目的 探讨极低出生体重早产儿生后第一年生长发育情况及相关影响因素。方法 对61例极低出生体重早产儿进行出生后第一年的生长发育监测。采用Z评分法评价体格指标、丹佛发育筛查测验(DDST)进行发育筛查。结果 61例中小于胎龄儿(SGA)27例(44.3%),适于胎龄儿(AGA)34例(55.7%)。随访1年,年龄别体重(WAZ)、年龄别身长(HAZ)、年龄别头围(HCZ)、身长别体重(WHZ)的Z积分中位数均>-1 SD;年龄别体质指数(BMI)的Z积分(BAZ)以及WHZ的高峰在纠正年龄1个月。纠正胎龄40周时,低体重、生长迟缓、消瘦、小头畸形、超重和肥胖等的生长偏离发生率最高,分别为15%、16%、11%、13%、20%和10%。与纠正胎龄40周比,纠正年龄6个月及9~12个月的超重发生率(3%,3%)明显降低(P < 0.05)。至生后第一年,15例(25%)发育商(DQ)异常。SGA组DQ异常率高于AGA组(P < 0.05)。小于胎龄为极低出生体重早产儿生后第一年生长落后的独立危险因素。结论 极低出生体重早产儿在纠正龄3个月以内生长偏离明显。生后第一年DDST筛查异常的比例较高。
Abstract
Objective To investigate the physical growth and psychomotor development of very low birth weight (VLBW) preterm infants in the first year after birth and related influencing factors. Methods A total of 61 VLBW preterm infants received growth and development monitoring for 12 months. Z score was used to evaluate parameters for physical growth, and Denver Development Screen Test (DDST) was used for development screening. Results Among the 61 VLBW preterm infants, 27 (44.3%) were small-for-gestational-age (SGA) infants, and 34 (55.7%) were appropriate-for-gestational-age (AGA) infants. During the 1-year follow-up, the median weight-for-age Z-score (WAZ), height-for-age Z-score (HAZ), head circumference-for-age Z-score (HCZ), and weight-for-height Z score (WHZ) were >-1 SD in all age groups. The peaks of body mass index-for-age Z-score (BAZ) and WHZ appeared at 1 month of corrected age. At a corrected age of 40 weeks, the incidence rates of underweight, growth retardation, emaciation, microcephalus, overweight, and obesity were 15%, 16%, 11%, 13%, 20%, and 10%, respectively. Compared with those with a corrected age of 40 weeks, the infants with a corrected age of 6 months or 9-12 months had a significantly reduced incidence rate of overweight (3%) (P < 0.05). Up to 1 year after birth, 15 infants (25%) had abnormal developmental quotient (DQ). The SGA group had a significantly higher incidence rate of abnormal DQ than the AGA group (P<0.05). SGA was the independent risk factor for retarded growth in the first year after birth in VLBW preterm infants.Conclusions VLBW preterm infants experience an obvious growth deviation within 3 months of corrected age. Within the first year after birth, the proportion of infants with abnormal DQ screened by DDST is high.
关键词
极低出生体重 /
生长发育 /
Z积分 /
早产儿
Key words
Very low birth weight /
Growth and development /
Z-score /
Preterm infant
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参考文献
[1] Glass HC, Costarino AT, Stayer SA, et al. Outcomes for extremely premature infants[J]. Anesth Analg, 2015, 120(6): 1337-1351.
[2] Beck S, Wojdyla D, Say L, et al. The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity[J]. Bull World Health Organ, 2010, 88(1): 31-38.
[3] Patel RM, Kandefer S, Walsh MC, et al. Causes and timing of death in extremely premature infants from 2000 through 2011[J]. N Engl J Med, 2015, 372(4): 331-340.
[4] 曹玮, 张永红, 赵冬莹, 等. 34周以下早产儿宫外生长发育迟缓发生的影响因素[J]. 中国当代儿科杂志, 2015, 17(5): 453-458.
[5] 郭明明, 庄思齐, 李易娟. 早产儿宫外生长发育迟缓及相关因素分析[J]. 中国妇幼保健, 2010, 25(12): 1644-1647.
[6] Rüegger C, Hegglin M, Adams M, et al. Population based trends in mortality, morbidity and treatment for very preterm-and very low birth weight infants over 12 years[J]. BMC Pediatr, 2012, 12: 17.
[7] Cooke RW. Are there critical periods for brain growth in children born preterm?[J]. Arch Dis Child Fetal Neonatal Ed, 2006, 91(1): F17-20.
[8] Pierrat V, Marchand-Martin L, Guemas I, et al. Height at 2 and 5 years of age in children born very preterm: the EPIPAGE study[J]. Arch Dis Child Fetal Neonatal Ed, 2011, 96(5): F348-354.
