Postnatal growth curves for extremely low birth weight infants with early enteral nutrition

Early enteral nutrition improves growth of extremely low birth weight infants, but growth curves beyond 30 days of life are lacking for such infants receiving early enteral nutrition. Based on the data of all infants born in a 4-year interval with a birth weight <1000 g and surviving for >56 days, we calculated growth rates and weight gain over 120 postnatal days. Infants with major congenital anomalies or necrotising enterocolitis were excluded. Daily weight, weekly length, head circumference and nutritional data were collected until discharge or for maximal 120 days. Curves were calculated in 100 g birth weight intervals, and separately for appropriate for gestational age (AGA) and small for gestational age (SGA) infants. Data were available from 163 infants (birth weight 768 g ± 153 g; gestational age 26.8±1.8 weeks; mean ± SD) including 55 SGA infants (33.7%). Full enteral feeding was achieved at day 21.7 (±10.4). After 12.8% (±6.6%) maximal postnatal weight loss at day 7.5 (±3.0), birth weight was regained at 14.6 (±6.0) days. Mean overall weight gain was 15 g/kg per day with a significantly higher weight gain for SGA than for AGA infants ( P <0.05). Conclusion:Our early fed infants achieved better weight gain than those recently published receiving late enteral nutrition, but nevertheless fell below the 10th percentile of intrauterine curves. Which postnatal growth is ideal for extremely low birth weight infants infants is unclear. Our growth curves should not be taken as reference curves of a normal population but may help to identify infants with growth failure.These data are part of the doctoral thesis of Mareike Diekmann. The study was partly supported by Nestlé     

中国不同胎龄新生儿出生体重曲线研制

目的 调查我国新生儿出生体重状况,制定新的新生儿出生体重标准,绘制不同出生胎龄新生儿出生体重曲线.方法 在全国范围内建立新生儿协作网,收集产科出生的新生儿数据.在全国七大区域23个省、市、自治区,共有63家医院设立监测点.研究对象为2011-2014年各监测点出生的单胎活产儿,采用连续收集的方法收集产科出生新生儿的胎龄和出生体重数据.新生儿生后2h内用电子秤进行裸身体重测量,胎龄判断为母亲末次月经、孕早期超声检查和出生后胎龄评分相结合的方法.出生体重曲线拟合方法采用LMSP方法,利用R2.11.1软件中的基于位置、尺度、形状的广义可加模型(GAMLSS) 1.9-4软件包进行曲线绘制和检验.结果 共收集单胎新生儿159 334名,其中男84 447名,女74 907名,平均出生体重(3 232±555)g,其中男性平均体重(3 271±576)g,女性平均出生体重(3 188±528)g.对新生儿出生体重数据的正态分布进行检验,结果提示胎龄和体重数据分布均不符合正态分布,BCT分布拟合度最优.用虫形图检测和拟合模型残差图检验,提示本曲线较好拟合了本研究的数据分布.采用同样的方法分别绘制男性新生儿和女性新生儿出生体重曲线.结论 对我国不同出生胎龄新生儿出生体重参考值进行了更新,使用GAMLSS方法建立新生儿出生体重曲线,分性别制定不同参考曲线,制定的出生体重曲线经统计学检验提示较为准确拟合实际情况.     

极低出生体重儿肠内营养与生长速度的研究进展

本文阐述了极低出生体重儿消化系统特点、肠内营养方式、乳类选择、开始时间、奶量增长速度及理想的生长速度,旨在了解不同的肠内营养开始时间对极低出生体重儿消化功能及生长速度的影响,以期寻找极低出生体重儿适宜的肠内营养开始时间,为临床制定极低出生体重儿肠内营养方案提供依据.     

