早产儿宫外生长迟缓

随着新生儿重症监护病房（NICU）的建立以及呼吸支持、营养支持技术的快速发展,早产儿成活率逐年上升。但由于宫内营养储备不足、生后早期生活能力差且多有营养热卡供给不足、加之各种并发症的影响,而导致其生长发育进一步落后。     

预防早产儿宫外生长迟缓的营养策略

早产儿是一个特殊群体,其宫内营养储备存在不同程度缺陷,加之生后要完成追赶生长,营养需求更高,保证充足营养支持不仅关系到早产儿近期生长发育,还会影响到远期预后,充足均衡营养是保证早产儿健康生长物质基础。近年来人们就早产儿的营养支持手段获得越来越多的新认识,本文对此作一综述。     

早产儿宫外生长迟缓发生情况及危险因素

目的 探讨新生儿重症监护室(NICU)早产低出生体重儿宫外生长迟缓(EUGR)发生情况及危险因素.方法 对本院NICU 2006年1月至12月早产低出生体重儿EUGR发生情况及相关因素进行回顾性分析.结果 EUGR发生率39.22%.EUGR组胎龄(33.73±1.89)周与非EUGR组(33.54±2.04)周比较,差异无统计学意义(t=6.59,P＞0.05),但EUGR组出生体重(1648.58±304.22)g较非EUGR组(2017.63±325.53)g(t=-5.12)低,胎儿生长迟缓(FGR)、宫内缺氧、产前或产间感染及生后并发症发生率、呼吸机治疗率EUGR组分别为68.3%、41.7%、41.7%、68.3%、13.3%较非EUGR组分别为7.5%、24.7%、25.8%、31.2%、3.2%高,肠外营养(PN)及外源性肺表面活性物质(PS)应用率EUGR组分别为11.7%、5.0%较非EUGR组分别为24.7%、16.1%低,两组比较,差异均有统计学意义(P＜0.05).出生体重低(OR=1.003,P＜0.05),FGR(OR=20.723,P＜0.05),生后出现并发症(OR=7.580,P＜0.05)及未应用PN(OR=0.024,P＜0.05)是EUGR发生的危险因素.结论 EUGR发生与多因素有关,预防产前及生后各危险因素,及时合理治疗是避免EUGR的关键.     

早产儿宫外生长迟缓发生情况及危险因素

目的探讨新生儿重症监护室(NICU)早产低出生体重儿宫外生长迟缓(EUGR)发生情况及危险因素。方法对本院NICU2006年1月至12月早产低出生体重儿EUGR发生情况及相关因素进行回顾性分析。结果EUGR发生率39.22%。EUGR组胎龄(33.73±1.89)周与非EUGR组(33.54±2.04)周比较,差异无统计学意义(t=6.59,P(0.05),但EUGR组出生体重(1648.58±304.22)g较非EUGR组(2017.63±325.53)g(t=-5.12)低,胎儿生长迟缓(FGR)、宫内缺氧、产前或产间感染及生后并发症发生率、呼吸机治疗率EUGR组分别为68.3%、41.7%、41.7%、68.3%、13.3%较非EUGR组分别为7.5%、24.7%、25.8%、31.2%、3.2%高,肠外营养(PN)及外源性肺表面活性物质(PS)应用率EUGR组分别为11.7%、5.0%较非EUGR组分别为24.7%、16.1%低,两组比较,差异均有统计学意义(P(0.05)。出生体重低(OR=1.003,P<0.05),FGR(OR=20.723,P<0.05),生后出现并发症(OR=7.580,P<0.05)及未应用PN(OR=0.024,P<0.05)是EUGR发生的危险因素。结论EUGR发生与多因素有关,预防产前及生后各危险因素,及时合理治疗是避免EUGR的关键。     

高危早产儿宫外生长迟缓的危险因素分析

目的探讨我院高危早产儿宫外生长迟缓(EUGR)的发生率和相关危险因素。方法回顾性调查2011年1月至2012年12月我院收治并存活至出院的高危早产儿(出生体重<1500 g或出生胎龄<33周)及其母亲的住院资料。根据"中国15城市不同胎龄新生儿出生体重值",出生体重位于同胎龄儿第10百分位以下定义为宫内生长受限(IUGR)早产儿,出院体重位于校正胎龄儿第10百分位以下定义为EUGR早产儿。并根据此表计算出生体重的Z值(Z1)、出院体重的Z值(Z2),比较Z值的变化。比较EUGR组及非EUGR组围产期及出生后危险因素的差异,根据Logistic回归分析得出EUGR的高危因素。结果共194例早产儿纳入本研究,IUGR发生率为29.9%(58/194),EUGR发生率为51.5%(100/194)。出院时Z2(-1.27±0.83)较出生时Z1(-0.83±0.78)显著下降(P<0.001)。IUGR早产儿发生EUGR比例明显高于非IUGR早产儿(93.1%比33.8%,P<0.001),但Z值下降幅度却小于非IUGR早产儿[(-0.31±0.58)比(-0.50±0.53),P=0.039]。根据Logistic回归分析,高危早产儿发生EUGR的高危因素为出生体重<1500 g、IUGR、住院天数超过6周及CRP升高。结论 EUGR是极低出生体重儿及小胎龄早产儿的重要并发症,针对相关的围产因素进行积极的营养管理,有可能减少其发生率,改善早产儿的结局。     