[9] Horemuzova E, Åmark P, Jacobson L, et al. Growth charts and long-term sequelae in extreme preterm infants-from full-term age to 10 years[J]. Acta Paediatr, 2014, 103(1): 38-47.
[10] Niklasson A, Engström E, Hard AL, et al. Growth in very preterm children: a longitudinal study[J]. Pediatr Res, 2003, 54(6): 899-905.
[11] Allin M, Walshe M, Fern A, et al. Cognitive maturation in preterm and term born adolescents[J]. J Neurology Neurosurg Psychiatry, 2008, 79(4): 381-386.
[12] Murray E, Fernandes M, Fazel M, et al. Differential effect of intrauterine growth restriction on childhood neurodevelopment: a systematic review[J]. BJOG, 2015, 122(8): 1062-1072.
[13] 刘维民, 鲍秀兰, 马磊, 等. 早期干预降低极低出生体重儿脑瘫发生率的临床研究[J]. 中国儿童保健杂志, 2015, 23(4): 360-363.
[14] 蔡威, 汤庆娅, 王莹, 等. 中国新生儿营养支持临床应用指南[J]. 临床儿科杂志, 2013, 31(12): 1177-1182.
[15] 中国康复医学会儿童专业委员, 中国残疾人康复协会小儿脑瘫康复专业委员会.小儿脑瘫的定义分型和诊断条件[J].中华物理医学与康复杂志, 2007, 29(5): 309.
[16] 中国15城市体格发育科研协作组. 我国不同胎龄新生儿体格发育的现状[J]. 临床儿科杂志, 1991, 9(2): 72-77.
[17] 毛萌.生长发育[M]//王卫平,毛萌,李延玉,等. 儿科学. 第 8 版.北京: 人民卫生出版社, 2013: 8-22.
[18] 王庆红, 杨于嘉, 魏克伦, 等. 我国小于胎龄儿现状分析[J]. 中国实用儿科杂志, 2009, 24(3): 177-180.
[19] 王丹华. 关注早产儿的营养与健康—国际早产儿喂养共识解读[J]. 中国当代儿科杂志, 2014, 16(7): 664-669.
[20] Sharma PK, Sankar MJ, Sapra S, et al. Growth and neurosensory outcomes of preterm very low birth weight infants at 18 months of corrected age[J]. Indian J Pediatr, 2011, 78(12): 1485-1490.
[21] Mukhopadhyay K, Mahajan R, Louis D, et al. Longitudinal growth of very low birth weight neonates during first year of life and risk factors for malnutrition in a developing country[J]. Acta Paediatr, 2013, 102(3): 278-281.
[22] Fewtrell MS, Lucas A, Cole TJ, et al. Prematurity and reduced body fatness at 8-12y of age[J]. Am J Clin Nutr, 2004, 80(2): 436-440.
[23] Hovi P, Andersson S, Eriksson JG, et al. Glucose regulation in young adults with very low birth weight[J]. N Eng J Med, 2007, 356(20): 2053-2063.
[24] Finken MJ, Inderson A, Van Montfoort N, et al. Lipid profile and carotid intima-media thickness in a prospective cohort of very preterm subjects at age19 years: effects of early growth and current body composition[J]. Pediatr Res, 2006, 59(4 Pt 1): 604-609.
[25] 童梅玲, 张敏, 池霞, 等. 84 例早产适于胎龄儿第一年体格追赶生长纵向评估[J]. 中国当代儿科杂志, 2011, 13(1): 12-15.
[26] 欧阳小琳, 林希平. 极低出生体重儿的婴幼儿时期生长发育情况调查[J]. 中华儿科杂志, 2000, 38(5): 296-298.
[27] 田新新, 冉霓. 早产儿低出生体重对神经精神发育远期预后影响研究进展[J]. 中国实用儿科杂志, 2011, 26(2): 154-156.
[28] Guerra CC, Barros MC, Goulart AL, et al. Premature infants with birth weights of 1500-1 999 g exhibit considerable delays in several developmental areas[J]. Acta Paediatr, 2014, 103(1): e1-6.
[29] Kato T, Mandai T, Iwatani S, et al. Extremely preterm infants small for gestational age are at risk for motor impairment at 3 years corrected age[J]. Brain Dev, 2016, 38(2): 188-195.
[30] Westerberg AC, Henriksen C, Ellingvag A, et al. First year growth among very low birth weight infants[J]. Acta Pædiatr, 2010, 99(4): 556-562.
[31] 钱玉萍. 早产小于胎龄儿血清 Ghrelin, 胰岛素样生长因子-1, 胰岛素水平及其与生长发育关系[D]. 合肥: 安徽医科大学, 2013.
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