值,而HAZ在矫正3月龄前为正值,3月龄后均为负值。(3)比较两组早产儿体格发育的增长速率发现,3~4月龄段,SGA组体重、身长和头围的增长速率值低于AGA组,两组差异有统计学意义(t值分别为-2.57、-4.23、-2.73,均P<0.05),SGA组在5~6月龄身长增长速率值、8~10月龄头围增长速率值、10~12月龄体重和头围增长速率值均低于AGA组,两组差异有统计学意义(t值分别为-3.03、-2.36、-3.42、-2.48,均P<0.05)。18~24月龄段,SGA组体重、身长的增长速率值低于AGA组,两组差异有统计学意义(t值分别为-3.73、-2.91,均P<0.05)。(4)比较两组早产儿体格发育的增速发现,在出生1个月内,SGA组体重的△Z值明显大于AGA组(t=2.63,P<0.05),而SGA组在3~4月龄体重、身长和头围的△Z值,12~18月龄体重和头围的△Z值,18~24月龄体重、身长和头围的△Z值低于AGA组早产儿,两组差异均有统计学意义(t值分别为-2.72、-3.23、-2.63、-2.52、2.26、-2.73、3.61、2.91,均P<0.05)。结论 AGA早产儿追赶生长持续到2岁,SGA早产儿1岁内追赶生长明显,其生长潜能落后于AGA早产儿。在临床工作中应重视早产儿尤其SGA早产儿的追赶生长发育。

Objective To understand the characteristics of longitudinal growth and development of preterm infants from 0 to 24 months old and to provide reference for the growth and development monitoring and nutritional guidance for preterm infants.Methods A total of 89 preterm infants in the department of children healthcare in Sichuan Maternal and Children＇s Hospital were selected as study subjects.According to gestational age and weight at birth,the infants were divided into small for gestational age group（SGA,29 cases）and appropriate for gestational age group（AGA,60 cases）.The growth and development indexes of the infants,including weight,body length,and head circumference were monitored within 24 months.Feeding advice and guidance were provided.A total of 12 follow-ups were completed.Results At most corrected month age,the body length,weight,head circumference,Z-scores of weight-for-age（WAZ）,Z-scores of height-for-age（HAZ）,and Z-scores of head circumference-for-age（HCZ）of preterm infants in the SGA group were lower than those in the AGA group,and the differences were statistically significant（weight：t value ranged-5.24 to-3.15,all P〈0.05;length：t value ranged-5.23 to-2.95,all P〈0.05;head circumference：t value ranged-2.91 to-2.01,all P〈0.05;WAZ：t value ranged-5.93 to-3.07,all P〈0.05;HAZ：t value ranged-5.51 to-4.01,all P〈0.05;HCZ：t value ranged-3.52 to-2.36,all P〈0.05）.At most corrected month age,WAZ,HAZ,and HCZ of preterm infants in the SGA group were negative,while in the AGA group,WAZ and HAZ were positive.And in the AGA group,HAZ was positive within 3 months but negative after 3 months.The comparison of growth rate of physical development between two groups showed that at 3-4 months old,the growth rates of weight,body length and head circumference in the SGA group were lower than those in the AGA group.There were statistically significant differences between two groups（t value was-2.57,-4.23 and-2.73,respectively,all P〈0.05）.The growth rate of body lenght at 5-6 months old,the growth rate of head circumference at 8-10 months old,and the growth rates of weight and head circumference at 10-12 months old in the SGA group were lower than those in the AGA group,and the differences between two groups were statistically significant（t value was-3.03,-2.36,-3.42 and-2.48,respectively,all P〈0.05）.At 18-24 months old,the growth rates of weight and body length in the SGA group were lower than those in the AGA group,and the differences between two groups were statistically significant（t value was-3.73 and-2.91,respectively,both P〈0.05）.Comparison of growth rates of physical development of preterm infants between two groups showed that within 1 month of birth,the △Z value of weight in the SGA group was significantly greater than that in the AGA group（t=2.63,P〈0.05）,but the △Z values of weight,body length and head circumference at 3-4 months old,the△Z values of weight and head circumference at 12-18 months old,and the△Z values of weight,body length and head circumference at 18-24 months old in the SGA group were lower than those of the AGA group,and the differences between two groups were statistically significant（t value was-2.72,-3.23,-2.63,-2.52,2.26,-2.73,3.61,and 2.91,respectively,all P〈0.05）.Conclusion The catch-up growth of AGA preterm infants lasts until 2 years old.The catch-up growth of SGA preterm infants is remarkable within 1 year old,and their growth potential lags behind AGA preterm infants.In clinical practice,we should pay attention to the catch-up growth of preterm infants,especially SGA preterm infants.