中国不同出生胎龄新生儿体重身长比、体质指数和重量指数的参照标准及生长曲线

目的:制定中国出生胎龄24~42周新生儿体重身长比、体质指数和重量指数的参照标准及生长曲线,为新生儿出生时身体比例及营养状况评价提供参考依据。方法:横断面研究,于2015年6月至2018年11月在北京、哈尔滨、西安、上海、南京、武汉、广州、福州、昆明等13个城市调查出生胎龄24~42周单胎活产新生儿24375名,排除了影响参照标准建立的母亲和新生儿因素。采用基于位置、尺度、形状的广义可加模型构建出生胎龄24~42周男、女新生儿体重身长比、体质指数和重量指数的百分位数(P 3、P 10、P 25、P 50、P 75、P 90、P 97)参照值及生长曲线。将研制的参照标准与我国1988年数值、INTERGROWTH项目及美国相关参照值进行比较。结果:24375名新生儿中早产儿12264名(男7042名、女5222名),足月儿12111名(男6155名、女5956名)。研制出出生胎龄24~42周男、女新生儿体重身长比、体质指数和重量指数百分位数生长参照值及生长曲线。男新生儿体重身长比在不同出生胎龄P 10、P 50、P 90上比女新生儿高0~0.2 kg/m,男新生儿体质指数在不同出生胎龄P 10、P 50、P 90上比女新生儿高0.1~0.3 kg/m²。体重身长比和体质指数曲线在高百分位数上、重量指数曲线在高、低百分位数上与我国1988年数值均有较大差异,如体重身长比、体质指数、重量指数与我国1988年数值在P 90上的差值范围分别为-1.09~0.40 kg/m、-1.19~0.92 kg/m²、-0.64~0.81 kg/m³。体重身长比曲线与INTERGROWTH项目参照值有较好的一致性,在P 50上的差值范围-0.17~0.20 kg/m,出生胎龄≤32周时在P 90上低0.02~0.40 kg/m、在P 10上高0.13~0.41 kg/m。体质指数曲线与美国参照值差异较为明显,在P 50上的差值范围-0.47~0.17 kg/m²,出生胎龄≥37周时在P 90上低0.53~1.10 kg/m²但≤28周时高0.17~0.45 kg/m²。结论:建立中国出生胎龄24~42周新生儿不同性别的体重身长比、体质指数和重量指数的标准化参照值,可供临床及相关科研工作参照使用。     

Postnatal body weight curves for infants below 1000 g birth weight receiving early enteral and parenteral nutrition

No body weight curves are available for preterm infants <1000 g birth weight receiving early enteral and parenteral nutrition. Postnatal weight changes of 136 infants with a birth weight <1000 g were analysed retrospectively. Body weight curves for the first 30 days of life were generated for five separate birth weight groups (430–599 g, 600–699 g, 700–799 g, 800–899 g, 900–999 g). All infants had received intravenous glucose and amino acids from day 1 and intravenous lipids from day 2. Enteral feeding was started on day 1. Thus caloric intake (±SD) was advanced to 384 ± 46 kJ/kg per day (92 ± 11 kcal/kg/day) in the 1st week of life. In 136 preterm infants mean postnatal weight loss was 10.1% ± 4.6% of birth weight, birth weight was regained at a mean postnatal age of 11 ± 3.7 days, but significantly earlier (7.8 ± 3.5 days) in the lowest compared to the highest weight group. Mean subsequent weight gain was 15.7 ± 7.2 g/kg per day. This was accomplished by exclusive enteral nutrition from day 20 (median). Conclusion Our body weight curves are more adequate to evaluate growth of preterm infants than older published reference values because they are based on infants treated according to current nutritional standards. Received: 6 July 1997 and in revised form 5 October 1997 / Accepted: 15 October 1997     

Free-radical-induced lipid peroxidation during the early neonatal period

The effect of gestational age on postnatal free-radical-mediated lipid peroxidation was studied in 19 term (gestational age 37–42 weeks) and 21 healthy preterm (gestational age 31–36 weeks) infants by measurement of expired ethane and pentane during the first 7 days of life. Ethane (11.9 versus 5.7 pmol/kg/min; p = 0.0001) and pentane (11.4 versus 7.5 pmol/kg/min; p = 0.01) were significantly higher in preterm than in term infants. Correlations were found between gestational age and ethane ( r = 0.60, p = 0.0001) for days 1–7 and pentane ( r = 0.54, p = 0.0003) for days 3–7; and between birth weight and ethane ( r = 0.58, p = 0.0001) and pentane (r = 0.55, p = 0.0003). These results indicate that during the postnatal period, immaturity is a major factor determining the rate of free-radial-mediated lipid peroxidation.     

Vitamin D intake during pregnancy: Association with maternal characteristics and infant birth weight

Background

Vitamin D insufficiency is beginning to be recognized as a public health problem. It is plausible that some portion of the lower Vitamin D levels which characterize minority populations is related to diet.

