小于胎龄儿与适于胎龄儿化脓性脑膜炎临床特点的比较

目的 探讨小于胎龄儿(SGA)和适于胎龄儿(AGA) 化脓性脑膜炎(PM)临床特征的差异。方法 选取58 例足月新生儿PM 患儿作为研究对象进行回顾性研究。根据出生体重与胎龄,将PM 患儿分为SGA 组(13 例)和AGA 组(45 例)。比较两组临床表现、实验室检查结果及预后的差异。结果 SGA 组的肌张力降低发生率高于AGA 组(PPP结论 SGA 发生PM 后,脑损伤发生率更高,提示其预后较AGA 更差。     

Cerebral structure and metabolism and long-term outcome in small-for-gestational-age preterm neonates

In the present study, we compared brain development and metabolism of small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) infants using proton magnetic resonance spectroscopy ((1)H-MRS). We tested the hypothesis that intrauterine growth retardation caused by placental insufficiency is associated with changes in cerebral metabolism and is followed by an adverse neurodevelopmental outcome at the age of 2 y. Twenty-six AGA and 14 SGA (birth weight

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Placental size of small-for-gestational-age infants at term

Placental size was compared between appropriate-for-gestational age (AGA) and small-for-gestational age (SGA) infants born at term. Placental weight, chorionic plate area and villous surface area were significantly reduced in the SGA infants. Although the ratio of placental weight to birth weight was similar in the AGA and SGA infants, the latter had significantly underweight placentas for their head circumference and crown-heel length. The ratios of placental weight to assessed brain weight and villous surface area to assessed brain weight were also significantly reduced in the SGA infants. It is concluded that the study SGA infants had both absolutely and relatively small placentas.     

Changes in serum concentrations of thyroid hormones and thyroid hormone-binding proteins during early infancy. Studies in healthy fullterm, small-for-gestational age and preterm infants aged 7 to 240 days.

Serum concentrations of thyrotropin (TSH), thyroxine (T4), triiodothyronine (T3), thyroxine-binding globulin (TBG), prealbumin (TBPA) and albumin (Alb) were determined in 492 blood samples from 127 fullterm (FT), 91 small-for-gestational age (SGA) and 88 preterm (PT) healthy infants aged 7 to 240 days. Serum T4 decreased about 20% during the first month of life. In infants aged 7--49 days, serum T4 concentrations were significantly lower in SGA than in FT infants, and even lower values were found in PT infants. Serum T3 increased 50--70% reaching maximal values by 50--79 days of life. Serum T3 levels were higher in FT than in SGA infants throughout the observation period. In PT infants serum T3 increased from low values to levels which exceeded those of SGA and FT infants by 120--240 days of life. Serum TSH level did not change with age and was less than or equal to 5 mU/l in all infants. Serum TBG values were high compared to normal adult values and did not change significantly with age. Comparable serum TBG values were found in FT, SGA and PT infants. Serum TBPA increased with age. Serum TBPA increased gradually in FT infants. In SGA infants serum TBPA increased from low values to levels which by 120--240 days of life exceeded those of PT and FT infants. In PT infants a decrease in serum TBPA appeared before the rise commenced. Serum Alb increased gradually in FT, SGA and PT infants during the observation period. Serum Alb in PT infants aged 30--119 days was lower than those in FT infants with similar ages. These physiological changes in serum concentrations of thyroid hormones and hormone-binding proteins during early infancy should be considered when interpreting thyroid function tests in infants with various maturity.     

