我国小于胎龄儿现状分析

研究我国小于胎龄儿（SGA）的现状。方法　调研我国22个省、自治区、直辖市的86所医院提供的2005 - 01 - 01 T 00:00:00至2005 - 12 - 31 T 00:00:00出院的产科出生的新生儿（45 014例）中SGA的发生率,总结分析该86所医院新生儿科住院患儿（54 466例）中SGA的临床资料。结果　（1）产科出生的 新生儿中SGA 的发生率为6.61 %,其中早产儿中SGA发生率（13.10 %）高于足月儿（6.05 %）;（2）新生儿科住院患儿中SGA的比例为9.19 %;（3）SGA中窒息 、呼吸窘迫综合征（RDS） 、肺出血、呼吸暂停、缺氧缺血性脑病（HIE）、胃潴留、消化道出血、坏死性小肠结肠炎（NEC）、寒冷损伤综合征、先天畸形的构 成比高于适于胎龄儿（AGA）和大于胎龄儿（LGA）;（4）在SGA的转归中,治愈、好转率分别为57.47 %和27.41 %, 自动出院占13.17 %,病死率为1.95 %。其 中SGA病死率明显高于AGA和LGA, 而治愈好转率（84.88 %）则明显低于AGA 和LGA。 结论　我国新生儿科住院患儿中SGA的患病率和病死率较高,加强围生期监 测和干预以减少SGA发生、积极防治SGA并发症仍是我国目前围产工作的重点。     

早产和低出生体重及小于胎龄儿与脑性瘫痪发病的关系

目的 明确早产、低出生体重及小于胎龄儿(SGA)与脑性瘫痪(简称脑瘫)的关联程度。方法 1997年5—7月对江苏省7个市的1～6岁儿童进行了现况普查,共查305263名,并对其胎龄、出生体重及胎龄别出生体重与脑瘫的关系进行了分析。结果 本组儿童共发现脑瘫484例,发生率为1．59‰。早产儿及过期产儿脑瘫发生率相对危险性(RR)分别为足月儿的25．16倍及2．40倍;低出生体重及巨大儿的脑瘫发生率RR分别为正常出生体重儿的19．63倍及1．34倍;SGA及大于胎龄儿(LGA)脑瘫发生率RR为适于胎龄儿(AGA)的4．34倍及0．84倍。先按胎龄别出生体重分层再按胎龄分组,发现各层内早产儿脑瘫发生率均较足月儿高,RR最高AGA层为28．34倍,其次LGA层为21．41倍,最低SGA层为9．29倍,各层内过期产儿脑瘫发生率也较足月儿高,RR最高AGA层为2．63倍,其次SGA层为1．90倍,最低LGA层为1．55倍;先按胎龄分层再按胎龄别出生体重分组发现各层内SGA脑瘫发生率均较AGA高,RR最高足月儿层为4．41倍,其次过期产儿层为3．19倍,最低早产儿层为1．45倍,各层内LGA脑瘫发生率均不比AGA高,除足月儿层相近为0．98倍外,早产儿及过期产儿层均较AGA低,RR分别为0．74倍和0．58倍。按胎龄大小及胎龄别出生体重大小联合分成9组进行比较,发现多数组脑瘫发生率均较足月AGA组高,RR按次序为早产SGA40．99倍、早产AGA28．34倍、早产LGA21．08倍、过期SGA8．39倍、足月SGA4．41倍、过期AGA2．63倍、过期LGA1．53倍、足月LGA0．98倍;前6组差异均有显著性,后2组倍数接近1．0,差异无显著性。结论 早产及SGA两种因素均与小儿脑瘫发生率增加关联,这两个因素分别为小儿脑瘫独立的危险因素;过期产与脑瘫的关联很弱,LGA则与脑瘫的发生率增加无关。     

母乳喂养对小于胎龄儿血浆ghrelin水平和胰岛素敏感性的影响

目的:探讨母乳喂养对小于胎龄儿(SGA)出生早期胰岛素(INS)敏感性和血浆ghrelin水平的影响。方法:选择2014年10月至2019年4月在武汉儿童医院新生儿科住院的足月SGA为SGA组(120例),同期出生足月适于胎龄儿(AGA)为AGA组(96例),记录出生体质量、身长,出生第7天检测血浆空腹血糖(FG)、三...     

