极低出生体重儿颅内出血危险因素的分析

目的：颅内出血是造成极低出生体重（VLBW）儿智力及运动障碍主要原因之一,了解其发病的危险因素、及早预防,可减少残疾、提高生存质量。方法研究169例极低出生体重儿,对产前因素及生后因素进行分析,采用SPSS12.0对数据进行卡方检验,有意义因素再进行logistic回归分析,得出回归方程。结果胎膜早破、1分钟Apgar评分≤7分、使用PS及呼吸机治疗、上机时间＞3 d、入院时PT＞20 s、生后1 d和2 d低钠血症及生后1 d pH值＜7.25为VLBW颅内出血危险因素。结论1分钟Apgar评分≤7分和使用呼吸机治疗是VLBW儿颅内出血的主要危险因素,而凝血功能和内环境紊乱均与缺氧窒息有关。因此,作好产前保健,减少窒息及生后合并症发生,有利于降低VLBW儿颅内出血发生率,提高患儿生存质量。 ［中国当代儿科杂志,2007,9（4）：297-300］     

Risk factors for small-for-gestational-age babies: The Auckland Birthweight Collaborative Study

OBJECTIVE: This case-control study determined whether internationally recognized risk factors for small-for-gestational-age (SGA) term babies were applicable in New Zealand. METHODOLOGY: All babies were born at 37 or more completed weeks of gestation in one of three hospitals in Auckland. Cases weighed less than the sex specific 10th percentile for gestational age at birth, and controls (appropriate-for-gestational-age (AGA)) were a random selection of heavier babies. Information was collected by maternal interview and from obstetric databases. RESULTS: Information from 1714 completed interviews (844 SGA and 870 AGA) was available for analysis. Computerized obstetric records were available for 1691 of the 1701 women who consented to such access. In a multivariate analysis allowing for sex, gestational age at birth, social class and other potential confounders, mothers who smoked had a significantly increased risk of an SGA baby (adjusted OR 2.41; 95% CI 1.78-3.28), as did primiparous mothers (adjusted OR 1.34; 95% CI 1.03-1.73), mothers of Indian ethnicity (adjusted OR 3.22; 95% CI 1.95-5.30), women with pre-eclamptic toxaemia (adjusted OR 2.42; 95% CI 1.08-5.40) and those with pre-existing hypertension toxaemia (adjusted OR 5.49; 95% CI 1.81-16.71). Mothers of SGA infants were shorter (P < 0.001) and reported lower prepregnancy body weights (P < 0.001) than mothers of AGA infants. The population attributable fraction for smoking suggests that up to 18% of SGA infants born in the ABC Study could be related to maternal smoking. CONCLUSIONS: Risk factors associated with SGA births in other countries are also important in New Zealand. Smoking in pregnancy is an important and potentially modifiable behaviour, and efforts to decrease the number of women who smoke during pregnancy should be encouraged.     

孕前双亲体重指数、母孕期体重增值及其交互作用对新生儿出生体重的影响

目的 探讨孕前双亲体重指数（BMI）和母孕期体重增值及其交互作用对新生儿出生体重的影响。方法 选取2017年1月至2018年10月在西安交通大学第一附属医院做定期产检并足月单胎分娩的孕妇1 127例,收集其孕前BMI、孕期体重增值、孕前丈夫BMI、新生儿出生体重等信息,分析新生儿出生体重与孕前父母BMI和母亲孕期体重增值之间的相关性及两变量间的交互作用。结果 1 127例足月新生儿中,低出生体重检出25例（2.22%）,巨大儿检出43例（3.82%）。低出生体重儿、正常体重儿、巨大儿三组双亲孕前BMI值、母亲孕期体重增值的比较差异均有统计学意义（P < 0.05）。新生儿出生体重与孕前双亲BMI值、母亲孕期体重增值呈低度正相关（r=0.097~0.322,P < 0.05）;母亲孕前低体重可增加低出生体重儿的发生风险（RR=4.17,95% CI：1.86~9.38）;母亲孕前超重/肥胖、孕期体重增值超标可增加巨大儿的发生风险（分别RR=3.59,95% CI：1.93~6.67;RR=3.21,95% CI：1.39~7.37）。未发现母亲孕前BMI与孕期体重增值对新生儿出生体重的交互作用。结论 孕前双亲BMI和母亲孕期体重增值与新生儿出生体重有关,而母亲孕前BMI和孕期体重增值之间无交互作用。     

