126例低出生体重儿相关危险因素分析

低出生体重儿不仅有较高的围产期发病率和死亡率，而且成活者通常留有远期体格和智力发育障碍，故研究低出生体重儿的发生率及发生因素对提高人口素质和延长人均寿命都有重要意义。本文对在我院分娩的126例低出生体重儿的相关危险因素分析如下：     

合肥市城区低出生体重儿婴儿期体格发育生长速率的纵向研究

目的 纵向随访合肥市城区低出生体重儿（LBWI）0～12月体格发育情况,科学评价LBWI婴儿期生长速率,明确LBWI出生后的生长追赶状况,为生长发育监测及科学喂养提供依据。方法 建立LBWI出生队列,共228名LBWI进入随访队列,在儿保系统中选择同期的161名正常出生体重儿（NBWI）作为对照组,监测婴儿0～12月龄体格发育结果。结果 LBWI男女婴体重、身长、头围各指标在婴儿期均明显低于 NBWI组同性别婴儿,LBWI和NBWI婴儿期最大生长速率在生后前3个月内,LBWI组男女婴在1~3月期间体格发育指标增长速度大于NBWI组,3月龄之后各体格指标增长速率逐渐下降,其中体重和头围顺位为1月龄＞2月龄＞3月龄,身长顺位为3月龄＞1月龄＞2月龄,LBWI在1岁内体重、身长和头围呈追赶生长,且6个月内追赶较快,尤以4月内明显。早产低出生体重儿（PLBWI）和足月低出生体重儿（MLBWI）体格发育增长速度存在差异,PLBWI出生后6月内增长速度基本大于MLBWI,但两组男女婴最大生长速率均出现在生后前3个月内。结论 低出生体重对婴儿的体格发育存在影响,LBWI男女婴婴儿期最大生长速率均出现在生后前3个月内,各体格发育指标增长速度大于NBWI,且各体格发育指标呈现追赶性生长,在4月龄内尤为明显,早产低出生体重儿出生后6月内体重、身长增长速度基本大于足月低出生体重儿。     

不同孕龄早产儿的5年随访分析

回顾性分析总结并随访了2000年全在苏大附一院产科出生的早产儿。通过随访不同孕龄早产儿的智力和体格发育情况。了解低体重阜产儿的抢救存活价值。结果：早产儿74例，早产发生率9．45％。早产儿孕龄30^＋1w～36^＋6w，新生儿死亡3例，死亡率为4．05％。〈33w孕龄组新生儿阿氏评分和出生体重明显低于其他组，需抢救率高于其他组，5年后该组儿童的身高和体重指标低于正常值，但智力发育指标属正常。提示：〈33w的新生儿生存风险大，需抢救率高。但一旦抢救成功，该组新生儿的智力发育和体格发育与正常儿无显著性差异。     

白噪声疗法结合袋鼠式干预在低出生体重儿中的应用

目的 探究白噪声疗法结合袋鼠式干预对低出生体重儿生长发育的影响。方法 选取2020年1月至2021年10月杭州市妇产科医院新生儿重症监护病房（neonatal intensive care unit，NICU）收治的94例低出生体重儿为研究对象，采用随机数字表法分为对照组（n=47）和联合组（n=47），对照组给予常规低出生体重儿护理，联合组在对照组的基础上给予白噪声疗法结合袋鼠式护理，比较两组临床指标、体格发育、智力发育指数（mental development index，MDI）、心理运动发育指数（psychomotor development index，PDI）及神经行为发育[新生儿神经行为测定（neonatal behavioral neurological assessment，NBNA）]情况。结果 干预后，联合组患儿喂养耐受天数、恢复出生体重时间、住院天数均显著低于对照组（P<0.05）；联合组新生儿头围、体重、身长增长均显著高于对照组（P<0.05）；干预后，两组新生儿MDI、PDI、NBNA评分均显著升高（P<0.05），且上述指标联合组显著高于对照组（P<0.05）。结论 白噪声疗法结合袋鼠式干预用于低出生体重儿的临床护理，可有效促进患儿智力、体格及神经行为的发育。     

低出生体重儿童的影响因素和生长发育随访研究

对４７例出生低体重儿童进行了３年定期的体格发育随访，定期测量体重、身长及头围，并与正常儿对照组进行两组比较，结果发现：在婴幼儿期低出生体重儿生长发育速度较正常儿快；其中早产低体重儿生长速度又较足月小样儿为快；到２岁左右，早产儿体重、身长及头围超过小样儿达到正常儿水平（Ｐ〉０．０５），而小样儿直到３岁各项指标仍低于正常铆（Ｐ〈０．０５）。对低出生体重儿的母婴情况调查分析显示，造成低出生体重的因素主要     