血清抵抗素与胎儿宫内生长发育相关性研究

目的探讨不同类型足月儿血清抵抗素及胰岛素水平与胎儿宫内生长发育的关系。方法收集2010年10月至2011年5月在山西省儿童医院新生儿科住院、无严重疾病的足月新生儿(日龄<24h):分为小于胎龄儿(SGA)组、适于胎龄儿(AGA)组和大于胎龄儿(LGA)组,用酶联免疫吸附测定法检测其生后24h内血清抵抗素及胰岛素水平,并分析血清抵抗素和胰岛素之间的关系。结果 (1)血清抵抗素水平(ng/ml)随体重增加而下降,LGA组低于SGA组[(6.6±0.3)比(7.9±0.5),P<0.05]。(2)胰岛素水平(mIU/ml)随体重增加而上升,LGA组高于AGA组和SGA组[(75.9±5.0)比(58.8±5.6)、(43.3±3.6),P分别<0.05和0.01],AGA组高于SGA组(P<0.05)。(3)各组血清抵抗素和胰岛素水平均无明显相关性(SGA组:r=-0.229,AGA组:r=-0.405,LGA组:r=-0.241,P均>0.05)。结论新生儿血清抵抗素及胰岛素均在一定程度上反映了胎儿宫内生长发育的情况,但二者调节胎儿宫内生长的相互关系尚不完全明确。     

脂联素、瘦素及胰岛素样生长因子-Ⅰ在胎儿生长发育中的作用

目的探讨脂联素、瘦素及胰岛素样生长因子-Ⅰ(IGF-Ⅰ)在胎儿生长发育中的作用。方法选择2006年10月-2007年10月在本院产科出生的新生儿86例。胎龄31~42周;男57例,女29例。根据不同出生体质量分为小于胎龄儿(SGA)组(16例),适于胎龄儿(AGA)组(41例)及大于胎龄儿(LGA)组(29例)。胎儿娩出后立即断脐留脐血20 mL,采用放射免疫分析法测定血清脂联素、瘦素及IGF-Ⅰ水平,同时检测其血脂水平,测量新生儿生长参数,计算体质量指数(BMI)。结果1.新生儿脐血瘦素、脂联素及IGF-Ⅰ水平无显著性别差异。2.脐血瘦素水平在SGA、AGA、LGA3组间有显著差异(P<0.001),LGA组显著高于AGA及SAG组(P<0.01,0.001);脐血瘦素水平与体质量、胎龄、头围、身长、足长及胎盘质量均呈显著正相关(Pa<0.01)。3.脐血脂联素水平与出生体质量、头围、足长、BMI水平均呈显著正相关(Pa<0.05)。脐血脂联素水平在SGA、AGA、LGA3组间有显著差异(P<0.001),LGA组高于AGA及SAG组(Pa<0.01)。4.LGA组脐血IGF-Ⅰ水平显著高于AGA及SAG组,3组间有明显差异(P<0.001);脐血IGF-Ⅰ水平与体质量、头围、身长、足长及胎盘质量均呈显著正相关(Pa<0.01)。5.脐血瘦素与脂联素、IGF-Ⅰ水平呈显著正相关(Pa<0.01),脐血脂联素与IGF-Ⅰ水平无明显相关关系(P>0.05)。6.SGA、AGA、LGA3组血脂水平比较无显著差异(Pa>0.05)。脐血IGF-Ⅰ水平与三酰甘油水平呈明显负相关(P<0.05),脐血脂联素、瘦素水平与血脂各指标间均无明显相关性(Pa>0.05)。结论瘦素与脂联素、IGF-Ⅰ在胎儿宫内生长和发育过程中起重要的调节作用,可作为评价胎儿生长发育及营养状态的临床指标之一。     