胎龄≤32周早产儿低血糖的危险因素分析

目的 探讨胎龄≤32周早产儿出生后发生低血糖的危险因素。方法 回顾性纳入2017年1月至2020年6月入住新生儿重症监护病房的86例胎龄≤32周低血糖早产儿作为低血糖组,随机选取同期住院监测血糖正常的早产儿172例为对照组。采用单因素分析与多因素logistic回归分析筛选早产儿低血糖的危险因素。结果 研究期间早产儿共计515例,其中低血糖86例（16.7%）。低血糖组小于胎龄儿（SGA）、剖宫产出生、孕母高血压、产前使用激素的比例均高于对照组（P < 0.05）,而出生体重及血糖检测前已静脉使用葡萄糖的比例均低于对照组（P < 0.05）。SGA（OR=4.311,95% CI：1.285~14.462）、孕母高血压（OR=2.469,95% CI：1.310~4.652）和产前使用激素（OR=6.337,95% CI：1.430~28.095）为早产儿低血糖的危险因素（P < 0.05）,静脉使用葡萄糖（OR=0.318,95% CI：0.171~0.591）为早产儿低血糖的保护因素（P < 0.05）。结论 SGA、孕母高血压和产前使用激素可增加胎龄≤32周早产儿早期发生低血糖的风险;对胎龄≤32周早产儿,建议生后尽早静脉使用葡萄糖,以减少低血糖的发生。     

产妇年龄对新生儿不良结局影响的回顾性队列研究

目的 探讨不同怀孕年龄单胎妊娠产妇和新生儿不良结局的关系。方法 采用回顾性队列研究的方法,通过截取产科和新生儿科电子病例资料,获得2006年1月至2018年12月复旦大学附属妇产科医院住院单胎妊娠孕妇的社会人口学资料、孕产史及本次妊娠情况。按照分娩年龄不同将产妇分为低龄(<20岁)、适龄(~34岁)和高龄组(≥35岁)。分析各年龄组产妇相关特征的基线和妊娠的新生儿结局的发生率。组间比较采用χ²或Fisher精确检验。采用多自变量logistic回归模型,进行产妇亚组分析,以~34岁组为参考组,对<20、≥35岁组产妇,通过比值比(Crude OR)、调整比值比(Adjusted OR)和95％CI表示各产妇亚组相关的新生儿不良结局的风险。结果 2006至2014年高龄产妇比例6.9%~9.9%,2015、2016、2017和2018高龄产妇的比例分别为13.1%、13.8%、17.6%和19.6%。低龄组、高龄组在流动人口、初产妇、剖宫产比例方面与适龄组相比差异均有统计学意义(P均<0.001)。高龄组较适龄组胎产式为非头位者、不良孕产史、男性新生儿比例增加(P<0.05)。校正后低龄组和高龄组早产儿的发生率分别是适龄组的1.88倍(95%CI:1.34~2.65)和1.31倍(95%CI:1.21~1.42)。低龄组和高龄组中期早产儿的发生率分别是适龄组的2.83倍(95%CI:1.45~5.54)和1.34倍(95%CI:1.13~1.60),低龄组和高龄组晚期早产儿的发生率分别是适龄组的1.75倍(95%CI:1.22~2.51)和1.27倍(95%CI:1.17~1.36)。低龄组和高龄组低出生体重儿的发生率分别是适龄组的2.35倍(95%CI:1.66~3.33)和1.26倍(95%CI:1.16~1.37)。高龄组出生缺陷发生率是适龄组的1.39倍(95%CI:1.20~1.62)。结论 与适龄组相比,高龄组和低龄组产妇增加了早产、中期早产儿、晚期早产儿和低出生体重的风险。对低龄产妇应加强流动人口的管理,定期产检。对高龄产妇,应预防出生缺陷的发生,积极处理妊娠期并发症,加强孕中后期监护,预防围生期感染。本研究结果有助于不同怀孕年龄产妇的产前咨询和管理。     