The premature small-for-gestational-age infant during the first year of life: comparison by birth weight and gestational age

To determine the effect of intrauterine growth retardation on the outcome of the premature infant, we compared a group of 35 premature, small-for-gestational-age (SGA) infants with two groups of premature, appropriate-for-gestational-age (AGA) infants: one with similar birth weight (AGA-BW group) and the other with similar gestational age (AGA-GA group). Groups were matched by year of birth, race, gender, and socioeconomic status. Infants were free of major congenital anomalies and intrauterine infection. They were evaluated at term, at 20 and 40 weeks, and at 1 year corrected age. The SGA infants had a lower mean developmental quotient than the two groups of AGA infants. The SGA infants had significantly smaller body dimensions at birth, more nursery complications, and a higher incidence of major neurologic problems than their AGA-GA matches but were comparable to the AGA-BW matches. Poor growth constitutes an additional risk factor to prematurity. The results highlight the importance of comparing premature SGA infants with premature AGA infants of similar gestational age rather than similar birth weight.     

Is the raised metabolic rate of the small for gestation infant due to his relatively large brain size

Oxygen consumption at different stages of vigilance, and for the whole 24 h, was measured in 13 small-for-gestational age (SGA) and 16 appropriate-for-age (AGA) premature infants at ages of 4-25 days. Brain weight was calculated from head circumference measurements and expressed as percentage of body weight and was found to be significantly higher in SGA infants than AGA ones (14% +/- 2.1 (S.D.) in the SGA and 12.3% +/- 1.5 (S.D.) in the AGA infants). Metabolic rate (MR) was calculated and expressed as kcal/centimetre head circumference, kcal/g brain wt. and kcal/kg body wt. Whereas MR expressed in kg body wt. was significantly higher in SGA infants than in AGA ones, no difference could be detected in the values when MR was expressed as kcal/cm head circumference, or MR/g brain wt. The difference that exists in the metabolic rates between SGA and AGA infants can be minimised by using head circumference as a reference. Therefore, the apparently high MR found in SGA infants in the neonatal period can be attributed, in a major way, to their relatively large brain size.     

CHANGES IN SERUM CONCENTRATIONS OF THYROID HORMONES AND THYROID HORMONE-BINDING PROTEINS DURING EARLY INFANCY Studies in Healthy Fullterm, Small-for-gestational Age and Preterm Infants Aged 7 to 240 Days

Abstract. Serum concentrations of thyrotropin (TSH), thyroxine (T₄), triiodothyronine (T₃), thyroxine-binding globulin (TBG), prealbumin (TBPA) and albumin (Alb) were determined in 492 blood samples from 127 fullterm (FT), 91 small-for-gestational age (SGA) and 88 preterm (PT) healthy infants aged 7 to 240 days. Serum T ₄ decreased about 20% during the first month of life. In infants aged 7–49 days, serum T₄ concentrations were significantly lower in SGA than in FT infants, and even lower values were found in PT infants. Serum T ₃ increased 50–70% reaching maximal values by 50–79 days of life. Serum T₃ levels were higher in FT than in SGA infants throughout the observation period. In PT infants serum T₃ increased from low values to levels which exceeded those of SGA and FT infants by 120–240 days of life. Serum TSH level did not change with age and was 5 mU/1 in all infants. Serum TBG values were high compared to normal adult values and did not change significantly with age. Comparable serum TBG values were found in FT, SGA and PT infants. Serum TBPA increased with age. Serum TBPA increased gradually in FT infants. In SGA infants serum TBPA increased from low values to levels which by 120–240 days of life exceeded those of PT and FT infants. In PT infants a decrease in serum TBPA appeared before the rise commenced. Serum Alb increased gradually in FT, SGA and PT infants during the observation period. Serum Alb in PT infants aged 30–119 days was lower than those in FT infants with similar ages. These physiological changes in serum concentrations of thyroid hormones and hormone-binding proteins during early infancy should be considered when interpreting thyroid function tests in infants with various maturity.     