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。     

骨钙素、Ⅰ型前胶原羧基端前肽、胰岛素样生长因子-1及其相关激素与胎儿骨发育的关系

目的 探讨骨钙素(OC)、Ⅰ型前胶原羧基端前肽(PICP) 及胰岛素样生长因子.1(IGF.1)等激素水平与胎儿骨生长发育的关系.方法 选择本院2008年10月-2009年10月收治的新生儿80例.男41例,女39例;胎龄28～42周.根据不同出生体质量分为小于胎龄(SGA)儿组22例,适于胎龄(AGA)儿组36例及大于胎龄(LGA)儿组(22例).胎儿娩出后,胎盘娩出前抽取其脐静脉血6 mL,采用放射免疫分析法测定其血清OC、IGF.1及甲状旁腺激素水平,酶联免疫吸附法检测其脐血PICP水平;同时检测其血钙、磷、ALP水平,测量新生儿生长参数,计算体质量指数(BMI).结果 1.脐血OC水平在SGA儿组、AGA儿组、LGA儿组间比较差异有统计学意义(P=0.000),LGA儿组显著高于AGA儿及SAG儿组(P＜0.01,0.001);脐血OC水平与出生体质量、头围、BMI呈正相关(Pa＜0.05),与身长无明显相关性(P＞0.05).2.LGA儿组脐血IGF.1水平显著高于AGA儿及SAG儿组,3组间比较有统计学差异(P=0.002);脐血IGF.1水平与出生体质量、头围、BMI水平均呈正相关(Pa＜0.05),与身长无明显相关性(P＞0.05).3.AGA儿组、LGA儿组脐血PICP水平明显高于SGA儿组,但3组间无统计学差异(P=0.070).脐血PICP、PTH水平与生长参数各指标水平均无直线相关关系(Pa＞0.05),偏相关分析脐血PICP与出生体质量、头围、BMI均呈正相关(r=0.239、0.250、0.306,Pa<0.05).4.脐血OC水平与PICP、IGF.1水平均呈正相关(Pa＜0.05),OC、PICP与PTH、ALP水平之间均无明显相关(Pa＞0.05).5.3组脐血钙、血磷、ALP水平均无统计学差异(Pa＞0.05).结论 SGA儿低血清OC、PICP水平与骨形成活动下降相关,脐血OC、PICP及IGF.1可作为评价胎儿骨骼生长发育的临床指标之一.     

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。     

早产小于胎龄儿生长代谢的临床研究

目的 探讨早产小于胎龄儿（SGA）与适于胎龄儿（AGA）在住院期间生长代谢的差异,为临床对早产SGA进行营养干预提供依据。方法 1 370例早产儿纳入研究,根据胎龄与出生体重的关系分为SGA组（675例）与AGA组（695例）,比较两组早产儿住院期间的一般情况、体格增长及血生化指标等情况。结果 SGA组住院天数长于AGA组（P < 0.05）。与AGA组相比,SGA组出院体重、出院体重Z评分及出院身长均较低,宫外生长迟缓发生率较高（P < 0.05）,头围增长速率大于AGA组。与AGA组相比,SGA组达全肠内喂养时间及需肠外营养时间均较长（P < 0.05）。SGA组入院时白蛋白、前白蛋白、血清磷、出院前总胆汁酸高于AGA组,白蛋白低于AGA组（P < 0.05）。SGA组窒息、新生儿呼吸窘迫综合征、心肌损伤、喂养不耐受、肺炎、败血症、低血糖、低甲状腺素血症的发生率高于AGA组（P < 0.05）。结论 早产SGA住院期间体格发育明显落后于AGA,宫外生长迟缓发生率较高,更易出现并发症。     

张路指数在怀化市新生儿体格发育评价中的应用

目的验证张路指数(ZLI)在新生儿体格发育评价中的应用。方法对413例新生儿测量体质量、头围、身长,根据ZLI公式计算ZLI值,并通过31例小于胎龄(SGA)儿、65例大于胎龄(LGA)儿、317例适于胎龄(AGA)儿首次测量的原始数据对ZLI与惯用胎龄-体质量法进行验证比较。结果1.ZLI与胎龄-体质量法比较,灵敏度高于全国验证结果,有统计学差异(χ2=6.45 P<0.05),特异度、总符合率与全国验证结果比较,无统计学差异(χ2=2.38,0.22 P均>0.05);2.怀化市新生儿ZLI平均值高于全国参考值,有统计学差异(P<0.01);3.ZLI随胎龄及生后日龄增大而增加,有统计学差异(P<0.01);4.ZLI纵向累积增长率SGA儿最大,LGA儿最小,有统计学差异(P<0.05);5.超重或肥胖发生率LGA儿最大,SGA儿在各时段均为0,有统计学差异(P<0.01)。结论ZLI是一个综合评价胎儿期及新生儿期体格发育水平的指数。     