产妇年龄对新生儿不良结局影响的回顾性队列研究

目的 探讨不同怀孕年龄单胎妊娠产妇和新生儿不良结局的关系。方法 采用回顾性队列研究的方法,通过截取产科和新生儿科电子病例资料,获得2006年1月至2018年12月复旦大学附属妇产科医院住院单胎妊娠孕妇的社会人口学资料、孕产史及本次妊娠情况。按照分娩年龄不同将产妇分为低龄(<20岁)、适龄(~34岁)和高龄组(≥35岁)。分析各年龄组产妇相关特征的基线和妊娠的新生儿结局的发生率。组间比较采用χ²或Fisher精确检验。采用多自变量logistic回归模型,进行产妇亚组分析,以~34岁组为参考组,对<20、≥35岁组产妇,通过比值比(Crude OR)、调整比值比(Adjusted OR)和95％CI表示各产妇亚组相关的新生儿不良结局的风险。结果 2006至2014年高龄产妇比例6.9%~9.9%,2015、2016、2017和2018高龄产妇的比例分别为13.1%、13.8%、17.6%和19.6%。低龄组、高龄组在流动人口、初产妇、剖宫产比例方面与适龄组相比差异均有统计学意义(P均<0.001)。高龄组较适龄组胎产式为非头位者、不良孕产史、男性新生儿比例增加(P<0.05)。校正后低龄组和高龄组早产儿的发生率分别是适龄组的1.88倍(95%CI:1.34~2.65)和1.31倍(95%CI:1.21~1.42)。低龄组和高龄组中期早产儿的发生率分别是适龄组的2.83倍(95%CI:1.45~5.54)和1.34倍(95%CI:1.13~1.60),低龄组和高龄组晚期早产儿的发生率分别是适龄组的1.75倍(95%CI:1.22~2.51)和1.27倍(95%CI:1.17~1.36)。低龄组和高龄组低出生体重儿的发生率分别是适龄组的2.35倍(95%CI:1.66~3.33)和1.26倍(95%CI:1.16~1.37)。高龄组出生缺陷发生率是适龄组的1.39倍(95%CI:1.20~1.62)。结论 与适龄组相比,高龄组和低龄组产妇增加了早产、中期早产儿、晚期早产儿和低出生体重的风险。对低龄产妇应加强流动人口的管理,定期产检。对高龄产妇,应预防出生缺陷的发生,积极处理妊娠期并发症,加强孕中后期监护,预防围生期感染。本研究结果有助于不同怀孕年龄产妇的产前咨询和管理。     

早产儿和小于胎龄儿发生的危险因素的比较分析

目的 比较早产儿和小于胎龄儿发生的危险因素.方法 选择1 270例排除明确孕母疾病和产科危险因素的新生儿,自制调查问卷调查母亲身高、体重、被动吸烟和不良孕产史等因素,将研究对象分类为早产儿和足月儿、小于胎龄儿和适于胎龄儿,采用多因素logistic 回归分析比较早产儿和小于胎龄儿发生的危险因素.结果 孕期增重<9 kg使早产(OR=1.63,95%CI:1.12~2.07)和小于胎龄儿(OR=1.92,95%CI:1.56~2.58)发生的危险性均增高;母亲既往流产史(OR=1.46,95%CI:1.09~1.93)和早产史(OR=2.63,95%CI:1.81~3.92)是早产儿发生的的独立危险因素;孕母身高<1.55 m(OR=2.46,95%CI:1.78~3.48)、孕前BMI<18.5(OR=2.16,95%CI:1.53~3.16)、被动吸烟(OR=2.24,95%CI:1.65~2.98)是小于胎龄儿发生的的独立危险因素.结论 早产儿和小于胎龄儿的危险因素不同,针对两类特征孕妇应采取不同的预防措施,有针对性地减少两类不良妊娠结局的发生.     

新生儿先天性甲状腺功能减低症危险因素的Meta分析

目的 探讨新生儿先天性甲状腺功能减低症(congenital hypothyroidism,CH)的危险因素,为CH的预防提供参考依据.方法 系统收集中国生物医学文献数据库、中国知网、维普中文期刊数据库、万方数据库、PubMed、Web of Science、Embase、SpringerLink、Elsevier/S...     