Cardiac hypertrophy and altered hemodynamic adaptation in growth-restricted preterm infants

The objective was to elucidate hemodynamic adaptation in very low birth weight (<1500 g) infants after intrauterine growth retardation. 31 growth-retarded (SGA, birth weight <-2 SD) and 32 appropriate for gestational age (AGA, birth weight within +/- 1 SD range) infants were enrolled. In SGA infants, the diastolic diameters of the interventricular septum and the left ventricle were increased, and serum brain natriuretic peptide (BNP) was elevated. Left ventricular output (LVO) of the AGA infants increased from 150 +/- 28 to 283 +/- 82 mL/kg/min during the study (p < 0.01). The SGA infants had a higher initial LVO than the AGA infants (243 +/- 47 versus 150 +/- 28 mL/kg/min, p < 0.05), but did not show further LVO increase during the study period. Red cell (RCV) and blood (BV) volume were assessed by Hb subtype analysis, when packed donor red cells were transfused. RCV and BV did not differ between the groups initially, but RCV increased by 18% and BV by 29% in the AGA group during the first 3 d. On day 3, AGA infants had larger BV than the SGA infants (88 +/- 5 versus 73 +/- 12 mL/kg, p < 0.05). In conclusion, cardiac hypertrophy, elevated initial LVO and BNP of the SGA infants suggest increased cardiac workload after intrauterine growth retardation. Based on the BV and RCV data, blood volume regulation may also be impaired. The data suggest that SGA preterm infants may be exposed to an increased risk of circulatory failure during early adaptation.     

485例足月小样儿颅内出血危险因素分析

目的探讨足月小样儿发生颅内出血的类型及相关危险因素。方法回顾性分析485例足月小样儿的临床资料,分析颅内出血的围生期因素、颅内出血诊断前存在的合并症、头颅影像学检查结果及神经行为评分。结果 485例足月小样儿中,83例(17.1%)发生颅内出血。83例颅内出血患儿中,68例(81.9%)存在脑室周围及脑室内出血,其中Ⅰ度15例(22.1%)、Ⅱ度50例(73.5%)、Ⅲ度1例(1.5%)、Ⅳ度2例(2.9%);另15例(18.1%)主要为蛛网膜下隙出血(60%,9/15)。单因素分析发现,颅内出血组患儿的羊水污染率、新生儿硬肿症、动脉导管未闭患病率高于未发生颅内出血组,差异有统计学意义(P0.05)。Logistic回归分析发现,羊水污染、新生儿硬肿症、动脉导管未闭为导致颅内出血的独立危险因素。结论足月小样儿发生颅内出血的类型为脑室周围及脑室内出血,羊水污染、新生儿硬肿症、动脉导管未闭为导致颅内出血的危险因素。     

Lipoproteins in preterm and small-for-gestational-age infants during the first week of life

Plasma lipoprotein levels and composition have been determined in preterm and small-for-gestational-age (SGA) infants, and compared to full-term infants, during the first week of life. Significantly lower levels of HDL and higher levels of VLDL were found in both preterm and SGA infants in comparison to full-term healthy infants. These results suggest a low capacity to metabolize VLDL. Preterm infants showed a behaviour similar to full-term infants with regard to the changes in lipoprotein composition. Small-for-gestational-age infants showed a higher lipoprotein lipid content than preterm infants. A low ratio of cholesteryl ester to free cholesterol (CE/FC) was found in both preterm and SGA infants suggesting a reduced lecithin: cholesterol acyl transferase (LCAT) activity. In preterm infants we observed no changes in the CE/FC ratio during the first week of life, whereas in SGA infants this ratio increased after birth.     