极低出生体重儿的近期随访及预后研究

目的：了解极低出生体重儿（ＶＬＢＷＩ）的预后,更好地指导临床实践。方法 对１９９６～１９９９年从我院新生儿加强监护病房（ＮＩＣＵ）治愈或好转出院的ＶＬＢＷＩ进行近期随访,了解其生长发育、疾病等情况,并对３１例ＶＬＢＷＩ作全面的体格检查和智力、视听功能测试以及免疫功能检查。结果 体格发育和生长发育情况与随访年龄有关,随访年龄越小,体格发育和生长发育异常率越高,１～２岁时基本达正常,但以小于－１ｓ占多数;智力发育异常率占２１．４３％。体格发育和智力发育异常与胎龄和出生体重、并发症、喂养方式、早期教育间均未见相关性。本组随访儿中有反复呼吸道感染者达８０％,但免疫球蛋白基本正常。视听功能正常。结论 ＶＬＢＷＩ早期存在体格、生长发育迟后,至１～２岁趋正常范围;智力发育大多数正常;存在反复感染,而免疫球蛋白正常。视力、听力     

综合干预对极低出生体重儿婴儿期生长发育的影响

目的：：探讨出院后早期综合干预对极低出生体重儿婴儿期体格和运动发育的影响。方法：以我院35例极低出生体重儿为干预组,以同期40例正常健康足月儿为对照组,干预组早期给予系统化的综合干预。分别于3月龄、6月龄、9月龄、12月龄时观察两组体格发育和运动发育情况。结果：干预组极低出生体重儿在出生、3月龄、6月龄时体格和运动发育均明显落后于对照组足月儿(P＜0.05)。9月龄时,极低出生体重儿身长、体重和运动发育已达足月儿水平(P＞0.05);但干预组极低出生体重儿的头围仍小于对照组足月儿(P＜0.05)。12月龄时,极低出生体重儿的体格发育和运动发育均已达足月儿水平(P＞0.05)。结论：出院后早期对极低出生体重儿实施综合干预,能使极低出生体重儿在婴儿期完成体格和运动发育的追赶生长,达到正常发育的水平。     

早期干预对低出生体重儿体格发育的影响

目的观察早期干预对低出生体重儿体格发育的影响。方法将208例低出生体重儿（其中早产小于胎龄儿54例,早产适于胎龄儿74例,足月小于胎龄儿80例）在出院时按家长意愿分为干预组112例和非干预组96例,干预组指导家长在家进行抚触、听、视觉刺激及婴儿操,非干预组采用常规育儿方法,未进行干预。在出生后3d、3个月、6个月进行体重、身长、头围、胸围等体格发育值测量及采集相关资料,分析两组体格发育值的变化。结果出生后3d干预组和非干预组各项体格发育值差异无统计学意义（P〉0．05）;3、6个月时干预组在体重、身长、头围、胸围等各项体格发育值优于非干预组,差异均有统计学意义（P〈0．05）。结论早期干预对低出生体重儿体格发育有明显的促进作用。     

24例出生低体重儿的护理体会

总结了24例出生低体重儿的护理.对低体重儿采取放入暖箱保暖的措施,辅以合理的喂养;严密的观察病情发现异常情况及时处理;预防颅内出血和预防感染相结合.在精心的护理和合理的措施下,出生低体重儿均能改变其不成熟的弱点,体格及智力迅速发育,增长相对加快.     

190例低出生体重儿影响因素与防治分析

低出生体重儿（low birth weight infant，LBWI）指出生儿体重小于2500g，属于高危儿，为新生儿死亡的主要因素之一。且部分LBWI日后可出现智力与体格发育障碍。对2000年1月-2004年12月于我院产科分娩的190例LBWI进行围生影响因素分析。     

The incidence of low birth weight infant in north China]

From September 1989 to August 1990, the incidence of low birth weight (LBW) infant was studied collaboratively in 8 areas in north China. 29,941 infants (14,003 males and 12,938 females) were investigated, 1,348 LBW infants included those of preterm and small for gestational age (SGA) term. The incidence of LBW infant was 5.00%. The incidence of male preterm (3.15%) was higher than that of female preterm (2.39%). The incidence of female SGA term (2.46%) was higher than that of male SGA term (1.82%). 52.09% of the infants with birth weight (BW) < 2,500g was of SGA term. 35-36 weeks premature infants accounted for 61.78% and 1,500-2,499g LBW infants for 93.28%. The incidence of SGA preterm (GA < 37 weeks) was 17.8%. In this study, the incidence of LBW infant was higher in Changchun and Huhehot than in other areas.     

