新生儿营养不良的诊断方法和对生长发育影响的研究

A Study on the Diagnosis of Neonatal Malnutrition and Fellow-up of the Infants.

【目的】 探讨新生儿营养不良的诊断方法和预后。 【方法】 对 49例小于胎龄儿 (SGA)和 3 5例出生体重位于第 10～ 2 5百分位数的适于胎龄儿 (AGA)进行临床营养状况评分法 (CANS)和血清胰岛素样生长因子I(IGF 1)、视黄醇结合蛋白 (RBP)与前白蛋白 (PA)测定 ,并在 2岁半时测定其体重、身高、智力发展指数 (MDI)和精神运动发展指数 (PDI)。 【结果】 CANS≤ 2 4分的营养不良SGA 2 4例 (4 9.0 % )、AGA 19例 (5 4.3 % ) ,无论SGA或AGA ,其血清IGF 1、RBP和PA水平、2岁半时体重、身高及其增幅 ,以及MDI与PDI ,营养不良组均显著低于营养正常组。 【结论】 新生儿营养不良的预后不良 ,推荐CANS和血清IGF 1、RBP与PA测定作为其诊断方法 ;这两类检查优于同类指标并优势互补 ,可常规应用于SGA和出生体重位于第 10～ 2 5百分位数的AGA。

To study the diagnostic methods and the prognosis of neonatal malnutrition. In 49 cases of small for gestational age infant (SGA) and 35 cases of appropriate for gestational age infant (AGA) whose birth weight were in 10th to 25th percentiles,the clinical assessment of nutritional status(CANS) and Insulin-like growth factor-1(IGF-1),Retinol-binding protein(RBP),prealbumin (PA) in serum were measured.The weight,stature,mental development index(MDI) and psychomotor development index(PDI) of the infants were measured at two and a half years old.The results were compared in groups of different nutritional status and SGA or AGA.24 cases of SGA (49.0%) and 19 cases of AGA(54.3%) had malnutrition (CANS≤24 cent).The levels of IGF-1,RBP and PA in the group of 24 malnutritional SGAs[(79.7±13.8)ng/ml,(20.6±7.0)mg/L and (35.3±24.4)mg/L] were significantly lower than that of 25 other SGAs[(95.0±28.3)ng/ml,(28.9±14.2)mg/L and (65.2±34.1)mg/L;t=2.930,2.578,3.513;P<0.05,0.05,0.001].The levers of IGF-1 RBP and PA in the group of 19 mulnutritional AGAs[(86.6±16.5)ng/ml,(24.5±11.6)mg/L and (106.6±16.6)mg/L] were also significantly lower than that of 16 other AGAs[(100.0±32.4)(31.8±7.5)mg/L and (198.3±68.3)mg/L;t=2.286,2.164,5.673;P<0.05,0.05,0.001].In spite of SGA or AGA,the weight,stature and their increased,MDI,PDI of the malnutritional one were significantly lower than that of the normal nutritional one.[Conclusions]The prognosis of neonatal malnutrition was poor.The CANS,IGF-1,RBP and PA in serum must be measured for the diagnosis of it.These examinations,which must be used routinely in SGA and AGA whose birth weight is in 10th to 25th percentile,are better than that in the same kind and have complemental advantages.