Aims

We examined and described total Vitamin D intake during pregnancy from the mean of three 24-hour recalls plus use of dietary supplements.

Study design

Prospective cohort.

Subjects

2251 low income, minority gravidae from Camden, New Jersey, USA.

Outcome measures

Differences in total Vitamin D intake by maternal ethnicity. BMI and other factors (age, parity) and associations of total Vitamin D intake with gestation duration and birth weight adjusted for gestation.

Results and conclusions

Total Vitamin D intake was significantly lower for minority gravidae (African American, and Hispanic, mainly Puerto Rican), for parous women, and for women with pregravid BMIs consistent with obesity or being overweight. After control for energy, other nutrients, and other potential confounding variables, total intake of Vitamin D was associated with increased infant birth weight; gravidae below the current adequate intake (< 5 μg/day or 200 IU) had infants with significantly lower birth weights (p < 0.05). Additional intake of Vitamin D may be of importance since higher intake is associated with increased birth weight in a population at risk of adverse pregnancy outcomes.     

Sex-specific differences in birth weight due to maternal smoking during pregnancy

Introduction We investigated the sex-specific risk of maternal smoking during pregnancy on the birth weight and the proportion of small-for-gestational-age (SGA) newborns in 888,632 (49.9%) of 1,815,318 singleton births (ca. 80% of all singleton births in Germany from 1995 to 1997) in whom data on maternal cigarette consumption were available.Results and discussion Newborns below the 10th percentile for weight and duration of pregnancy were classified SGA. Maternal smoking during pregnancy lowers the mean birth weight and increases the risk of SGA newborns. The negative effect depends on the daily number of cigarettes consumed, and is greater in girls than in boys. In non-smokers, 9.8% of the newborns were SGA, with a sex-ratio of females:males=1, but this percentage increased with increasing number of cigarettes consumed (p<0.001), as did the sex-ratio, i.e. the negative effect of smoking on growth was greater in girls than in boys. In mild smokers (1–5 cigarettes/day), the risk of giving birth to an SGA girl was 1.7275-fold (95% CI: 1.7266–1.7284) above normal, but was 1.7143-fold (95% CI: 1.7137–1.7150) in boys. More than 21 cigarettes/day increased the risk of SGA 3.15-fold for a boy, but 3.51-fold for a girl (p<0.001).Conclusion In conclusion, particularly in heavy smokers, the negative effect of maternal smoking during pregnancy on the mean birth weight and risk of SGA is significantly greater in newborn girls than in newborn boys.     

Postnatal weight increase and growth velocity of very low birthweight infants

BACKGROUND: Only a few studies have dealt with postnatal growth velocity of very low birthweight (VLBW) infants. OBJECTIVE: To analyse weight growth kinetics of VLBW infants from birth to over 2 years of age. PATIENTS: A total of 262 VLBW infants were selected; inaccurate estimate of gestational age, major congenital anomalies, necrotising enterocolitis, death, and loss to follow up within the first year were the exclusion criteria. METHODS: Body weight was recorded daily up to 28 days or up to discontinuation of parenteral nutrition, weekly up to discharge, then at 1, 3, 6, 9, 12, 18, and 24 months of corrected age. Individual growth profiles were fitted with a seven constant, exponential-logistic function suitable for modelling weight loss and weight recovery, two peaks, and the subsequent slow decrease in growth velocity. RESULTS: After a postnatal weight loss, all infants showed a late neonatal peak of growth velocity between the 7th and 21st weeks; most also experienced an early neonatal peak between the 2nd and 6th week. VLBW infants who were small for gestational age and those with major morbidities grew less than reference VLBW infants who were the appropriate size for gestational age without major morbidities: at 2 years of age, the difference in weight was about 860 g. The more severe growth impairment seen in VLBW infants with major morbidities is almost entirely due to the reduced height of the late neonatal peak of velocity. CONCLUSIONS: The growth model presented here should be a useful tool for evaluating to what extent different pathological conditions or nutritional and medical care protocols affect growth kinetics.     