Feeding pattern, supplementary foods and growth of low birthweight and normal birthweight infants in Machakos, Kenya

Feeding pattern, food consumption, and growth in weight were assessed for 168 low-birthweight and 187 normal birthweight infants in Machakos district, Kenya, an agricultural region 80 km East of Nairobi, between September 1977-December 1980. Birthweight was defined as the weight taken within 48 hours after birth, and the old WHO cutoff point of 2500 g or less was used to define low birthweight. It was planned to measure the infant's weight and food intake at 6-week inttervals during the 1st year; however, the number of measurements per infant ranged from 1 to 9. No differences were found in the breastfeeding pattern or the type of supplementary foods given to low birth weight (LBW) and normal birth weight (NBW) infants. At 6 weeks, 60% of the infants were exclusively breastfed. The number decreased over time, but only 1.7% were completely weaned before 52 weeks. At 5-6 months, and 10-12 months the energy intake from supplementary foods was 225 and 450 kcal (950 and 1900 kJ) respectively; at the same ages daily protein intake was 9 and 14 g respectively. Yet both groups followed their own growth channel, maintaining the difference in weight observed at birth. It is assumed, therefore, that LBW infants had a lower breast milk intake than NBW infants, as yield is influenced by vigor of suckeling and the nutritional status of the mother. No data is available for breast milk intake. However, in Machakos, LBW does carry a high mortality risk.     

The Association between Outdoor Ambient Temperature and the Risk of Low Birth Weight: A Population-Based Cohort Study in Rural Henan,China

Low birth weight (LBW) is defined as a birth weight of less than 2,500 g. It has been estimated that 15％–20％ of infants (more than 20 million worldwide) were born with LBW, and 95.6％ of the overall LBW infants were born in low and middle income countries[1]. Not only is LBW a crucial cause of infant mortality and morbidity, it also plays a critical role in adverse health outcomes later in life. Therefore, exploring the factors influencing LBW may have important implications for reducing maternal-child health burden. In recent years, the global climate has been undergoing drastic changes. Pregnant women are susceptible to extreme temperature due to their hormone-related physiological changes and variations in immunity and mood[2]. Although the risk of LBW in relation to prenatal exposures to temperature has been studied previously, the findings are inconsistent due to heterogeneity in the socio-economic and environmental factors of different regions[3]. Therefore, it is necessary to explore the effects of meteorological conditions on LBW risk in specific regions.     

低体重儿与优生的临床研究

本文对我院产科住院分娩的孕龄在28周以上、出生体重在1000～2500g之间的低体重儿进行了回顾性研究。分析了低体重儿的相关因素,如早产、妊娠高血压综合征(妊高征)、双胎、前置胎盘等妊娠并发症,内科合并症以及脐带异常、胎盘异常等,同时对低体重儿的产科处理与如何争取优良的结局也进行了探讨。     

低出生体重对儿童青春期生长发育的影响

目的　研究低出生体重儿童 (LBW)青春期生长发育状况和胰岛素样生长因子 1(IGF 1)水平 ,并与正常出生体重儿童 (NBW )进行比较 ,以探讨LBW儿童生长迟缓的发病机制。方法　对处于不同年龄及青春发育阶段的LBW儿童和NBW儿童的身高和身高标准差得分 (HtSDS)、体重和体重标准差得分 (WtSDS)以及血清IGF 1水平进行了比较 ,采用放射免疫法测定血清IGF 1水平。结果　①LBW儿童的身高、体重与相同青春发育分期的NBW儿童相似 ,但HtSDS与WtSDS在 - 2～ - 1的比例显著高于NBW儿童 ,分别为 ( 16 1%vs 5 7% ,P <0 0 1) ,( 2 1 4 %vs 5 5 % ,P <0 0 1)。②两组儿童血清IGF 1浓度均随年龄增长逐渐升高 ,且与年龄、身高、体重呈正相关关系。除 9～ 10岁组外 ,LBW儿童的IGF I水平均显著低于同年龄组NBW儿童。③两组儿童的青春期发育指标相似 ,各青春发育阶段LBW组平均IGF 1水平明显低于NBW组。结论　部分LBW儿童在青春期的身高、体重等生长发育指标仍处于较低水平 ,IGF 1水平低下可能是导致LBW儿童青春期生长迟缓的原因之一。     

Umbilical cord blood plasma vitamin A levels in low birth weight (LBW) babies

Background

Role of vitamin A in reducing the mortality in infants more than six months of age is well known. Supplementing newborn infants with vitamin A within 48 hours of birth reduces infant mortality by almost a quarter, with the greatest benefit to those of low birth weight (LBW). Studies that could highlight deficiency states in neonates, particularly LBW babies by objective measurement of vitamin A levels would help in formulating the recommendations to supplement these babies with vitamin A.

Methods

Cord blood plasma vitamin A levels of 154 LBW babies with birth weight in the range of 1505-2455 were analysed for plasma vitamin A (retinol) levels by HPLC method. Samples of 55 babies with normal birth weight were also analysed. LBW babies were divided into two subgroups of preterm LBW and LBW-term small for gestational age (SGA).