Peripheral circulatory response to feeding in newborn low-birth-weight infants

The effect of feeding on calf blood flow (CBF) was investigated in 27 preterm and 10 term small-for-gestational-age (SGA) neonates using the venous occlusion plethysmographic method pre- and postprandially. Blood pressure and heart rate were simultaneously monitored. Feeding consisted of commercially prepared formula with average amounts of 20 ml/kg for preterm and 30 ml/kg for term SGA infants. As a group, the preterm neonates showed no significant CBF changes 1/2 h postprandially from the control value of 8.4 +/- 2.6 ml/min/100 ml (mean +/- SD). Although the difference was not statistically significant, 10 of the 27 preterm infants showed a mean CBF decrease of 9% and 17 showed no change to a slight increase immediately postprandially. These changes were followed by a 35% mean increment in CBF of all preterm infants at 2-2 1/2 h postprandially. CBF decreased in term SGA infants by 40% at 1/2 h postprandially from a control flow of 8.6 +/- 2.9 ml/min/100 ml (p less than 0.01). CBF returned to the control level 1-1 1/2 h postprandially and superseded the control value by 16% at 2-2 1/2 h. Peripheral vascular resistance varied inversely with CBF. Blood pressure and heart rate showed no significant changes. These observations indicated that unlike term infants, most preterm infants manifest no significant immediate peripheral vascular response to feeding before the onset of a hyperdynamic circulatory state. This difference was related to gestational age rather than to birth weight as term SGA infants responded like term appropriate-for-gestational-age infants. The possible mechanisms involved in these CBF changes with feeding are discussed.     

宫内生长受限对神经系统结构和功能影响的研究进展

宫内生长受限由多种因素导致,生后常表现为小于胎龄儿（small for gestational age,SGA）。SGA在围生期有较高的死亡及患病风险,其中神经系统在宫内即发生了结构改变,包括脑容积、灰质体积减小等,并伴有影像学及病理的异常改变;宫内生长受限胎儿在宫内进行血流再分布以保护脑部供血,目前对于脑保护机制的临床作用仍存在争议。SGA在新生儿及儿童期有较高的认知、运动、语言及行为功能发生异常的风险。早产儿神经功能损害程度比足月儿更严重。早期干预有利于神经系统功能的改善。 引用格式:     

磁共振弥散张量成像定量评价生长受限胎儿脑白质发育的研究

目的探讨胎儿生长受限(FGR)是否对胎儿脑白质发育造成不良影响。方法选择28例足月小于胎龄儿(SGA)为研究对象,15例足月适于胎龄儿(AGA)为对照组,均行头颅磁共振及磁共振弥散张量成像(DTI),将颅脑白质分为122个脑区,比较两组不同脑区各向异性分数(FA)、平均弥散系数(MD)、平行弥散系数(λ_//)及垂直弥散系数(λ_⊥)的差异。结果 SGA儿16个脑区的FA值低于对照组(P0.01);7个脑区的MD值高于对照组(P0.05);8个脑区的λ_//值高于对照组(P0.05);16个脑区的λ_⊥值高于对照组(P0.05)。结论宫内生长受限可导致脑白质纤维束成熟度及完整性异常。     

Increased energy expenditure and fecal fat excretion do not impair weight gain in small-for-gestational-age preterm infants.

In order to optimize the nutrition of high-risk premature infants beyond the early postnatal period, a more precise knowledge of individual nutritional requirements is needed. We therefore studied the influence of intrauterine growth retardation on energy expenditure and nutrient utilization determined by indirect calorimetry and fecal fat excretion (steatocrit) in nineteen premature infants who were appropriate-for-gestational-age (AGA; mean gestational age 29.9+/-0.3 weeks, mean birth weight 1.30+/-0.05 kg) and thirteen small-for-gestational-age (SGA) premature infants [mean gestational age 32.4+/-0.5 weeks, mean birth weight 1.024+/-0.07 kg (i.e., below the 10th percentile)] during the first and second month of life. All infants were clinically stable during the study period. In nine SGA infants we observed a significantly higher steatocrit compared to twelve AGA infants (29+/-1 vs. 17+/-1% p = 0.0001). SGA infants (n = 12) also showed a slightly (albeit statistically not significantly) higher energy expenditure than AGA infants (n = 15) (58.7+/-1.9 vs. 53.6+/-1.5 kcal/kg per day, p = 0.054). Despite the increased fat excretion and higher energy expenditure, SGA infants gained weight more rapidly during the study period than AGA infants (20+/-1 vs. 17+/-1 g/kg per day, p = 0.026). We conclude that influences of intrauterine growth retardation on energy expenditure and nutrient utilization persist during the first weeks of extrauterine life. However, these metabolic changes do not impair the capability of SGA infants for extrauterine catch-up growth if adequate nutrition is provided.     