Turner's syndrome in Italy: familial characteristics, neonatal data, standards for birth weight and for height and weight from infancy to adulthood

In 1990, the Italian Study Group for Turner's Syndrome (ISGTS) undertook a nationwide survey, involving the retrospective collection of cross-sectional data and longitudinal growth profiles of 772 girls with Turner's syndrome born between 1950 and 1990. The study was carried out in 29 pediatric endocrinological centers. In this first report, the familial characteristics and neonatal data of Turner girls are described, compared to those of the general population, and related to postnatal somatic development. Furthermore, charts for birth weight and growth standards for height and weight from infancy to adulthood are presented (these are the first charts based on a large sample from the Mediterranean area). The main findings were: (1) incidence of Turner births increases with parental age or parity; (2) most of the neonates are small for dates; (3) girls with normal birth weight tend to be both taller and heavier than girls with low birth weight during the whole growth period; and (4) a 10-cm difference in midparental height leads to a 6.5-cm difference in adult stature.     

Cessation of smoking during pregnancy improves foetal growth and reduces infant morbidity in the neonatal period. A population-based prospective study

All pregnant women in Uppsala county in 1987 were questioned on three different occasions about smoking habits, socio-demographic factors and obstetric history. After delivery, information was collected regarding their children. Twenty percent of the mothers continued to smoke during pregnancy, while 8% stopped smoking. The mean birth weight of infants of smokers was 3378 g and of non-smokers 3589 g. The difference was significant ( p < 0.001) and persisted after statistical adjustment for maternal age, parity and educational level. Perinatal morbidity (admission to the Department of Neonatology) was higher in thc smoking group (11.4% versus 8.8%, p < 0.05). The proportion of infants with a birth weight less than 2500 g and that of small-for-gestational-age infants were 60% and 100% greater, respectively, in the smoking group. The mean birth weight and perinatal morbidity rate in infants of mothers who stopped smoking were almost identical to those in infants of non-smokers. Cessation of smoking improves foetal growth and perinatal health.     