Results

Of the 154 babies with LBW, 92 were preterm LBW and 52 were LBW-term SGA. Mean cord blood plasma vitamin A levels were significantly lower in the preterm LBW group (n = 92) compared to levels observed in babies with normal birth weight (n = 55) and LBW-term SGA subgroups (n = 62). There was no significant difference in the mean vitamin A values between the normal birth weight babies and LBW-term SGA group. There was significant positive correlation of cord blood vitamin A levels with birth weight in the entire set of (n = 154) LBW babies (r = 0.37, P < 0.0001).

Conclusion

This study revealed significantly lower cord blood vitamin A levels in the preterm LBW babies. The level of vitamin A in LBW babies also correlated with their birth weight. There are enough evidence to support causative association between vitamin A deficiency state and neonatal morbidity. Simple interventions like vitamin A supplementation during a crucial stage of an infant's life may be beneficial in the long run. There is a need to establish norms for vitamin A levels and seriously examine the role of vitamin A supplementation for LBW babies during the immediate postnatal period.     

135名低出生体重儿的贝利婴幼儿发展量表测试分析

目的：了解低出生体重儿智能发育状况及其影响因素,为促进与改善婴幼儿智力发育提供依据．方法对135名低出生体重儿采用贝利婴幼儿量表进行评估并分析婴幼儿智力发展的影响因素．结果135名婴幼儿平均MDI为（86.76±18.95）分,MDI＜80分检出率为17.8%、PDI＜80分检出率为29.6%;婴幼儿MDI的影响因素是出生体重、年龄、父母亲文化程度、喂养方式;婴幼儿PDI的影响因素是年龄和出生体重．结论减少早产儿、低出生体重儿的出生;提高父母文化程度;提倡母乳喂养;进行早期干预可促进婴幼儿智力发育．     

成功救治并随访1例27周800克超低出生体重儿

目的：探讨超低出生体重儿的治疗经验。方法分析1例27周800 g女婴的住院治疗和随访资料。结果该患儿共住院60 d,入院后出现肺透明膜病、呼吸暂停、新生儿肺炎、败血症、贫血等并发症,出院时体重1890 g,体格、智力发育良好。随访至纠正年龄12个月,患儿体格与智力发育正常。结论呼吸衰竭、严重感染是超低出生体重儿常见的死亡原因;除加强患儿生命体征的监护外,通过加强客观指标的监测,如血常规、C反应蛋白、血培养、痰培养、血气分析、血糖、胸片、体重等,可早期发现和控制感染,维持患儿内环境的稳定;出院后定期随访,可早期发现发育异常,及时干预,减少后遗症。     

A longitudinal study to determine association of various maternal factors with neonatal birth weight at a tertiary care hospital

Background

Neonatal birth weight is a powerful predictor of infant growth and survival and maternal factors like poor knowledge and insufficient dietary intake are significant risk factors. Other preventable determinants like pre pregnant BMI <18.5, low gestational weight gain (GWG) and anemia are also associated with low birth weight. This study was carried out to identify the impact of these maternal factors with risk of low birth weight (LBW).

Methods

A longitudinal study was carried out on 124 booked antenatal cases at a tertiary care center. A validated protocol containing socio demography, food frequency and anthropometry was administered at the 3rd trimester. Birth weight of the newborn was noted after delivery.

Results

26.28% children had low birth weight (<2500 g), 14.6% mothers were thin (BMI < 18.5), 55.3% mothers had a weight gain of less than 9 kgs and 45.5% were anemic. 81.81% mothers with BMI >18.5 and 28.92% women who were educated till high school had a baby with LBW. Most mothers consumed milk and vegetables daily and a few consumed non vegetarian foods but quality and quantity of food were grossly inadequate. GWG levels and Hb levels were significantly different in different birth weight groups and also were significantly associated with low birth weight.

Conclusion

Quality and quantity of maternal dietary intake during pregnancy, even in normal weight mothers (BMI > 18.5), are important determinants of birth weight. Nutritional counseling for mothers during the antenatal period is the cornerstone for healthy mother and healthy child.     

464例婴儿听力筛查结果分析

目的了解婴儿听力筛查现状及影响因素。方法采用瞬态诱发耳声发射技术,对就诊于武汉市3所妇幼保健机构的464例3月以下婴儿进行听力筛查,并用自拟“婴儿听力筛查影响因素调查表”分析有关影响因素。结果婴儿听力筛查未通过率为17.67%;单因素Logistic回归分析表明,父亲年龄≥40岁、父亲或家族有听力障碍史,母亲孕期营养差、病毒感染、接触金属或化学毒物,妊娠次数2次及以上、早产、低出生体重、新生儿期有重症病房监护史是听力筛查未通过的危险因素;婴儿对外界声音反应灵敏是保护因素。结论婴儿听力损失受多种因素影响,应采取措施进行针对性的预防和干预。