Neurosonographic findings in premature infants and infants with intrauterine growth retardation with a birth weight below 1,500 grams]

The cranial ultrasound of 111 preterm infants were reviewed. 57 patients were appropriate for gestational age (AGA) and 54 small for gestational age (SGA). In the two groups, the incidence of peri-intraventricular hemorrhage (PIVH), posthemorrhagic ventricular dilation (VM) and peri-ventricular leucomalacia (PVL) was compared. PIVH was more common in AGA than in SGA babies (36.8% vs 18.5%). In both groups (AGA and SGA), birth weight less than 1000 g should be considered a further risk factor for hemorrhagic brain lesion (72.2% in AGA babies less than 1000 g and 20.5% ind AGA babies greater than 1000 g birth weight, p less than 0.01) (34.8% in SGA babies less than 1000 g and 6.4% in SGA babies greater than 1000 g birth weight, p less than 0.05). However, ischemic brain lesions (PVL) were not dependent from birth weight (p greater than 0.5). This study shows that low birth weight infants are an eterogeneous group of babies with different risk of hemorrhagic or ischemic cerebral lesion depending on gestational age and birth weight.     

足月小于胎龄儿脐血血红蛋白氧合酶-1测定的意义

目的 探讨血红蛋白氧合酶/一氧化碳(HO-CO)系统与足月小于胎龄儿(SGA)发病的关系及其机制.方法 2004年11月-2005年11月正常分娩的足月SGA(非匀称型SGA)50例.其中母亲无妊娠高血压综合征(PIH)为SGA 1组(30例),母亲患中重度PIH为SGA 2组(20例),健康足月适于胎龄儿(AGA)20例为对照(AGA组).新生儿娩出后立即采集脐动脉血标本,用双波长分光光度法测定血红蛋白氧合酶-1(HO-1)的活性,用Chalmers血红蛋白结合及连二亚硫酸钠还原法测定血浆碳氧血红蛋白(HbCO)质量分数.单因素方差分析进行多重比较,直线回归法进行相关分析.结果 SGA1组及SGA2组脐血HO-1活性、HbCO质量分数均显著低于AGA组(P<0.01).SGA1组与SGA2组脐血HO-1活性、HbCO水平比较无显著性差异(Pa>0.05).AGA组、SGA1组及SGA2组脐血HO-1活性与新生儿出生体质量均呈正相关(Pa<0.05).结论 SGA脐血HO-1活性显著低于ASA,AGA和SGA脐血HO-1活性水平与出生体质量均呈正相关,说明脐血HO-1活性与胎儿宫内发育及新生儿营养状况有关.     

Neonatal behavior of small for gestational age infants

The behavioral pattern of small for gestational age (SGA) infants differs from that of appropriate for gestational age (AGA) infants. Maternal malnutrition and SGA infants being a common problem in our country, we assessed the behavior of 36 full term SGA infants using the Brazelton scale. These infants had an excellent orienting capacity, state control and self quieting. Their motor performance was fair and autonomic regulation showed a good recovery over first 10 days. A comparison of this behavior with full term AGA infants showed a better orientation in SGA infants. Though there was a significant difference in motor, state regulation, and autonomic regulation, by the end of the first month they recovered to the same level as the AGA infants. The pattern of SGA behavior described is at marked variance with most of other reports from abroad.     