极低出生体重儿院内生长发育状态多中心回顾性研究

目的 研究极低出生体重儿(VLBWI)住院期间的生长发育状态及相关影响因素.方法 回顾性调查广东省珠江三角洲地区9个城市的9家医院新生儿科于2010年7月1日至2011年6月30日,出院的VLBWI的住院资料,根据出生体重,分为宫内生长发育迟缓[IUGR组(n=63)]和非IUGR组(n=120),非IUGR组又根据其出院时是否发展为宫外生长发育迟缓(EUGR)而分为EUGR组(n=71)和非EUGR组(n=49),对比性研究IUGR组和非IUGR组住院期间的日均体重增长速度和出院时EUGR的发生率,及各组的院内营养摄入情况、生长速度和相关疾病因素的影响.结果 (1)出生时IUGR和出院时EUGR的发生率分别为34.4％和72.1％,IUGR组的日均体重增长速度高于非IUGR组[(12.5 ±2.7) g/kg vs (11.3±2.5) g/kg,t=3.068,P=0.002],但IUGR组发展为EUGR的比例明显高于非IUGR组(96.8％vs 59.2％,x2=29.145,P =0.000).(2) IUGR组在生后1、2、4周、达完全经口喂养前和住院期间的日均热卡摄入[62(51,69) kcal/kg vs 56(45,64) kcal/kg、83 (71,94) kcal/kg vs 76(66,88) kcal/kg、107(94,120) kcal/kg vs 95(85,108) kcal/kg; 103(96,110) kcal/kg vs 97(89,106) kcal/kg、121(111,131) kcal/kg vs 111 (101,119) kcal/kg](1 kcal=4.1840 kJ).蛋白质摄入[1.7(1.3,2.0) g/kgvs 1.6(1.2,1.8) g/kg、2.6(2.1,2.9) g/kg vs 2.3(1.9,2.7) g/kg、3.3(2.7,3.6) g/kgvs2.7(2.4,3.2) g/kg、3.1(2.6,3.4) g/kgvs 2.8(2.4,3.3) g/kg、3.4(3.1,3.8) g/kgvs3.1(2.8,3.5) g/kg]均高于非IUGR组(P＜0.05).热卡累积损失[407(360,483)kcal/kg vs 448(393,527) kcal/kg、534(369,689) kcal/kg vs 612(453,758) kcal/kg、367(12,724) kcal/kg vs 718(330,996) kcal/kg、381 (231,609) kcal/kg vs 656(394,959) kcal/kg、0(0,350) kcal/kg vs 387(85,826) kcal/kg].蛋白质累积损失[12.3(10.2,15.5) g/kg vs 13.7(11.7,16.4) g/kg、12.8(7.8,19.4) g/kg vs 17.5(11.9,22.7) g/kg、6.2(0,22.6)g/kg vs 21.7 (7.3,30.3)g/kg、6.6(1.8,23.0)g/kg vs22.1(7.2,32.5) g/kg、1.9(0,16.7)g/kg vs 20.1 (0,32.6) g/kg]则相应低于非IUGR组(P＜0.05).(3)非EUGR组的日均体重增长速度高于EUGR组[(12.7±2.2)g/kgvs (10.3±2.1) g/kg,t=6.137,P=0.000];开始喂养时间[1.0(1.0,3.0)dvs 3.0(2.0,5.0)d]、禁食时间[3.0(1.0,5.5)d vs 4.0(3.0,9.0)d]、最低体重出现时间[4.0(3.0,6.0) dvs6.0(5.0,8.0)d]、恢复出生体重时间[11.0(9.0,14.0) dvs 13.0(10.0,17.0)d]均短于非EUGR组(P＜0.05);需机械通气治疗者比例(70.4％ vs 51.0％)低于非EUGR组(P＜0.05).(4)非EUGR组在生后2周的日均热卡摄入[81(70,91) kcal/kg vs 73(63,85) kcal/kg]和生后1周[1.6(1.4,2.0) g/kgvs 1.4(1.1,1.8) g/kg]、生后2周[2.4(2.1,2.7) g/kg vs 2.1(1.8,2.6) g/kg]、达完全经口喂养前[3.0(2.5,3.4) g/kg vs 2.7(2.3,3.1)g/kg]的蛋白质摄入高于EUGR组(P＜0.05),而生后2周的热卡累积损失[546(403,707) kcal/kg vs 655(494,795) kcal/kg]和生后1周[13.1(10.9,15.1) g/kg vs 14.8(12.0,16.6) g/kg]、生后2周[15.5(11.4,19.8) g/kg vs 20.0(12.1,24.0) g/kg]的蛋白质累积损失低于EUGR组(P＜0.05),在其余各阶段的日均热卡、蛋白质摄入量及累积损失量比较差异无统计学意义(P＞0.05).(5)IUGR组新生儿呼吸窘迫综合征发生率低于非IUGR组(34.9％ vs 56.7％),孕母妊娠期高血压疾病、胎儿窘迫发生率则高于非IUGR组(54.0％ vs 24.2％、25.4％ vs 7.5％),新生儿窒息、坏死性小肠结肠炎、败血症、支气管肺发育不良、缺氧缺血性脑病/颅内出血、胆汁淤积症和孕母胎膜早破、胎盘早剥/前置胎盘的发生率组间比较差异无统计学意义(P＞0.05).(6) EUGR组新生儿败血症发生率(11.3％ vs0％)和孕母妊娠期高血压疾病发生率(31.0％ vs 14.3％)高于非EUGR组(P＜0.05),但新生儿呼吸窘迫综合征、窒息、坏死性小肠结肠炎、支气管肺发育不良、缺氧缺血性脑病/颅内出血、胆汁淤积症和孕母胎膜早破、胎盘早剥/前置胎盘、胎儿宫内窘迫的发生率组间比较差异无统计学意义(P＞0.05).结论 IUGR早产儿发生EUGR的风险远高于非IUGR者;导致非IUGR早产儿发生EUGR的危险因素包括:日均体重增长速度、最低体重出现时间、恢复出生体重时间、开始喂养时间、禁食时间、机械通气治疗、营养摄入与累积损失、疾病等因素.     

