住院极早产儿宫外生长迟缓及相关因素的多中心前瞻性研究

沈蔚; 郑直; 林新祝; 吴繁; 田倩欣; 崔其亮; 袁媛; 任玲; 毛健; 石碧珍; 王玉梅; 刘玲; 张京慧; 常艳美; 童笑梅; 朱燕; 张蓉; 叶秀桢; 邹静静; 李怀玉; 赵宝银; 邱银萍; 刘淑华; 马莉; 徐颖; 程锐; 周文莉; 武辉; 刘志勇; 陈冬梅; 高金枝; 刘晶; 陈玲; 李丛; 杨春燕; 许平; 张亚昱; 呼斯乐; 梅花; 杨祖铭; 冯宗太; 王三南; 孟二艳; 尚利宏; 徐发林; 欧少苹; 巨容

doi:10.7499/j.issn.1008-8830.2111143

PDF(674 KB)

HTML

中国当代儿科杂志 ›› 2022, Vol. 24 ›› Issue (2) : 132-140. DOI: 10.7499/j.issn.1008-8830.2111143

论著·临床研究

住院极早产儿宫外生长迟缓及相关因素的多中心前瞻性研究

沈蔚, 郑直, 林新祝, 吴繁, 田倩欣, 崔其亮, 袁媛, 任玲, 毛健, 石碧珍, 王玉梅, 刘玲, 张京慧, 常艳美, 童笑梅, 朱燕, 张蓉, 叶秀桢, 邹静静, 李怀玉, 赵宝银, 邱银萍, 刘淑华, 马莉, 徐颖, 程锐, 周文莉, 武辉, 刘志勇, 陈冬梅, 高金枝, 刘晶, 陈玲, 李丛, 杨春燕, 许平, 张亚昱, 呼斯乐, 梅花, 杨祖铭, 冯宗太, 王三南, 孟二艳, 尚利宏, 徐发林, 欧少苹, 巨容

作者信息 +

Incidence of extrauterine growth retardation and its risk factors in very preterm infants during hospitalization: a multicenter prospective study

SHEN Wei, ZHENG Zhi, LIN Xin-Zhu, WU Fan, TIAN Qian-Xin, CUI Qi-Liang, YUAN Yuan, REN Ling, MAO Jian, SHI Bi-Zhen, WANG Yu-Mei, LIU Ling, ZHANG Jing-Hui, CHANG Yan-Mei, TONG Xiao-Mei, ZHU Yan, ZHANG Rong, YE Xiu-Zhen, ZOU Jing-Jing, LI Huai-Yu, ZHAO Bao-Yin, QIU Yin-Ping, LIU Shu-Hua, MA Li, XU Ying, CHENG Rui, ZHOU Wen-Li, WU Hui, LIU Zhi-Yong, CHEN Dong-Mei, GAO Jin-Zhi, LIU Jing, CHEN Ling, LI Cong, YANG Chun-Yan, XU Ping, ZHANG Ya-Yu, HU Si-Le, MEI Hua, YANG Zu-Ming, FENG Zong-Tai, WANG San-Nan, MENG Er-Yan, SHANG Li-Hong, XU Fa-Lin, OU Shao-Ping, JU Rong

Author information +

文章历史 +

摘要

目的了解我国住院极早产儿（very preterm infant，VPI）宫外生长迟缓（extrauterine growth restriction，EUGR）的发生率及影响因素。方法采用多中心前瞻性调查研究方法，纳入2019年9月至2020年12月我国7个地区28家医院新生儿科的2 514例VPI临床资料，根据纠正胎龄36周或出院时的体重评估是否发生EUGR，分成EUGR组（n=1 189）和非EUGR组（n=1 325）。比较两组VPI的临床特征，探讨EUGR的发生情况及相关因素。结果以体重评价，EUGR的发生率为47.30%（1 189/2 514）。多因素logistic结果显示，恢复出生体重后平均体重增长速率快和住院第1周累计热卡高是EUGR的保护因素（P<0.05），小于胎龄儿、达全肠内营养所需时间长、累计禁食时间长、开始添加母乳强化剂时的母乳量少及达到全强化的所需时间长、中-重度支气管肺发育不良是EUGR发生的危险因素（P<0.05）。结论尽早达全肠内营养，及时强化母乳喂养，增加生后第1周的热卡摄入，提高体重增长速率，以及防治中-重度支气管肺发育不良对降低VPI EUGR的发生率至关重要。

