海口市不同宫内生长状态早产儿体格生长状况分析

Analysis of physical growth of preterm infants with different intrauterine growth patterns in Haikou

目的分析不同宫内生长状态早产儿的生长模式。方法回顾性分析2015年10月1日至2021年6月1日在海口市各辖区出生并定期进行系统保健及管理的早产儿10 856例的一般资料和生长发育及监测随访指标, 按不同宫内生长状态分为适于胎龄、小于胎龄和大于胎龄3组。采用H检验或χ2检验比较不同组别早产儿的一般特征, 局部加权回归(LOESS)拟合不同组别的体格生长指标的发育曲线。结果 10 856例早产儿中男6 317例、女4 539例, 出生胎龄35(34, 36)周, 出生体重2.5(2.1, 2.8)kg。小于胎龄 754例(6.9%), 适于胎龄 9 301例(85.7%), 大于胎龄 801例(7.4%)。小于胎龄组出生体重低于适于胎龄和大于胎龄组(Z=2 274.93, P<0.001);适于胎龄组在首次体检中纯母乳喂养的比例高于小于胎龄组[68.6%(6 378/9 301)比62.9%(474/754), χ^(2)=13.82, P=0.003]。LOESS拟合结果显示, 3组早产儿的体重、身长在校正月龄0~6月龄增长较快, 适于胎龄与大于胎龄组各校正月龄段的年龄的体重Z评分、年龄的身长Z评分和身长的体重Z评分回归预测值在0s左右, 而小于胎龄早产儿为-1~0s;校正月龄0~17月龄, 适于胎龄组低体重、生长迟缓和消瘦的比例分别为0.3%(16/4 838)~1.9%(47/2 506)、0.4%(18/4 838)~2.4%(51/2 124)、2.1%(88/4 135)~4.4%(214/4 838), 大于胎龄组分别为0(0/296)~1.0%(2/199)、0(0/341)~1.6%(3/186)、1.0%(2/199)~2.6%(9/341), 小于胎龄组分别为7.6%(25/330)~16.8%(28/167)、5.2%(17/330)~10.6%(32/303)、3.9%(3/77)~12.6%(21/167);此外, 3组体重、身长月增长值随着月龄的增加而减少, 其中小于胎龄组身长月增长值在校正月龄0~2、2~5月龄分别为4.0和2.4 cm/月。结论大部分早产儿出现了追赶生长, 小于胎龄早产儿生长发育整体落后于适于胎龄和大于胎龄早产儿, 应重点关注小于胎龄早产儿的体格生长, 及时纠正生长偏离情况。

Objective To analyze the physical growth of preterm infants with different intrauterine growth patterns.Methods A total of 10856 preterm infants who were born in various districts of Haikou City from October 1st,2015 to June 1st,2021 and received regular health care and management were retrospectively enrolled.The preterm infants were divided into appropriate for gestational age(AGA),small for gestational age(SGA)and large for gestational age(LGA)groups according to different intrauterine growth patterns.The general characteristics of preterm infants in different groups were compared by H test(Kruskal and Wallis)or Chi-squared test.And the developmental curves were plotted by local regression(LOESS)with their physical growth indexes.Results Of the 10856 preterm infants,6317 were boys and 4539 were girls.The gestational age at birth was 35(34,36)weeks,and the birth weight was 2.5(2.1,2.8)kg.There were 754(6.9%)SGA,9301(85.7%)AGA,and 801(7.4%)LGA preterm infants.All preterm infants were followed up until 18 months of corrected age.The birth weight of the SGA group was lower than that of the AGA and LGA groups(Z=2274.93,P<0.001).The proportion of exclusive breastfeeding at the first health care interview was higher in the AGA group(68.6%(6378/9301))than in the SGA group(62.9%(474/754))(χ^(2)=13.82,P=0.003).The LOESS curving fitting showed that the weight and height of the preterm infants in all the 3 groups increased rapidly during 0-6 months of corrected age.The regression prediction values of weight for age Z-score(WAZ),height for age Z-score(HAZ)and weight for height Z-score(WHZ)were around 0 s,while the regression prediction values of these three indicators in SGA were all below 0 s but greater than-1 s.The rates of low birth weight,growth retardation and wasting during 0-17 months of corrected age were 0.3%(16/4838)-1.9%(47/2506),0.4%(18/4838)-2.4%(51/2124),and 2.1%(88/4135)-4.4%(214/4838)in AGA groups,and 0(0/296)-1.0%(2/199),0(0/341)-1.6%(3/186)and 1.0%(2/199)-2.6%(9/341)in LGA group,whereas 7.6%(25/330)-16.8%(28/167),5.2%(17/330)-10.6%(32/303)and 3.9%(3/77)-12.6%(21/167)in SGA group.In addition,the monthly growth of weight and height of preterm infants in all the 3 groups decreased with the increasing age,and the monthly weight gain.The length increment was 4.0 cm/month during corrected 0-2 month of age and 2.4 cm/month during corrected 2-5 month of age in the SGA preterm infants.Conclusions Most of the preterm infants could have an appropriate catch-up growth,but the growth and development in the SGA preterm infants lags behind that of their AGA and LGA peers.The physical growth of SGA premature infants should be paid more attention to,to timely correct the growth deviations.