Morbidity during the first year of life in small for gestational age infants.

Postneonatal morbidity during infancy was studied in 284 small for gestational age (SGA) and 359 non-SGA term infants. None of these babies had congenital malformations and they were born to para 1 and para 2 mothers. SGA infants had an increased risk (OR: 1.7, 95% confidence interval: 1.1-2.6) of being admitted to hospital compared with non-SGA infants. The principal cause was respiratory tract infections. Increased hospitalisation among SGA infants was a factor only if the mother was a smoker-that is, smoked cigarettes at the time of conception. Among subgroups of SGA babies, there was an increased risk for infants of non-repeaters (women without a previous SGA child) (OR: 2.4, 95% CI: 1.4-3.8) and for infants with symmetric (OR: 2.0, 95% CI: 1.2-3.3) body proportions compared with non-SGA infants. The results suggest that, beginning in early pregnancy, growth retardation may have long term consequences for subsequent infant morbidity, particularly if the mother is smoker.     

Prepregnancy Maternal Weight and Body Mass Index of Children with and without Congenital Heart Disease

Objective: Congenital heart diseases are among the most frequent major congenital anomalies. One of the suspected reasons for congenital heart defects is overweight and obesity of mother during prepregnancy and pregnancy. We studied the relationship between maternal overweight and obesity and the risk of congenital anomaly. Methods: All of children with congenital heart defect (164 infants with major nonsyndromic heart disease) referred to our pediatric cardiology clinic or admitted to our ward during 2011-2012 were included in this study. Controls were 158 live-born infants without any major malformations and their mothers. Mothers of these infants were studied for weight, height and body mass index (BMI). Findings : The most frequent congenital heart disease was ventricular septal defect (39%), patent ductus arteriosus (11%), complete atrioventricular septal defect (10%), pulmonary stenosis (9.1%), and atrial septal defect (8.5%). There was no significant difference between maternal age (P=0.1), weight (P=0.8) and height (P=0.3) in the two groups. The mothers had not significantly higher BMI than that of the control mothers. Compared with underweight (BMI <18.5) and normal weight women (OR: 1.24, 95%CI: 0.40-3.89), overweight (OR: 0.98, 95%CI: 0.31-3.10) and obese women (OR: 1.16, 95%CI: 0.34-4.00) were not more likely to have an infant with a congenital heart defect. Conclusion: This study suggests that there may not be a relation between maternal BMI and having a child with congenital heart defect.Key Words: Congenital Heart Defects; Maternal Obesity; Maternal Overweight     

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。     

Associations between prepregnancy body mass index,gestational weight gain and weight catch-up in small-for-gestational-age children

Inadequate gestational weight gain (GWG) was related with a higher incidence of small-for-gestational-age (SGA) births than appropriate GWG; however, the long-term association of maternal GWG with weight catch-up growth in SGA children remains unknown. The objective of this study is to evaluate the associations between prepregnancy body mass index (pBMI), GWG and weight catch-up patterns in SGA children. Data were from the Collaborative Perinatal Project, an American multicentre prospective cohort study. A total of 56,990 gravidas were recruited at the first prenatal visit, and children were followed up until school age. Maternal pBMI, GWG and physical growth of the offspring at birth, 4 months, 1 year, 4 years and 7 years old were recorded. The latent class analysis was employed to form weight catch-up growth patterns (appropriate, excessive, slow, regression and no catch-up patterns) in SGA children. SGA children who developed the ‘appropriate catch-up growth’ pattern and whose mothers had appropriate pBMI and GWG were chosen as the reference. Associations between GWG for different pBMI and weight catch-up patterns were analysed by multivariate logistic regression models. A total of 1619 infants (9.45%) were born term SGA. After adjusting for relevant confounders, compared with SGA children whose mothers had appropriate pBMI and GWG, SGA children with maternal prepregnancy underweight (for inadequate GWG, GWG below recommendations, adjusted OR: 2.88, 95% CI: 1.13–7.31; for appropriate/excessive GWG, adjusted OR: 3.07, 95% CI: 1.74–5.42) or with prepregnancy normal weight but inadequate GWG (adjusted OR: 2.14, 95% CI: 1.36–3.38) were at a higher risk of having the ‘no catch-up growth’ pattern. We suggest that SGA children with maternal prepregnancy underweight or inadequate GWG tend to have a poor weight catch-up growth at least until school age.     