早产儿宫外生长发育迟缓与营养支持

近20年来,随着新生儿急救及监护的不断进步,尤其是营养支持方法的改善,早产儿、特别是极低出生体重儿(VLBWI)的存活率已得到了显著提高.     

早产儿宫外生长发育迟缓的研究进展

早产儿宫外生长发育迟缓(extrauterine growth restriction,EUGR)是由围生期疾病及新生儿期各种并发症、生后营养不足等因素所造成的早产儿生后某个时期体重、身长或头围低于相应生长曲线参考值的一种生长落后状态。EUGR的发生在小胎龄、低体重早产儿中十分普遍,对早产儿的体格发育、神经认知功能、心...     

早产儿宫外生长迟缓的流行情况及危险因素

目的分析新生儿重症监护室中早产儿宫外生长迟缓（extrauterine growth retardation,EUCR）的流行情况及危险因素。方法研究对象为2011年1月至2012年12月出生于院内、并于出生后24h入住新生儿科、胎龄≤34周且存活至出院的适于胎龄早产儿。排除标准为：伴有先天畸形;小于或大于胎龄儿。依据WHO提供的早产儿宫内生长曲线,回顾性分析早产儿院内EUGR的发生率及其危险因素。结果共有134例病例符合入选标准。按出院时体重、身长、头围判断,EUGR的发生率分别为35．8％（48／134）、22．4％（30／134）和11．9％（16／134）,其中体重、身长、头围小于或等于其相应胎龄第3百分位的分别为17．9％（24／134）、7．5％（10／134）和4．5％（6／134）。EUGR组的出生体重、生后第1周的热卡供应及肠内营养提供的热卡、出院体重均低于非EUGR组,而恢复至出生体重的日龄、肠外营养持续时间和住院时间均高于非EUGR组。除喂养不耐受、性别、动脉导管未闭的发生率两组差异无统计学意义外,EUGR组发生坏死性小肠结肠炎、败血症、呼吸窘迫综合征、肠外营养相关性胆汁淤积的几率均高于非EUGR组（P〈0．05）。二分类Logistic回归分析显示,出生体重低和恢复至出生体重的日龄长为独立危险因素。结论早产儿生后的生长落后问题依然非常严峻。各种早产儿并发症的防治以及早期采取积极的营养支持方案可能减少EUGR的发生。     

早产儿宫外生长研究进展

近年来,随着新生儿重症监护病房的建立和营养支持的发展,极低出生体重儿的生存率明显上升.随着越来越多的早产儿和低体重儿被抢救存活,围产医学的关注焦点逐渐由新生儿护理技术方面扩大至早产儿出生后的生长发育随访情况以及相关影响因素的研究.记录并研究早产儿出生后包括身高、体重、头围、体重指数的生长发育情况,可以更清楚地评价早产儿在出生后通过有效的营养支持和医疗决策对其健康发育和生活质量是否产生影响.该文就目前国内外对早产儿和低出生体重儿的各个成长阶段的生长发育的随访情况、追赶性生长以及远期发育的影响作一综述.     

Extrauterine growth restriction in very-low-birthweight infants

Postnatal growth failure of very-low-birthweight (VLBW) infants may result from a complex interaction of genetic and environmental factors, including inadequate nutrition, morbidities affecting nutrient requirements, endocrine abnormalities and treatments. Among VLBW infants, those small for gestational age (SGA) at birth and those with postnatal growth restriction at the time of discharge are at higher risk of later growth failure and long-term consequences. Nutritional intervention with an "aggressive nutrition" during the first weeks of life may be able to minimize the interruption of nutrients that occurs at birth, and reduce as much as possible the incidence of growth restriction at the time of discharge and later. Even though aggressive parenteral and enteral nutrition appear to be effective and safe in VLBW infants, further evaluations of their long-term effect on growth and health consequences are needed. Several studies evaluating the effect of enriched nutrient formulas after hospital discharge on growth and neurodevelopment have produced conflicting results, whereas the potential deleterious long-term effects of prolonged use of high protein and/or of later catch-up growth have been questioned. In contrast, recent data seem to indicate that the use of human milk after hospital discharge could be the most beneficial diet for subsequent health and development.

