出生体重<1500 g极早产儿宫外发育迟缓危险因素分析

Risk factors of extrauterine growth retardation in very preterm infants with birth weight less than 1500 g

目的分析出生体重<1500 g极早产儿住院期间发生宫外发育迟缓(extrauterine growth restriction,EUGR)的危险因素。方法选择2015—2020年南京市妇幼保健院收治、出生体重<1500 g的极早产儿进行回顾性研究,根据出院时体重分为EUGR组和非EUGR组,采用多因素logistic回归分析出生体重<1500 g极早产儿发生EUGR的危险因素。结果共纳入969例极早产儿,EUGR组400例(41.3%),非EUGR组569例(58.7%)。多因素logistic回归分析显示,出生体重Z评分(OR=0.057,95%CI 0.037~0.088,P<0.001)和EUGR的发生密切相关,恢复至出生体重后平均体重增长速率快(OR=0.537,95%CI 0.479~0.602,P<0.001)是EUGR的保护因素,母亲妊娠期高血压(OR=1.895,95%CI 1.059~3.394,P=0.031)、出生时窒息(OR=2.508,95%CI 1.265~3.347,P=0.004)、中重度支气管肺发育不良(OR=2.660,95%CI 1.503~4.708,P=0.001)是出院时发生EUGR的危险因素。结论EUGR仍是极早产儿普遍存在的问题,提高体重增长速率、防治中重度支气管肺发育不良可降低极早产儿EUGR发生率。

Objective To study the risk factors of extrauterine growth retardation(EUGR)during hospitalization in very preterm infants(VPIs)with birth weight(BW)<1500 g.Methods From Jan 2015 to Dec 2020,clinical data of VPIs admitted to neonatal department our hospital were retrospectively studied.The infants were assigned into EUGR group and non-EUGR group according to their weight at discharge.Multivariate logistic regression analysis was used to analyze the risk factors of EUGR in VPIs.Results A total of 969 VPIs were enrolled,including 400 cases of EUGR(41.3%).Multivariate logistic regression analysis showed that Z-score of BW(OR=0.057,95%CI 0.037-0.088,P<0.001)was closely correlated with the occurrence of EUGR and growth velocity(GV)after regain BW(OR=0.537,95%CI 0.479-0.602,P<0.001)was a protective factor for EUGR.Maternal hypertension during pregnancy(OR=1.895,95%CI 1.059-3.394,P=0.031),asphyxia at birth(OR=2.508,95%CI 1.265-3.347,P=0.004)and moderate to severe bronchopulmonary dysplasia(BPD)(OR=2.660,95%CI 1.503-4.708,P=0.001)were risk factors for EUGR at discharge.Conclusions EUGR is still common in VPIs.Increased GV after regain BW,prevention and treatment of moderate to severe BPD may reduce the incidence of EUGR at discharge in VPIs.