宫外生长迟缓早产儿出院后不同营养策略对体格及神经发育的近期影响

Short-term effects of different strengthening nutrition strategies on growth and neurobehavioral development of preterm infants with extrauterine growth restriction after discharge

目的对比分析宫外生长迟缓(extrauterine growth restriction,EUGR)早产儿出院后不同的强化营养策略对其生后1~6校正月龄体重、身长、头围等体格生长及神经发育指标的影响,为进一步寻找优化EUGR早产儿出院后的营养方案提供依据。方法收集连云港市第一人民医院新生儿重症监护病房2016年1月至2018年12月期间住院治愈出院的EUGR早产儿共178例,随机分为A、B两组,A组给予足量强化营养至校正胎龄40周后改半量强化营养至校正月龄6月龄,B组给予足量强化营养至体重达同校正胎龄平均体重的第10百分位后改半量强化营养至体重达同校正胎龄平均体重的第25百分位。分别在校正胎龄40周、校正月龄1~6月龄进行体格发育指标测定、校正月龄6月龄进行神经发育指标测定并比较两组的差异。统计学方法采用独立样本t检验和χ2检验。结果两组早产儿校正胎龄40周、校正月龄1月的体格发育情况比较差异无统计学意义(P>0.05)。校正月龄2月龄A组早产儿的体重、身长、头围均超过B组早产儿[体重(4692±196)与(4630±211)g,身长(55.7±0.8)与(55.3±0.9)cm,头围(37.4±0.6)与(37.0±0.6)cm,P<0.05]。校正月龄3月龄A组早产儿的体重、身长、头围均超过B组早产儿(P<0.05)。校正月龄4月龄A组早产儿的体重、身长、头围均超过B组早产儿[体重(6480±305)与(6385±270)g,身长(63.1±1.2)与(62.0±1.1)cm,头围(40.4±0.7)与(40.1±0.6)cm,P<0.05]。校正月龄5月龄A组早产儿的体重、身长、头围均超过B组早产儿(P<0.05)。校正月龄6月龄A组早产儿的体重、身长、头围均超过B组早产儿[体重(7643±359)与(7452±305)g,身长(66.1±1.3)与(65.7±1.0)cm,头围(42.2±0.7)与(42.0±0.6)cm,P<0.05]。校正胎龄40周两组早产儿新生儿神经行为评分以及异常率比较差异无统计学意义(P>0.05);校正月龄6月龄两组早产儿Gesell评分异常率、应物能、语言能、应人能评分比较均无统计学意义(P>0.05),A组早产儿粗大动作能及精细动作能评分明显高于B组早产儿(P<0.05)。结论两组所采用的强化营养策略均可帮助EUGR早产儿追赶性生长,足量强化营养至校正胎龄40周后改半量强化营养至校正月龄6月龄上在体格发育有明显优势,而神经发育的近期优势不明显。

Objective To compare the effects of different strengthening nutrition strategies on growth including weight,length and head circumference,and neurobehavioral development at 1 to 6 months of preterm infants with extrauterine growth restriction(EUGR)after discharge,so as to provide a basis for further optimizing the nutrition program of preterm infants with EUGR after discharge.Methods 178 preterm infants with EUGR hospitalized and discharged from NICU in the First People's Hospital of Lianyungang from January 2016 to December 2018 were collected.The preterm infants were randomly divided into two groups.Group A were given full dose enrich nutrition until they reached 40 weeks corrected gestational age and half dose enrich nutrition until they reached 6 months corrected age,while group B were given full dose enrich nutrition until their weight index reached the 10th percentile on growth charts with corrected age and half dose enrich nutrition until their weight index reached the 25th percentile on growth charts with corrected age.The two groups were evaluated and compared with growth index when they reached 40 weeks in corrected gestational age and 1 to 6 months in corrected age.And they were evaluated and compared with neurodevelopment index when they reached 6 months in corrected age.The statistical methods used independent sample t test andχ2 test.Results The differences of growth indexes between the two groups were not significant at 40 weeks corrected gestational age and 1 month corrected age(P>0.05).Group A had gained significantly more weight,length and head circumference than group B at 2 months corrected age[weight(4692±196)vs(4630±211)g,length(55.7±0.8)vs(55.3±0.9)cm,head circumference(37.4±0.6)vs(37.0±0.6)cm,P<0.05].Group A had gained significantly more weight,length and head circumference than group B at 3 months corrected age(P<0.05).Group A had gained significantly more weight,length and head circumference than group B at 4 months corrected age[weight(6480±305)vs(6385±270)g,length(63.1±1.2)vs(62.0±1.1)cm,head circumference(40.4±0.7)vs(40.1±0.6)cm,P<0.05].Group A had gained significantly more weight,length and head circumference than group B at 5 months corrected age(P<0.05).Group A had gained significantly more weight,length and head circumference than group B at 6 months corrected age[weight(7643±359)vs(7452±305)g,length(66.1±1.3)vs(65.7±1.0)cm,head circumference(42.2±0.7)vs(42.0±0.6)cm,P<0.05].The neonatal behavioral neurological assessment scores and abnormal rate of premature infants in groups A and B at 40 weeks corrected gestational age showed no statistical significance(P>0.05).There was no significant difference in abnormal rate of Gesell score,physical ability,language ability,or human ability scores between the two groups of premature infants at 6 months corrected age(P>0.05).Compared with group A,group B showed significantly backwardness at 6 months corrected age in gross motor and fine motor level(P<0.05).Conclusions The strengthening nutritional strategies adopted by the two groups can help preterm infants with EUGR to catch up with their growth.Full dose enrich nutrition until they reached 40 weeks corrected gestational age and half dose enrich nutrition until they reached 6 months corrected age shows a clear advantage in physical development,but the short-term advantage in neurodevelopment is not obvious.