Conclusion: VLBW infants SGA at birth and those with early postnatal growth restriction are at high risk of later growth failure and long-term consequences. Therefore, the first objective of early nutrition should be to reduce the incidence of growth restriction at the time of discharge. Further studies on VLBW infants to evaluate the safety and beneficial effects of prolonged dietary manipulation during the first year of life are needed.     

Extrauterine growth restriction in preterm infants of gestational age < or =32 weeks

BACKGROUND: Extrauterine growth restriction (EUGR) in low-birthweight (LBW) infants affects their growth and developmental prognoses as well as their incidence of adult diseases. The aim of the present paper was to determine the frequency and contributing factors of EUGR in infants > or =32 weeks of gestational age. METHODS: The subjects consisted of 416 infants from 22 facilities born between February and October 2002, whose gestational age was > or =32 weeks. For EUGR assessment, subjects whose body measurements in the 37-42 week postmenstrual age (PMA) period were below the 10th percentile of the standard normal distribution, were selected. RESULTS: EUGR incidence rates for weight, length, and head circumference were 57%, 49%, and 6%. In appropriate-for-gestational-age infants, a negative correlation was found between number of gestational weeks and EUGR incidence rates for weight, length, and head circumference, but in small-for-gestational-age infants this was true only for head circumference. Lower gestational age and age in days to achieve complete feeding were among the shared factors contributing to EUGR incidence for weight, length, and head circumference. The significant factors for EUGR incidence for weight and length included whether the infant was small for gestational age, whether oxygen was administered at 36 weeks PMA, age in days at which breast-feeding was initiated, and age in days when the infant regained birthweight. CONCLUSIONS: The growth retardation of preterm LBW infants in the neonatal intensive care unit continues to pose challenges. Relevant factors other than gestational age include intrauterine growth restriction, severe chronic lung disease, and poor nutrition.     

Management of preterm infants with intrauterine growth restriction

Preterm intrauterine growth restriction (IUGR) is strongly associated with increased mortality and morbidity. In the management of these infants, complications of preterm birth can be amplified by the effect of suboptimal fetal growth. It is important that pregnancies with IUGR are detected before birth, so that delivery can be arranged in a high-risk maternity unit with the appropriate neonatal staff in attendance. The provision of full support for resuscitation and stabilisation of these infants is crucial to the short-term and long-term health of these infants, who have suffered chronic hypoxia and malnutrition in utero. The long term outcome studies of these infants are retrospective and they include SGA infants. The effects of prematurity affect the outcome of IUGR infants. IUGR is associated with cerebral palsy in those delivered more than 32 weeks gestation. Infants less than 32 weeks of gestation may have poor developmental outcome if the head growth is affected, these infants may have associated cognitive and behavioural problems. Children who fail to grow by 2-4 years are at risk of long term growth problems. This paper outlines the acute and long-term management of these infants.     

呼吸窘迫综合征早产儿宫外生长受限及早期营养干预

目的 评价患有新生儿呼吸窘迫综合征(respiratory distress syndrome,RDS)的早产儿出生时宫内生长受限(intrauterine growth restriction,IUGR)和出院时宫外生长受限(extrauterine growth restriction,EUGR)的发生率,并分析其对早期营养支持的影响.方法 收集新生儿重症监护室符合入选标准的70例RDS早产儿的临床资料,根据出院时体重是否存在EUGR,分为EUGR组(48例)和非EUGR组(22例),比较两组患儿基本情况、围生期因素、住院期间营养摄入状况、治疗措施及合并症方面的差异.结果 以体重评价,70例RDS早产儿IUGR与EUGR的发生率分别为12.86％ (9/70)和60.00％ (42/70);两组出生体重[(1 666.10 ±440.16)g vs(2 108.20±552.81)g]、出生头围[(28.81±2.65) cm vs (30.48±2.39) cm]、多胎妊娠例数(16例vs 3例)、剖宫产例数(29例vs 7例)差异有统计学意义(P＜0.05);在出生胎龄、住院期间营养摄入、呼吸机支持及合并症方面两组之间差异无统计学意义(P＞0.05).结论 RDS早产儿的EUGR与存在IUGR、多胎妊娠、剖宫产、出生体重低、出生头围小有关,住院短时间的营养干预尚不能改善RDS早产儿的EURG.     