Abstract

Objective To investigate the incidence of extrauterine growth retardation (EUGR) and its risk factors in very preterm infants (VPIs) during hospitalization in China. Methods A prospective multicenter study was performed on the medical data of 2 514 VPIs who were hospitalized in the department of neonatology in 28 hospitals from 7 areas of China between September 2019 and December 2020. According to the presence or absence of EUGR based on the evaluation of body weight at the corrected gestational age of 36 weeks or at discharge, the VPIs were classified to two groups: EUGR group (n=1 189) and non-EUGR (n=1 325). The clinical features were compared between the two groups, and the incidence of EUGR and risk factors for EUGR were examined. Results The incidence of EUGR was 47.30% (1 189/2 514) evaluated by weight. The multivariate logistic regression analysis showed that higher weight growth velocity after regaining birth weight and higher cumulative calorie intake during the first week of hospitalization were protective factors against EUGR (P<0.05), while small-for-gestational-age birth, prolonged time to the initiation of total enteral feeding, prolonged cumulative fasting time, lower breast milk intake before starting human milk fortifiers, prolonged time to the initiation of full fortified feeding, and moderate-to-severe bronchopulmonary dysplasia were risk factors for EUGR (P<0.05). Conclusions It is crucial to reduce the incidence of EUGR by achieving total enteral feeding as early as possible, strengthening breastfeeding, increasing calorie intake in the first week after birth, improving the velocity of weight gain, and preventing moderate-severe bronchopulmonary dysplasia in VPIs.

导出引用

沈蔚, 郑直, 林新祝, 吴繁, 田倩欣, 崔其亮, 袁媛, 任玲, 毛健, 石碧珍, 王玉梅, 刘玲, 张京慧, 常艳美, 童笑梅, 朱燕, 张蓉, 叶秀桢, 邹静静, 李怀玉, 赵宝银, 邱银萍, 刘淑华, 马莉, 徐颖, 程锐, 周文莉, 武辉, 刘志勇, 陈冬梅, 高金枝, 刘晶, 陈玲, 李丛, 杨春燕, 许平, 张亚昱, 呼斯乐, 梅花, 杨祖铭, 冯宗太, 王三南, 孟二艳, 尚利宏, 徐发林, 欧少苹, 巨容. 住院极早产儿宫外生长迟缓及相关因素的多中心前瞻性研究[J]. 中国当代儿科杂志. 2022, 24(2): 132-140 https://doi.org/10.7499/j.issn.1008-8830.2111143

SHEN Wei, ZHENG Zhi, LIN Xin-Zhu, WU Fan, TIAN Qian-Xin, CUI Qi-Liang, YUAN Yuan, REN Ling, MAO Jian, SHI Bi-Zhen, WANG Yu-Mei, LIU Ling, ZHANG Jing-Hui, CHANG Yan-Mei, TONG Xiao-Mei, ZHU Yan, ZHANG Rong, YE Xiu-Zhen, ZOU Jing-Jing, LI Huai-Yu, ZHAO Bao-Yin, QIU Yin-Ping, LIU Shu-Hua, MA Li, XU Ying, CHENG Rui, ZHOU Wen-Li, WU Hui, LIU Zhi-Yong, CHEN Dong-Mei, GAO Jin-Zhi, LIU Jing, CHEN Ling, LI Cong, YANG Chun-Yan, XU Ping, ZHANG Ya-Yu, HU Si-Le, MEI Hua, YANG Zu-Ming, FENG Zong-Tai, WANG San-Nan, MENG Er-Yan, SHANG Li-Hong, XU Fa-Lin, OU Shao-Ping, JU Rong. Incidence of extrauterine growth retardation and its risk factors in very preterm infants during hospitalization: a multicenter prospective study[J]. Chinese Journal of Contemporary Pediatrics. 2022, 24(2): 132-140 https://doi.org/10.7499/j.issn.1008-8830.2111143