Association between birth weight and birth arm circumference of neonates in rural Egypt

In many developing countries including Egypt, the birth weights (BWs) of most babies go unrecorded because they are born at home. Since it is difficult to record BW in the community setting, birth arm circumference (BAC) has been used as a valid proxy for BW to identify at risk babies with low birth weight (LBW). However, the validity of BAC as an indicator of the actual BW has not been assessed fully. We did this study among neonates in rural Bilbeis, Egypt, to examine the association between BW and BAC, to assess whether BAC can serve as an indicator of the actual BW, and to determine the validity indices of 3 different cut-off levels of BAC as indicators of LBW. During 1987–88, the weights and arm circumference of 148 neonates were recorded within 2 weeks of birth. We observed a strong and highly significant positive linear correlation between BW and BAC (r=0.6188, p=0.0001). The BAC cut-off value of <9.5 cm was associated with the optimal combination of sensitivity (50%) and specificity (88.4%) as an indicator of LBW. In linear regression analysis BAC was found to be a significant (p=0.00001) predictor of BW. The means of the model predicted weights for males, females, and both genders together were identical to the corresponding means of the observed values. In contingency table analysis, for 78 (52.7%) of the 148 neonates studied the observed and predicted BW categories were identical. For another 59 (39.9%) neonates, agreement with the next lower or higher BW category was observed. We feel that BAC can be used as an indicator of the actual BW in settings where routine recording of BW is currently not practicable.     

Estimating the relative contributions of maternal genetic, paternal genetic and intrauterine factors to offspring birth weight and head circumference

Background

Genetic factors and the prenatal environment contribute to birth weight. However, very few types of study design can disentangle their relative contribution.

Aims

To examine maternal genetic and intrauterine contributions to offspring birth weight and head circumference. To compare the contribution of maternal and paternal genetic effects.

Study design

Mothers and fathers were either genetically related or unrelated to their offspring who had been conceived by in vitro fertilization.

Subjects

423 singleton full term offspring, of whom 262 were conceived via homologous IVF (both parents related), 66 via sperm donation (mother only related) and 95 via egg donation (father only related).

Measures

Maternal weight at antenatal booking, current weight and maternal height. Paternal current weight and height were all predictors. Infant birth weight and head circumference were outcomes.

Results

Genetic relatedness was the main contributing factor between measures of parental weight and offspring birth weight as correlations were only significant when the parent was related to the child. However, there was a contribution of the intrauterine environment to the association between maternal height and both infant birth weight and infant head circumference as these were significant even when mothers were unrelated to their child.

Conclusions

Both maternal and paternal genes made contributions to infant birth weight. Maternal height appeared to index a contribution of the intrauterine environment to infant growth and gestational age. Results suggested a possible biological interaction between the intrauterine environment and maternal inherited characteristics which suppresses the influence of paternal genes.     

The effect of genetic and seasonal factors on birth weight

Obesity is a heterogeneous group of disorders that have in common disturbances of energy balance and an increase of fat cells. Genetic and development factors, however, have an important role in making obese or not obese people. Recently there has been a surge of interest on the possible relationship of obesity with birth weight and with season of birth.We have studied the effect of season of conception and ACP1 phenotype (an enzyme associated with obesity disorders) on birth weight in a sample of 809 newborn infants from the Caucasian population of Central Italy.Birth weight of newborn conceived in the period January-April is higher compared to that of subjects conceived in the subsequent period of year. The effects of season of conception on birth weight is enhanced in newborns carrying the heterozygous ACP1BA phenotype. BA infants are also more represented among those conceived in the first months of the year.The observations suggest that environmental and genetic factors favouring reproduction in the early months of the year also favour the birth of well nourished offspring. These infants could have an increased susceptibility to over-weight during adult life in Western populations.     

Intergenerational birth weight associations by mother's birth order — The mechanisms behind the paradox: A population-based cohort study

Background

Mother's birth order is inversely associated with offspring birth weight despite positively associated with the mother's own birth weight. The causes behind this relation have not been elucidated.

Aims

To investigate the relation between mother's birth order and birth weight of her offspring, with emphasis on possible mechanisms behind the findings.

Study design

Population based cohort study over two generations.

Subjects

Data were from the Medical Birth Registry of Norway, based on all births in Norway, 1967-2006 (2.3 million births). Units where both mothers and offspring were singletons and offspring were first born were included, forming 272,674 mother-offspring units for the analyses.

Outcome measure

Birth weight in the second generation.

Results

Mother's birth weight increased steadily with increasing birth order from 3369 g for first born to 3538 g for fourth or later born mothers. In contrast, there was a monotonic decrease in offspring mean birth weight with increasing mother's birth order (9.1 g per birth order (95% C.I.; 6.8, 11.4)). First born mothers tended to be older, to have higher education, to more often be married or cohabiting, and to smoke less than later born mothers at the time of their first pregnancy.