广州和佛山地区早产低出生体重儿出院时宫外生长迟缓发生情况调查

目的评价早产低出生体重儿出生时宫内生长受限(IUGR)和出院时宫外生长迟缓(EUGR)的发生情况。方法广州市、佛山市10家医院新生儿科出院的早产低出生体重儿(胎龄<37周,体重<2500g),分别以出生时、出院时生长发育指标在相应宫内生长速率期望值的第10百分位水平以下定义为IUGR、EUGR,分别计算各胎龄组、各体重组IUGR、EUGR发生率及总的发生率,并计算各胎龄组、各体重组EUGR发生率比IUGR发生率增加的比例。结果共595例早产低出生体重儿,出生时以体重、身长、头围为指标的IUGR发生率分别为20.2%、16.5%和24.4%,出院时以体重、身长、头围为指标的EUGR发生率分别为42.2%、28.1%和34.3%。不同出生胎龄(<31周、31～32周、33～34周、≥35周)出院时EUGR发生率较出生时IUGR发生率变化的情况:以体重为指标,EURG发生率各组分别增加36.8%、24.8%、19.1%、18.3%;以身长为指标,EUGR发生率各组分别增加26.5%、17.4%、8.2%、6.5%;以头围为指标,各组分别增加26.5%、14.0%、8.2%、3.2%,胎龄越小,增加率越高,组间比较差异有统计学意义(P<0.05)。不同出生体重(<1500g、1500～1999g、≥2000g)出院时EUGR发生率较出生时IUGR发生率变化的情况:以体重为指标,EUGR发生率分别增加45.3%、21.2%、17.4%;以身长为指标,EUGR发生率分别增加29.7%、14.8%、4.6%;以头围为指标,EUGR发生率分别增加26.6%、12.0%、4.3%,体重越低,增加率越高,组间比较差异有统计学意义(P<0.05)。结论早产低出生体重儿IUGR发生率较高,出院时EUGR发生率较IUGR发生率增高,且出院时EUGR发生率较出生时IUGR发生率的增加随出生胎龄和出生体重的降低而升高。     

Extrauterine growth restriction: a review of the literature

Extrauterine growth restriction (EUGR) is a common condition in very low birth weight (VLBW) preterm infants (< or = 1,500 g). Most affected infants have a birth weight that is average for gestational age, but by the time of hospital discharge have a weight that is less than the tenth percentile for corrected gestational age. EUGR is the most frequent morbidity among VLBW survivors at their time of discharge from the hospital. Studies to elucidate the causes of EUGR have been inconclusive. Recent research has found an association between EUGR, developmental outcomes, and long-term morbidity. Low birth weight has also been associated with chronic diseases later in life. These findings emphasize the critical nature of understanding the phenomenon of EUGR and ways it can be prevented.     

Conventional birth weight standards obscure fetal growth restriction in preterm infants

BACKGROUND AND OBJECTIVE: It has been suggested that fetal growth restriction (FGR) is associated with fetal maturation so that, compared with appropriately grown preterm infants, mortality and some neonatal morbidities may be reduced. The evidence for this is conflicting, and severe FGR has been shown to be harmful. In addition excessive growth has also been shown to be associated with poorer outcomes. As preterm infants are often also growth restricted, centiles for birth weights are distorted and may conceal the degree of growth restriction in a given infant. This study investigated whether using estimated fetal weights (EFW) might reveal the effects of hidden FGR. POPULATION AND METHODS: Using a 25-year database of preterm admissions to a single neonatal unit the ORs for mortality and neonatal morbidities for z scores for birth weight above and below the mean were computed and compared with those computed for z scores for EFW. RESULTS: In 7898 infants born at less than 35 weeks' gestation, the OR for mortality was lowest for birth weights between 1 SD and 3 SD above the mean, but was lowest for EFW between -2 SD and 0 SD below the mean. For periventricular haemorrhage, increasing FGR below the mean reduced the OR with both birth weight and EFW. Apparent reductions in OR for septicaemia, chronic lung disease, persistent ductus arteriosus and necrotising enterocolitis with birth weights of >1 SD above the mean were not seen with EFW. FGR of >-3 SD was associated with increased OR for necrotising enterocolitis with both birth weight and EFW. CONCLUSION: Using fetal growth rather than birth weight standards gives a better indication of the incidence and role of FGR in neonatal disease.     

Protein metabolism in preterm infants with particular reference to intrauterine growth restriction

There is growing evidence that neonatal and long-term morbidity in preterm infants, particularly those born before 32 weeks' gestation, can be modified by attained growth rate in the neonatal period. Guidelines for optimal growth and the nutritional intakes, particular of protein, required to achieve this are not well defined. Due to delays in postnatal feeding and a lack of energy stores developed in the last trimester of pregnancy, preterm infants often suffer early postnatal catabolism until feeding is established. There are indications that infants born with intrauterine growth restriction have perturbations in protein metabolism. Therefore, they may have different protein requirements than appropriate for gestational age infants. This review summarises what is known about protein requirements and metabolism in the fetus and preterm infant, with particular emphasis on the distinct requirements of the growth-restricted infant.