参考文献

1 Martínez-Jiménez MD, Gómez-García FJ, Gil-Campos M, et al. Comorbidities in childhood associated with extrauterine growth restriction in preterm infants: a scoping review[J]. Eur J Pediatr, 2020, 179(8): 1255-1265. PMID: 32096070. DOI: 10.1007/s00431-020-03613-8.
2 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. PMID: 19573373. DOI: 10.3760/cma.j.issn.0578-1310.2009.01.003.
3 中国医师协会新生儿专业委员会-营养专家委员会协作组. 极低出生体质量早产儿院内营养现状多中心调查[J]. 临床儿科杂志, 2015, 33(1): 32-37. DOI: 10.3969/j.issn.1000-3606.2015.01.009.
4 山东省多中心极低出生体重儿预后评估协作组. 极低出生体重儿宫外生长发育迟缓危险因素的多中心研究[J]. 中华儿科杂志, 2020, 58(8): 653-660. PMID: 32842386. DOI: 10.3760/cma.j.cn112140-20200326-00308.
5 Izquierdo Renau M, Aldecoa-Bilbao V, Balcells Esponera C, et al. Applying methods for postnatal growth assessment in the clinical setting: evaluation in a longitudinal cohort of very preterm infants[J]. Nutrients, 2019, 11(11): 2772. PMID: 31739632. PMCID: PMC6893690. DOI: 10.3390/nu11112772.
6 Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants[J]. BMC Pediatr, 2013, 13: 59. PMID: 23601190. PMCID: PMC3637477. DOI: 10.1186/1471-2431-13-59.
7 中华医学会儿科学分会新生儿学组, 中国医师协会新生儿科医师分会感染专业委员会. 新生儿败血症诊断及治疗专家共识(2019年版)[J]. 中华儿科杂志, 2019, 57(4): 252-257. PMID: 30934196. DOI: 10.3760/cma.j.issn.0578-1310.2019.04.005.
8 Moore TA, Wilson ME. Feeding intolerance: a concept analysis[J]. Adv Neonatal Care, 2011, 11(3): 149-154. PMID: 21730906. DOI: 10.1097/ANC.0b013e31821ba28e.
9 Backstr?m MC, Kouri T, Kuusela AL, et al. Bone isoenzyme of serum alkaline phosphatase and serum inorganic phosphate in metabolic bone disease of prematurity[J]. Acta Paediatr, 2000, 89(7): 867-873. PMID: 10943972. DOI: 10.1111/j.1651-2227.2000.tb00395.x.
10 Patel AL, Engstrom JL, Meier PP, et al. Accuracy of methods for calculating postnatal growth velocity for extremely low birth weight infants[J]. Pediatrics, 2005, 116(6): 1466-1473. PMID: 16322172. DOI: 10.1542/peds.2004-1699.
11 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 5版. 北京: 人民卫生出版社, 2019.
12 Xu FD, Kong XY, Duan SY, et al. Care practices, morbidity and mortality of preterm neonates in China, 2013-2014: a retrospective study[J]. Sci Rep, 2019, 9(1): 19863. PMID: 31882629. PMCID: PMC6934849. DOI: 10.1038/s41598-019-56101-x.
13 Bonnar K, Fraser D. Extrauterine growth restriction in low birth weight infants[J]. Neonatal Netw, 2019, 38(1): 27-33. PMID: 30679253. DOI: 10.1891/0730-0832.38.1.27.
14 Chien HC, Chen CH, Wang TM, et al. Neurodevelopmental outcomes of infants with very low birth weights are associated with the severity of their extra-uterine growth retardation[J]. Pediatr Neonatol, 2018, 59(2): 168-175. PMID: 28866004. DOI: 10.1016/j.pedneo.2017.08.003.
15 Makker K, Ji Y, Hong X, et al. Antenatal and neonatal factors contributing to extra uterine growth failure (EUGR) among preterm infants in Boston birth cohort (BBC)[J]. J Perinatol, 2021, 41(5): 1025-1032. PMID: 33589730. PMCID: PMC7883994. DOI: 10.1038/s41372-021-00948-4.