母体高尿酸血症对妊娠结局和新生儿合并症影响的回顾性巢式病例对照研究

背景：高尿酸血症（HUA）患病率逐年增高,不仅与痛风、尿酸盐肾病和肾结石有关,还与内分泌代谢、心脑血管等系统疾病的发生和发展有关。 目的：探讨孕母妊娠晚期血尿酸水平与不良妊娠结局、新生儿尿酸水平及新生儿合并症的关系。 设计：回顾性巢式病例对照研究。 方法：以2020年1~12月在北京大学人民医院产检的孕母为队列人群,根据孕母妊娠晚期血尿酸水平分为HUA组和非HUA组,比较两组妊娠结局和新生儿临床结局。根据孕母妊娠晚期血尿酸水平（μmol·L-1）分为低浓度（<360）、中浓度（~420）和高浓度（>420）,采用线性回归和Logistic 回归模型分析孕母血尿酸水平与早产、低出生体重、小于胎龄儿的关系。孕母妊娠晚期尿酸值及新生儿生后24 h尿酸值相关性分析采用Spearman秩相关分析。 主要结局指标：孕母血尿酸水平与早产、低出生体重和小于胎龄儿的关系。 结果：共纳入孕母2 397例（新生儿2 581例）,HUA组216例（9.0%）,非HUA组2 181例。HUA组孕母所生新生儿出生体重低于非HUA组（2 925 g vs 3 260 g,P<0.001）,差异均有统计学意义;而早产（18.5% vs 8.9%）、低出生体重（23.1% vs 7.1%）、小于胎龄儿（29.2% vs 10.6%）和转儿科比例（19.9% vs 11.1%）均高于非HUA组,差异均有统计学意义（P<0.001）。尿酸水平高浓度组孕母分娩的新生儿出生体重较低浓度组低54.0 g（95%CI：-106.5~-1.6,P=0.043）,发生早产的风险增加74%（OR=1.74,95%CI：1.08~2.8,P=0.023）,发生小于胎龄儿的风险增加85%（OR=1.85,95%CI：1.26~2.73,P=0.002）。新生儿生后24 h内尿酸水平与孕母妊娠晚期尿酸水平呈中等相关（r=0.613,P=0.000）。两组早产儿合并症差异无统计学意义。 结论：母体妊娠晚期HUA与早产、低出生体重、小于胎龄儿的发生相关。     

Low Birth Weight and Its Related Risk Factors in Northeast Iran

Objective

This study was conducted to determine the prevalence of low birth weight (LBW) and its related risk factors in an appropriate sample of neonates in Shahroud, northeast Iran.

Methods

At this study, a random sample of 1000 neonates were selected of which 72 neonates were LBWs. We used univariate and multivariate logistic regression methods to evaluate the LBW risk factors in LBWs compared to normal weight infants.

Findings

7.2% of neonates were LBWs and 6.1% born before 37 weeks of gestation. Prematurity, high-risk pregnancy and maternal age have significant statistical association with LBW. Odds Ratio (OR) for prematurity was 42.82 (95%CI; 21.93-83.57), for high risk pregnancy 2.76 (95%CI; 1.47-5.19) and for maternal age group more than 35 years in comparison to 19-35 years age group 0.2 (95%CI; 0.05-0.71).

Conclusion

Based on this study; prematurity and high risk pregnancy were the most important risk factors for LBW. There was also a reverse association between maternal age and LBW.     