晚期早产儿中小于胎龄儿的临床特点

目的探讨晚期早产儿中发生小于胎龄儿(SGA)的围产期因素及新生儿期患病特点。方法对2009年10月至2010年9月在我院新生儿重症监护病房住院、胎龄34～36周的晚期早产儿临床资料进行回顾性分析,比较晚期早产儿中SGA和适于胎龄儿(AGA)的围产期因素及新生儿期患病情况。结果 SGA组(179例)住院天数明显长于AGA组(851例)[(16.4±6.2)天比(11.3±4.1)天,P<0.05]。SGA组母亲妊娠期高血压疾病(HDCP)、多胎妊娠、羊水过少和宫内窘迫的比例均高于AGA组(34.1%比17.9%,29.1%比13.7%,21.2%比12.6%,19.6%11.0%,P均<0.01)。SGA组患儿新生儿窒息、喂养不耐受、颅内出血、低血糖和红细胞增多症的发生率亦明显高于AGA组(12.8%比7.9%,7.8%比3.1%,6.1%比2.6%,27.4%比21.4%,3.4%比0.2%,P均<0.05)。结论母亲HDCP和多胎妊娠是造成晚期早产儿SGA的主要原因,SGA患儿相对于AGA患儿具有更高的患病风险,应针对造成SGA的围产期因素以及新生期疾病特点进行相应预防和干预。     

小于胎龄儿生后早期肾脏功能初探

目的对小于胎龄儿(SGA)生后早期肾脏功能进行回顾性对照研究,以探寻SGA儿早期肾功能损害的诊断方法。方法选择早产SGA儿40例、足月SGA儿33例作为研究组,并以早产适于胎龄儿(AGA)80例、足月儿AGA 33例作为对照组。比较各组入院48 h内血清尿素氮(BUN)、血清肌酐(SCr)、估算肾小球滤过率(eGFR)、血压、单位体重尿量以及蛋白尿的发生情况。结果早产儿SGA组的BUN低于AGA组(P0.05),两组间SCr、eGFR、血压的差异无统计学意义(P0.05)。与足月儿AGA组比较,SGA组的SCr较高、eGFR较低,差异均有统计学意义(P0.05);两组间BUN、血压的差异无统计学意义(P0.05)。早产儿或足月儿AGA与SGA之间单位体重尿量的差异无统计学意义(P0.05)。早产儿AGA与SGA之间蛋白尿发生率的差异无统计学意义(P0.05),足月儿AGA与SGA组均无蛋白尿发生。结论 SCr、eGFR对评估SGA早期肾脏损害较为敏感。足月儿SGA较AGA肾脏功能减低。     

Longitudinal follow-up of height up to five years of age in infants born preterm small for gestational age; comparison to full-term small for gestational age infants

OBJECTIVE: This aims to conduct a comparative study of the height catch-up rate in preterm small for gestational age (SGA) infants during early childhood by gestational age and identify the factors affecting short stature in comparison to full-term SGA infants. METHODS: 449 SGA infants (214 full-term infants, 73 infants with gestation of less than 32 weeks, and 162 infants with gestation of more than 32 weeks but less than 37 weeks) from 25 institutions in Japan were assessed for catch-up (> or = -2SD) rate in growth by measuring for length/height at 1 year, 3 years and 5 years of age and the risk factors for no catch-up (< -2SD) at 5 years. RESULTS: The overall length/height catch-up rate was 68% at 1 year, 89% at 3 years and 88% at 5 years. The catch-up rate at 3 and 5 years of age in the group with gestation of less than 32 weeks had a rate of 74%, which was significantly less than the other two groups (approximately 90%). A significant factor associated with short stature at 5 years in the group with gestation of less than 32 weeks was the lower length SD score at time of birth, and for preterm infants born more than 32 weeks of gestation and full-term infants, significant factors were the lower maternal height and head circumference at birth. CONCLUSION: SGA infants born less than 32 weeks of gestation had a higher risk of no catch-up and different factors affecting catch-up compared to preterm SGA infants of gestation more than 32 weeks and full-term SGA infants.