Vascular retinal abnormalities in neonates of mothers who smoked during pregnancy

OBJECTIVE: To investigate whether maternal smoking during pregnancy causes retinal abnormalities in the newborn. STUDY DESIGN: One hundred sixty-two neonates of smoking mothers and 162 matched neonates of nonsmoking mothers (112 appropriate for gestational age [AGA], 30 small for gestational age [SGA], 20 large for gestational age [LGA] in each group) were studied. RESULTS: Retinal arterial narrowing and straightening (RANS) was observed in 52 and 10 eyes of the newborns of smoking and nonsmoking mothers, respectively (P <. 000001) in association with elevated blood pressure in the neonates. The frequency of RANS was more than 3-fold greater in the SGA neonates than in the AGA and LGA neonates of the smoking mothers. Retinal venous dilatation and tortuosity (RVDT) was found in 100 and 36 eyes of neonates of smoking and nonsmoking mothers, respectively (P <.000001). The frequency of RVDT in the SGA neonates of the smoking mothers was 2.5-fold and 4.2-fold greater than in the AGA infants and the LGA infants, respectively. Also, intraretinal hemorrhages were found in 61 and 31 eyes of neonates of smoking and nonsmoking mothers, respectively (P =.0007) in association with elevated hematocrit and RVDT, whereas no intraretinal hemorrhages were found when RANS was present. All retinal abnormalities resolved by 6 months in infants of smoking mothers and by 2 months in infants of nonsmoking mothers. CONCLUSIONS: Maternal smoking during pregnancy causes increased frequency of RANS, RVDT, and intraretinal hemorrhages; but these retinal abnormalities resolve by 6 months of age.     

Intracranial hemorrhage in small-for-gestational-age neonates: comparison with weight-matched appropriate-for-gestational-age infants

In a comparative study of 93 small-for-gestational-age (SGA) infants against 93 weight-matched, appropriate-for-gestational-age (AGA) neonates, the SGA group exhibited a significantly lower incidence of periventricular-intraventricular type intracranial hemorrhage (ICH) at the first ultrasound scan than did the AGA neonates (9/93 vs 21/93; p less than 0.02). This apparent advantage was no longer maintained in later scans of the first week (16/93 vs 27/93; NS), despite the fact that the SGA group were 4 weeks advanced in gestational age and had fewer respiratory problems than the AGA controls. It is prudent, therefore, to follow SGA infants closely for ICH by repeat ultrasound examinations even if the first scan is negative. Evaluation of the subgroup of SGA infants with ICH against the total SGA population revealed lower admission body temperature and Apgar scores, and higher incidence of asphyxia, resuscitation, and mortality. The above observations in SGA infants with ICH and the lack of a similar trend between the AGA infants with ICH and the total AGA population suggest that SGA status, hypothermia, and ICH are interrelated. Hypothermia, therefore, can be used as a convenient marker for the possibility of ICH in low birth weight SGA infants. The authors' data is consistent with the view that hypothermia and ICH are both the consequences of perinatal asphyxia in SGA infants and probably reflect the magnitude of stormy perinatal events.     

Cord prealbumin values in newborn infants: effect of prenatal steroids, pulmonary maturity, and size for dates

We assessed cord prealbumin concentrations in 214 appropriate for gestational age newborn infants, 21 small for gestational age infants, and 27 large for gestational age infants to establish normal values and to assess the effect of intrauterine growth, prenatal steroids, and pulmonary maturity on prealbumin levels. Cord prealbumin values were significantly correlated with increasing gestational age (r = 0.33; P less than 0.001) and birth weight (r = 0.40, P less than 0.001) in the AGA neonates. Neonates born before 37 weeks gestation had significantly lower prealbumin levels than those born at term (P less than 0.001). The SGA infants had significantly lower levels than age-matched AGA controls (P less than 0.01), and LGA infants had significantly higher levels than age-matched AGA controls (P less than 0.001). In preterm infants, those with exposure to prenatal steroids (betamethasone or premature rupture of membranes) had significantly higher prealbumin values than control infants of comparable age and weight (P less than 0.001). Infants without respiratory distress syndrome had higher levels than those of comparable age and weight with hyaline membrane disease (P less than 0.05). This study demonstrates that a correlation of gestational age and birth weight exists with cord prealbumin levels, and that the large variability at each gestational age may be accounted for in part by appropriateness of size for dates, prenatal steroid exposure, and pulmonary maturity.     