儿童支气管哮喘与母孕期及新生儿期相关影响因素分析

目的 分析儿童支气管哮喘在母孕期及新生儿期的影响因素,为早期防治儿童哮喘提供依据。方法 选择306例哮喘患儿(哮喘组)和250例正常儿童(对照组),对所有儿童母孕期和新生儿期的临床资料进行调查。结果 单因素分析显示哮喘组与对照组在孕期使用抗生素、新生儿期使用抗生素、新生儿期服用益生菌、早产、剖宫产、低出生体重、母乳喂养方面比较差异有统计学意义(P0.05)。多因素logistic回归分析显示,孕期使用抗生素(OR=3.908,95%CI:1.277~11.962)、新生儿期使用抗生素(OR=24.154,95%CI:7.864~74.183)、早产(OR=8.535,95%CI:2.733~26.652)及剖宫产(OR=4.588,95%CI:2.887~7.291)为儿童哮喘的独立危险因素;而新生儿期服用益生菌(OR=0.014,95%CI:0.004~0.046)及母乳喂养6个月(OR=0.161,95%CI:0.103~0.253)为儿童哮喘的保护因素。结论 孕期减少抗生素的使用、减少剖宫产、新生儿期避免滥用抗生素、尽量母乳喂养、尽早添加益生菌可对儿童哮喘起到一定的早期预防作用。     

影响极低出生体重儿体重增长的多因素分析

目的探讨影响极低出生体重儿(VLBW)体重增长的相关因素。方法对1998年7月—2004年3月重庆医科大学儿童医院新生儿病房收治的51例VLBW进行回顾性分析。结果单因素分析发现,早开奶、热卡摄入量和蛋白质摄入量对体重增长有显著性影响(P<0·05)。多元逐步回归分析结果示,热卡摄入量和蛋白质摄入量是影响体重增长的显著因素,回归方程为Y(体重增长)=-6·426+0·120X1(热卡摄入量)+3·737X2(蛋白质摄入量)(P<0·01)。达到体重增长目标对象中单纯胃肠内营养组和部分胃肠外营养组热卡摄入量分别为(520·62±21·59)kJ/(kg·d)[(124·43±5·16)kcal/(kg·d)]、(451·49±68·41)kJ/(kg·d)[(107·98±16·35)kcal/(kg·d)],差异有统计学意义(P<0·05)。早开奶组出生体重恢复时间、住院时间和胃肠外营养液体量占总液量比例>75%时间平均秩分别为18·58、20·24、20·11,晚开奶组分别为33·00、32·48、31·83,差异有统计学意义(P<0·05)。结论VLBW在生后应保证足量热卡和蛋白质的供给,对于小于胎龄儿和有严重并发症的患儿更应该加强营养的补充,对VLBW应尽早喂养,同时需要胃肠外营养作为肠内营养的补充。     

极低出生体重儿败血症的临床分析

目的 分析极低出生体重儿败血症的发生情况及临床特征.方法 收集2019年1月至2020年6月南京医科大学附属妇产医院新生儿科收治的极低出生体重儿(出生体重<1500 g)的临床资料,分析败血症发生率、病原菌分布及危险因素.结果 共369例患儿纳入研究,其中败血症138例,包括早发型败血症(early-onset sep...     

益生菌预防早产儿坏死性小肠结肠炎的系统评价和Meta分析

目的 评价益生菌预防早产儿坏死性小肠结肠炎（NEC）的有效性和安全性。方法 计算机检索PubMed、Ovid-Embase、The Cochrane Library、中国知网、维普、中国生物医学文献和万方数据库,收集益生菌预防早产儿NEC的RCT,检索时间均从建库至2016年3月。2名评价员独立筛选文献、提取资料和评价偏倚风险,采用 RevMan5.3软件进行Meta分析。结果 最终纳入33个RCT (n=8 248)。Meta分析结果显示：①低出生体重儿（LBWI）：益生菌降低NEC 2级以上（包括2级和3级）发生率［OR=0.26（95%CI：0.10~0.66）］、3级发生率［OR=0.29（95%CI：0.11~0.78）］、缩短达全肠道喂养时间［WMD=-3.57（95%CI：-5.79~-1.34）］,差异有统计学意义,益生菌组和对照组总病死率［OR=0.80（95%CI：0.50~1.28）］和脓毒症发生率［OR=0.50（95%CI：0.13~1.99）］差异无统计学意义;②极低出生体重儿（VLBWI）：益生菌降低NEC 2级以上发生率［OR=0.34（95%CI：0.26~0.44）］、3级发生率［OR=0.39（95%CI：0.20~0.76）］、总病死率［OR=0.55（95%CI：0.44~0.69）］、NEC相关病死率［OR=0.38（95%CI：0.21~0.69）］和脓毒症发生率［OR=0.77（95%CI：062~095）］,差异均有统计学意义,益生菌组和对照组达全肠道喂养时间 ［WMD=-128（95%CI：-262~006）］差异无统计学意义;③超低出生体重儿（ELBWI）：益生菌缩短达全肠道喂养时间 ［WMD=-170（95%CI：-285~-055）］,差异有统计学意义,益生菌组和对照组的NEC 2级以上和3级发病率、总病死率、NEC相关病死率和脓毒症发生率差异无统计学意义。结论 预防性使用益生菌可减少LBWI和VLBWI的NEC 2级以上以及3级发生率,缩短达全肠道喂养时间,并降低VLBW的总病死率、NEC相关病死率和脓毒症发生率,但纳入研究在研究设计、方法学等方面仍存在局限性,仍需开展更多高质量研究予以验证。     