16 Clark RH, Thomas P, Peabody J. Extrauterine growth restriction remains a serious problem in prematurely born neonates[J]. Pediatrics, 2003, 111(5 Pt 1): 986-990. PMID: 12728076. DOI: 10.1542/peds.111.5.986.
17 Griffin IJ, Tancredi DJ, Bertino E, et al. Postnatal growth failure in very low birthweight infants born between 2005 and 2012[J]. Arch Dis Child Fetal Neonatal Ed, 2016, 101(1): F50-F55. PMID: 26201534. DOI: 10.1136/archdischild-2014-308095.
18 Crispi F, Rodríguez-López M, Bernardino G, et al. Exercise capacity in young adults born small for gestational age[J]. JAMA Cardiol, 2021, 6(11): 1308-1316. PMID: 34287644. PMCID: PMC8576583. DOI: 10.1001/jamacardio.2021.2537.
19 Klevebro S, Westin V, Stoltz Sj?str?m E, et al. Early energy and protein intakes and associations with growth, BPD, and ROP in extremely preterm infants[J]. Clin Nutr, 2019, 38(3): 1289-1295. PMID: 29885776. DOI: 10.1016/j.clnu.2018.05.012.
20 Baillat M, Pauly V, Dagau G, et al. Association of first-week nutrient intake and extrauterine growth restriction in moderately preterm infants: a regional population-based study[J]. Nutrients, 2021, 13(1): 227. PMID: 33466801. PMCID: PMC7830065. DOI: 10.3390/nu13010227.
21 Bartholomew J, Martin CR, Allred E, et al. Risk factors and correlates of neonatal growth velocity in extremely low gestational age newborns: the ELGAN study[J]. Neonatology, 2013, 104(4): 298-304. PMID: 24192897. PMCID: PMC3929951. DOI: 10.1159/000351020.
22 Roberts D, Brown J, Medley N, et al. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth[J]. Cochrane Database Syst Rev, 2017, 3(3): CD004454. PMID: 28321847. PMCID: PMC6464568. DOI: 10.1002/14651858.CD004454.pub3.
23 Lee SM, Kim N, Namgung R, et al. Prediction of postnatal growth failure among very low birth weight infants[J]. Sci Rep, 2018, 8(1): 3729. PMID: 29487306. PMCID: PMC5829148. DOI: 10.1038/s41598-018-21647-9.
24 Ramaswamy VV, Bandyopadhyay T, Ahmed J, et al. Enteral feeding strategies in preterm neonates ≤32 weeks gestational age: a systematic review and network meta-analysis[J]. Ann Nutr Metab, 2021, 77(4): 204-220. PMID: 34247152. DOI: 10.1159/000516640.
25 Amissah EA, Brown J, Harding JE. Protein supplementation of human milk for promoting growth in preterm infants[J]. Cochrane Database Syst Rev, 2020, 9(9): CD000433. PMID: 32964431. PMCID: PMC8094919. DOI: 10.1002/14651858.CD000433.pub3.
26 Belfort MB, Woodward LJ, Cherkerzian S, et al. Targeting human milk fortification to improve very preterm infant growth and brain development: study protocol for nourish, a single-center randomized, controlled clinical trial[J]. BMC Pediatr, 2021, 21(1): 167. PMID: 33836708. PMCID: PMC8033746. DOI: 10.1186/s12887-021-02635-x.
27 早产儿母乳强化剂使用专家共识工作组, 中华新生儿科杂志编辑委员会. 早产儿母乳强化剂使用专家共识[J]. 中华新生儿科杂志(中英文), 2019, 34(5): 321-328. DOI: 10.3760/cma.j.issn.2096-2932.2019.05.001.
28 Elbeely SH, AlQurashi MA. Pre-discharge growth pattern of very low birth weight infants (VLBW): a 5 year single center experience[J]. J Neonatal Perinatal Med, 2021, 14(2): 223-228. PMID: 33044202. DOI: 10.3233/NPM-200592.