
早产儿出院时宫外发育迟缓的危险因素分析
蔡岳鞠, 宋燕燕, 黄志坚, 李坚, 肖旭文, 齐俊冶, 王兰秀
中国当代儿科杂志 ›› 2015, Vol. 17 ›› Issue (7) : 659-662.
早产儿出院时宫外发育迟缓的危险因素分析
Risk factors for extrauterine growth retardation at discharge in premature infants
目的 探讨早产儿出院时宫外发育迟缓(EUGR)发生率及相关危险因素。方法 回顾性分析2006~2010 年入住NICU 的596 例早产儿的临床资料,根据出院时体重分为EUGR 组(n=217)与非EUGR 组(n=379),应用logistic 多因素回归分析EUGR 发生的危险因素。结果 596 例早产儿按体重、身长、头围评价,出院时EUGR 的发生率分别为36.4%(217 例)、42.0%(250 例)、22.8%(136 例)。小胎龄、低出生体重、宫内发育迟缓(IUGR)、首次肠道喂养时间晚及呼吸系统合并症是早产儿发生EUGR 的危险因素(OR分别为6.508、14.522、5.101、1.366、1.501)。结论 加强母亲围产期保健,减少早产的发生,减少IUGR 的发生,尽早进行肠道喂养,积极防治生后合并症对降低EUGR 的发生率有较大意义。
Objective To study the incidence and risk factors for extrauterine growth retardation (EUGR) at discharge in premature infants. Methods A retrospective analysis was performed on 596 premature infants who were admitted to the neonatal intensive care unit between 2006 and 2010. These subjects were classified into EUGR (n=217) and non-EUGR groups (n=379) based on the body weight at discharge. The risk factors for the occurrence of EUGR were studied by multivariate logistic regression analysis. Results Based on the body weight, length, and head circumference, the incidence of EUGR at discharge was 36.4% (217 cases), 42.0% (250 cases), and 22.8% (136 cases), respectively. Low gestational age, low birth weight, intrauterine growth retardation (IUGR), delayed enteral feeding and complications of the respiratory system were identified as risk factors for EUGR (OR=6.508, 14.522, 5.101, 1.366, and 1.501, respectively). Conclusions The incidence of EUGR might be greatly decreased by strengthening the perinatal care, reducing the incidence of premature delivery and IUGR, undertaking early enteral feeding, and actively preventing postnatal complications.
Extrauterine growth retardation / Risk factor / Premature infant
[1] Nash A, Dunn M, Asztalos E, et al. Pattern of growth of very low birth weight preterm infants, assessed using the WHO Growth standards,is associated with neurodevelopment[J]. Appl Physiol Nutr Metab, 2011, 36(4): 562-569.
[2] Ortiz-Espejo M, Perez-Navero JL, Olza-Meneses J, et al. Prepubertal children with a history of extrauterine growth restriction exhibit low-grade in flammation[J]. British J Nutr, 2014, 112(3): 338-346.
[3] Ortiz-Espejo M, Perez-Navero JL, Munoz-Villanueva MC, et al. Nutritional assessment in neonatal and prepubertal children with a history of extrauterine growth restriction[J]. Early Hum Dev, 2013, 89(9): 763-768.
[4] Ortiz-Espejo M, Gil Campos M, Munoz Villanueva MC, et al. Metabolic changes in prepuberty children with extrauterine growth restriction[J]. An Pediatr (Barc), 2012, 77(4): 247-253.
[5] 郭明明, 庄思齐, 李易娟. 早产儿宫外生长迟缓及相关因素 分析[J]. 中国妇幼保健, 2010, 25(12): 1644-1647.
[6] 柳洁, 肖绪武, 刁敬军, 等. 早产儿宫外生长迟缓发生情况 及相关危险因素分析[J]. 中国新生儿科杂志, 2011, 26(5): 308-310.
[7] Clark RH, Thomas P, Peabody J. Extrauterine growth restriction remains a serious problem in prematurely born neonates[J]. Pediatrics, 2003, 111(5): 986-990.
[8] 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 第4 版. 北京: 人民卫生出版社, 2011: 954-956.
[9] Cooke RJ, Ainsworth SB, Fenton AC. Postnatal growth retardation:a universal problem in preterm infants[J]. Arch Dis Child Fetal Neonatal Ed, 2004, 89(5): 428-430.
[10] 早产儿营养调查协作组. 新生儿重症监护病房中早产儿营 养相关状况多中心调查974 例报告[J]. 中华儿科杂志, 2009, 47(1): 12-17.
[11] 钟庆华, 梁琨, 贺湘英. 新生儿重症监护室中早产儿营养状 况及宫外生长发育迟缓的危险因素[J]. 中国当代儿科杂志, 2012, 14 (1): 20-23.
[12] Sakurai M, Itabashi K, Sato Y, et al. Extrauterine growth restriction in preterm infants of gestational age ≤32 weeks[J]. Pediatr Int, 2008, 50(1): 70-75.
[13] 极低出生体重儿营养与生长发育研究协作组. 极低出生体重 儿院内生长发育状态多中心回顾性研究[J]. 中华儿科杂志, 2013, 51 (1): 4-11.
[14] Koletzko B, Goulet O, Hunt J, et al. Guidelines on Pediatric Parenteral Nutrition of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPG HAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), Supported by the European Society of Pediattic Research (ESPR)[J]. J Pediatr Gastroenterol Nutr, 2005, 4l(Suppl 2): S1-S87.
[15] McCallie KR, Lee HC, Mayer O, et al. Improved outcomes with a standardized feeding protocol for very low birth weight infants[J]. J Perinatol, 2011, 31(1): 61-67.
[16] Clark RH, Thomas P, Peabody J. Extrauterine growth restriction remains a serious problem in prematurely born neonates[J]. Pediatrics, 2003, 111(5): 986-990.