Maternal nutritional risk factors for small for gestational age babies in a developed country: a case-control study

AIMS: To assess the effect of maternal diet during pregnancy on the risk of delivering a baby who is small for gestational age (SGA). METHODS: Case-control study of 844 cases (SGA) and 870 controls (appropriate size for gestational age (AGA)). Only term (37+ completed weeks of gestation) infants were included. Retrospective food frequency questionnaires were completed at birth on the diet at the time of conception and in the last month of pregnancy. RESULTS: At the time of conception, mothers of AGA infants ate significantly more servings of carbohydrate rich food and fruit, and were more likely to have taken folate and vitamin supplements than mothers of SGA infants. There was some evidence that mothers of AGA infants also ate more servings of dairy products, meat, and fish (0.05 < p < 0.1). However, after adjustment for maternal ethnicity, smoking, height, weight, hypertension, and occupation, fish intake (p = 0.04), carbohydrate-rich foods (p = 0.04), and folate supplementation (p = 0.02) were associated with a reduced risk of SGA. In the last month of pregnancy, only iron supplementation was associated with a reduced risk of SGA (p = 0.05) after adjustment for potential confounders. CONCLUSIONS: This study suggests that small variations in maternal diets within the normal range during pregnancy in developed countries are associated with differences in birth weight.     

Metabolic consequences of intrauterine growth retardation in very low birthweight infants

By the combination of energy and macronutrient balances, continuous open circuit computerized indirect calorimetry, and anthropometry, we have compared small for gestational age (SGA) and appropriate for gestational age (AGA) very low birthweight infants with respect to metabolizable energy intake (mean +/- SE: 125.9 +/- 2.5 versus 130.4 +/- 3.5 kcal/kg X day), energy expenditure (67.4 +/- 1.3 versus 62.6 +/- 0.9 kcal/kg X day), storage of energy and macronutrients and growth. Fourteen studies in six SGA infants (gestational age, 33.1 +/- 0.3 weeks; birthweight, 1120 +/- 30 g) and 22 studies in 13 AGA infants (gestational age, 29.3 +/- 0.4 weeks; birthweight, 1155 +/- 40 g) were performed. The SGA infants had a lower absorption of fat (68.7 +/- 3.2 versus 79.7 +/- 1.7%) and protein (69.1 +/- 3.2 versus 83.4 +/- 1.5%) and hence increased (P less than 0.001) energy loss in excreta (29.9 +/- 2.8 versus 18.2 +/- 1.5 kcal/kg X day). The significant hypermetabolism of SGA infants by 4.8 kcal/kg X day was associated with an increased fat oxidation. Despite lower energy storage, SGA infants were gaining weight (19.4 +/- 0.9 g/kg X day), length (1.25 +/- 0.14 cm/week), and head circumference (1.16 +/- 0.9 cm/week) at higher rates than the AGA group. The energy storage per g weight gain was lower (P less than 0.001) in the SGA group (3.0 +/- 0.14 versus 4.26 +/- 0.26 kcal) reflecting higher water, lower fat (22.2 +/- 1.8 versus 33.8 +/- 2.5%; P less than 0.001) and lower protein (7.7 +/- 0.5 versus 12.5 +/- 0.8%; P less than 0.001) contents of weight gain in the SGA group.