Conclusion

The general reduction in mean birth weight among first born mothers was not observed in the next generation. We suggest that first born mothers have the same biologically potential for achieving similar sized offspring as later born mothers, and that social factors account for the inverse relation.     

系统性红斑狼疮产妇孕期体重增长对新生儿出生体重影响的巢式病例对照研究

目的 考察系统性红斑狼疮(SLE)产妇孕期体重增长(GWG)对新生儿出生体重的影响。方法 以上海交通大学医学院附属仁济医院(我院)产科分娩的SLE产妇及其新生儿为研究对象。采集产妇一般情况(年龄、身高、孕前体重、教育程度、GWG、既往疾病史、分娩孕周)、第一次产检指标(收缩压、舒张压、胆固醇、甘油三酯、空腹血糖)、新生儿性别、Apgar评分及出生体重。根据年龄和教育程度1:3匹配健康产妇及其新生儿作为对照。产妇GWG与新生儿出生体重关系采用一般线性回归分析。结果 共纳入SLE产妇45例和健康产妇135例。所有产妇平均年龄(29.0±3.0)岁,新生儿平均出生体重(3 198.8±501.8)g。SLE组GWG显著低于对照组,(12.4±5.5)kg vs (15.0±5.1)kg, P=0.004,GWG 低于适宜体重增长的比例显著高于对照组(37.8% vs 16.3%, P<0.01)。将所有产妇按GWG进行四分位分组,结果显示随着GWG增长,新生儿出生体重明显增加。与GWG处于最低四分位的SLE产妇相比,处于最高四分位的产妇的新生儿出生体重多(246.4±234.1)g,差异无统计学意义。结论 SLE产妇GWG明显低于正常产妇,随着GWG的增加,新生儿出生体重有增加趋势。     

肠内营养开始时间对极低出生体重儿消化功能及生长速度的影响

目的 探讨极低出生体重儿（VLBWI）适宜的肠内营养开始时间,观察不同肠内营养开始时间对VLBWI 消化功能、生长速度及院内感染率的影响。方法 选择NICU 病区2012 年2~12 月入院的全部VLBWI,根据肠内营养开始时间,将其分为3 组,即≤ 3 d 组（116 例）、4~6 d 组（36 例）、≥ 7 d 组（26 例）。分析不同肠内营养开始时间对消化功能、生长速度及院内感染率等的影响。结果 ≤ 3 d 组生后1 周奶量明显高于另2 组,≤ 3 d 组及4~6 d 组生后2 周、3 周奶量明显高于≥ 7 d 组。3 组生长速度指标比较差异无统计学意义。≤ 3 d 组中心静脉置管时间明显短于另外2 组,≥ 7 d 组达全肠内营养的时间明显长于另外2 组。≤ 3 d组院内感染率（13.8%）明显低于≥ 7 d 组（46.2%）。结论 肠内营养开始时间对VLBWI 生长速度无影响,但早期开始肠内营养能促进其胃肠功能成熟,利于奶量增长,能更快达到全肠内营养,缩短中心静脉置管时间,降低院内感染率。     

Factors associated with variation in plasma copper levels in preterm infants of very low birth weight

At 2-weekly intervals from age 4–14 weeks, the possible effects on plasma copper concentration of gestation, multiple birth, fractional weight change from birth (W/BW) and, up to 10 weeks, average daily total copper intake from birth were explored in 43 preterm infants of very low birth weight. There was no significant association between the logarithm of the plasma copper concentration (ln Cu) and multiple birth at any time and no significant association between lnCu and gestation was found from 4–12 weeks. From age 4–10 weeks, there was a significant negative correlation between lnCu and W/BW and at 4, 6 and 10 weeks there was also a significant negative correlation between lnCu and copper intake. W/BW and copper intake were correlated throughout. At 14 weeks, lnCu correlated positively with gestation and negatively with W/BW but, at this age, gestation and W/BW were correlated. The maximum total variation (R²) in lnCu explained by its regression on gestation, multiple birth, W/BW and/or copper intake combined was only about 31% (at 10 weeks). The potential for copper depletion may be greater in rapidly growing infants.