早产儿宫外生长发育迟缓及相关因素分析

目的:了解早产儿出院时宫外生长发育迟缓(EUGR)的发生率,探讨影响EUGR发生率的相关因素。方法:以中山大学附属第一医院新生儿科2003年1月～2008年3月出生的早产儿为研究对象。生长发育迟缓定义为生长指标≤生长曲线的第10百分位。计数资料比较采用卡方检验;正态分布的计量资料比较用t检验;非正态分布计量资料采用秩和检验;发生EUGR的危险因素用Logistic回归分析。结果:对象共803例早产儿,其中极低出生体重儿占7.72%,发生体重EUGR者为56.45%,发生头围EUGR者为38.71%。IUGR与EUGR发生率以体重评价分别为17.06%和32.25%,以头围评价分别为12.58%和17.43%。Logistic回归中,出生胎龄、出生体重、生后体重下降时间是发生体重EUGR和严重体重EUGR的危险因素;出生头围和静脉用氨基酸最大量是发生头围EUGR的危险因素,出生头围和出生时是否为头围IUGR是发生严重头围EUGR的危险因素。结论:该院早产儿EUGR的发生率高于国外资料,但与国内资料相比较低。出生胎龄和出生头围越小、出生体重越低,EUGR发生率越高。应尽早给予早产儿足量热卡和高氨基酸静脉营养,从而缩短患儿的体重下降时间,保证生长需要,减少EUGR的发生率。

Analysis on extrauterine growth restriction and related factors in premature infants

Objective:To understand the incidence of extrauterine growth restriction(EUGR)in premature infants when they discharged from hospital,and explore the related effect factors of EUGR.Methods:The premature infants born from January 2003 to March 2008 in the First Affiliated Hospital of Sun Yat-Sen University were selected.Growth restriction is defined as measured growth values≤10th percentile of the values of growth expectation based on estimated postmenstrual age.Enumeration data is treated with the chi-square test;measurement data is treated with the t-test(normal distribution)and rank test(abnormal distribution);the risk factors of EUGR were analyzed by logistic regression analysis.Results:803 premature infants were included,the proportion of very low birth weight infants(VLBWI)was 7.72%,the incidences of EUGR were 56.45% assessed by weight and 38.71% assessed by head circumference,respectively.The incidences of intrauterine growth retardation(IUGR)and EUGR were 17.06% and 32.25% assessed by weight,and 12.58% and 17.43% assessed by head circumference,respectively.The risk factors of EUGR and severe EUGR assessed by weight included gestational age at birth,birth weight and the lasting time of weight decrease after birth;the risk factors of EUGR assessed by head circumference included birth head circumference and the highest quantity of amino acids in parenteral nutrition;the risk factors of severe EUGR assessed by head circumference included birth head circumference and EUGR assessed by head circumference at birth or not.Conclusion:The incidence of EUGR in premature infants in the hospital is higher than the data reported abroad,but lower than the data reported in China.The incidence of EUGR increases with the decreases of birth weight,gestational age at birth and birth head circumference.Early and enough calorie and amino acids are required in premature infants,in order to shorten the lasting time of weight decrease after birth,meet the growing needs and reduce the incidence of EUGR.