The influence of gestational age, size for dates, and prenatal steroids on cord transferrin levels in newborn infants

Serum transferrin levels assess protein status in older children and adults. To generate standards for its use in newborn infants, we measured umbilical cord serum transferrin levels in 161 appropriate (AGA), 25 large (LGA) and 16 small (SGA) for gestational age infants between 25 and 43 weeks' gestation. We also assessed the effects of intrauterine growth, exposure to prenatal steroids, and presence of pulmonary maturity on neonatal transferrin levels. Cord transferrin levels in AGA infants were significantly correlated with increasing gestational age (r = 0.60; p less than 0.001). Infants born before 37 weeks' gestation had significantly lower transferrin levels, when compared with those born at term (p less than 0.001). LGA infants had significantly higher levels than age-matched AGA infants (253 +/- 75 vs. 214 +/- 53 mg/dl; p less than 0.025). Despite significantly lower mean birth weights (p less than 0.001), SGA infants also had significantly higher levels than gestational age-matched AGA controls (227 +/- 63 vs. 167 +/- 40 mg/dl; p less than 0.005). For infants less than 35 weeks' gestation, neither the 20 preterm infants with exposure to prenatal steroids (maternal betamethasone), nor the 26 infants with pulmonary maturity had significantly elevated transferrin levels, when compared with gestational age-matched control infants. Newborn transferrin levels correlate well with gestational age and are significantly affected by size for dates, but not by a brief course of prenatal steroids or by pulmonary maturity.     

Birth weight categorization according to gestational age does not reflect percentage body fat in term and preterm newborns

This study was performed to prove the applicability of the small-for-gestational age (SGA), appropriate-for-gestational age (AGA), and large-for-gestational age (LGA) classification depending on birth weight to predict percentage body fat (%BF) measured by dual-energy X-ray absorptiometry (DXA) in term and preterm infants. The data of 159 healthy term and preterm neonates (87 boys and 72 girls) with a gestational age at delivery of 38.4 weeks from two longitudinal studies were analyzed. Anthropometry and body composition data were assessed within the first 10 days after birth. Correlations between anthropometric parameters and fat mass measured by DXA were calculated. Prevalences of observations with low, middle, and high %BF measured by DXA were compared between SGA, AGA, and LGA groups, according to sex and gestational age. In term infants, 42.9% of the newborns with less than 10% body fat were classified to be AGA; 9.9% of all AGA newborns had less than 10% body fat. For the whole group, among the ratios investigated, the weight-length ratio (r=0.82) showed the best correlation to fat mass measured by DXA. The %BF at the time of study was higher in girls (14.75%) than in boys (11.95%). In conclusion, traditional classification based on birth weight centiles does not reflect %BF in term and preterm newborns.     

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目的探讨胎儿生长迟缓(FGR)与新生儿胰岛素敏感性变化的关系。方法昆明医学院第一附属医院于2004年4~12月,对72例小于胎龄儿(SGA)和48例适于胎龄儿(AGA)空腹血糖(FPG)、空腹胰岛素(FINS)、C-肽、HDL-C、LDL-C、TG、非酯化脂肪酸(NEFA)等指标,计算葡萄糖/胰岛素比值(G/I)、胰岛素敏感性指数(ISI)、胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能(HBCI)等,探讨FGR与新生儿胰岛素敏感性变化的关系。结果(1)SGA组FPG、HDL-C低于AGA组,而FINS、LDL-C、TG、NEFA高于AGA组(P<0·01);(2)SGA组G/I比值、ISI低于AGA组,HOMA-IR高于AGA组(P<0·01),而HBCI两组相比差异无显著性(P>0·05)。结论FGR儿在生命早期存在胰岛素敏感性降低和不同程度的胰岛素抵抗(IR),而胰岛β细胞功能无明显变化。