小于胎龄极低出生体重早产儿营养摄入与骨代谢特点的回顾性研究

The characteristics of nutritional intake and bone metabolism in preterm infants with very low birth weight and small gestational age

目的探讨极低出生体重早产儿中小于胎龄儿(small for gestational age infant,SGA)与适于胎龄儿(appropriate for gestational age infant,AGA)营养摄入及骨代谢的差异。方法回顾性分析2015年1月至2020年1月首都医科大学附属北京妇产医院新生儿重症监护病房收治的胎龄<32周、出生体重<1500 g、生后即入院且存活4周以上的早产儿病例资料,选取SGA组,按1∶1的比例配对同时间住院的AGA组。收集患儿母亲孕期基本情况,早产儿生后第1、2、4周血生化中血清总钙、血磷、血镁、碱性磷酸酶情况,以及营养摄入指标。应用SPSS 22.0统计软件分析营养摄入与骨代谢指标的关系。结果SGA组和AGA组各纳入80例。两组生后2周内低磷血症发生率差异无统计学意义(P>0.05),生后第4周SGA组低磷血症发生率低于AGA组[36.3%(29/80)比56.3%(45/80)],差异有统计学意义(P<0.05);生后第2周、第4周SGA组碱性磷酸酶>500 U/L比例均高于AGA组[16.3%(13/80)比1.3%(1/80),21.3%(17/80)比2.5%(2/80)],差异有统计学意义(P<0.05);两组血清镁差异无统计学意义(P>0.05)。SGA组延迟开奶发生率高于AGA组[67.5%(54/80)比26.2%(21/80)],肠外营养时间长于AGA组[(49.4±14.4)d比(40.5±18.2)d],热卡摄入和肠内营养增长均较AGA组慢,差异有统计学意义(P<0.05)。结论极低出生体重早产儿中SGA较AGA营养摄入更差,更易发生骨代谢异常。

Objective To study the differences in nutritional intake and bone metabolism between small gestational age infant(SGA)and appropriate gestational age infant(AGA)in very low birth weight(VLBW)preterm infants.Methods From January 2015 to January 2020,infants admitted to the neonatal intensive care unit of our hospital immediately after birth and survived more than 4 weeks were retrospectively studied.The infants with GA<32 weeks,BW<1500 g and small for gestational age were assigned into SGA group.Each SGA group infants were paired with an AGA infants The perinatal history was reviewed.Serum total calcium,blood phosphorus,blood magnesium,alkaline phosphatase and other nutritional intake indicators in the blood biochemistry were examined at 1 w,2 w and 4 w after birth.SPSS 22.0 statistical software was used to analyze the relationship between nutritional intake and bone metabolism indexes.Results A total of 80 cases were included in SGA group and AGA group,respectively.No significant difference existed in the incidence of hypophosphatemia within 2w after birth between the two groups(P>0.05).SGA group had significantly lower incidence of hypophosphatemia at 4w than AGA group[36.3%(29/80)vs.56.3%(45/80)](P<0.05).SGA group showed significantly higher proportion of ALP>500 U/L cases than AGA group at 2 w and 4 w[16.3%(13/80)vs.1.3%(1/80),21.3%(17/80)vs.2.5%(2/80)](P<0.05).The two groups had similar serum magnesium level(P>0.05).SGA group had higher incidence of delayed milk feeding[67.5%(54/80)vs.26.2%(21/80)],longer parenteral nutrition duration[(49.4±14.4)d vs.(40.5±18.2)d]and slower increase of calorie intake and enteral nutrition than AGA group(P<0.05).Conclusions Among VLBW preterm infants,SGA infants have worse nutritional intake than AGA and are more vulnerable to abnormal bone metabolism.