早产儿追赶性生长随访资料回顾分析

目的分析早产儿追赶性生长的影响因素,为早产儿追赶性生长细分干预阶段和制定个性化随访方案提供参考依据。方法总结回顾2010年10月-2016年9月入住上海儿童医学中心新生儿科治疗出院后,定期随访至校正年龄满1周岁的247例早产儿病例追赶性生长的情况,分析早产儿校正1周岁时未达追赶性生长的风险因素。结果 247例早产儿校正1周岁以前达到追赶性生长共206例(83.4%)。多因素Logistic回归分析显示出院时体重宫外生长受限(EUGR)是早产儿校正1周岁时仍未达到追赶性生长的最大独立危险因素(OR=4.586,95%CI:1.712~12.288,P=0.002),而存在高危营养风险(OR=4.815,95%CI:1.860~12.467,P<0.001)、母亲妊娠期合并高血压疾病(OR=2.861,95%CI:1.384~5.914,P=0.005)是早产儿出院时体重EUGR的危险因素,较高出生体重(OR=0.151,95%CI=0.065~0.348,P<0.001)出院时体重EUGR的保护因素。胎龄<32周,出生体重越小,达到追赶性生长越晚。出生胎龄越小,头围达到追赶性生长越晚。结论加强早产儿院内管理,尤其是早期积极、合理的营养支持策略,减少EUGR发生,并坚持出院定期随访指导可能有助于降低早产儿追赶性生长不达标的发生率。

Retrospective analysis of catch-up growth in 247 premature infants

Objective To explore the influencing factors of physical catch-up growth of premature infants,in order to provide a reference for the subdivision intervention stage of catch-up growth of premature infants and the development of personalized follow-up program. Methods A total of 247 preterm infants admitted to Shanghai Children′s Medical Center from October 2010 to September 2016 and followed up regularly after discharge to the corrected age of 1 year,were evaluated for assessing differences on physical development of preterm infants to analyze the related factors of catch-up growth failed by 1 year old of adjusted age. Results Among 247 preterm infants,206(83.4%) cases got catch-up growth before one year old.Multivariate Logistic regression analysis indicated that extrauterine growth restriction(EUGR) with weight evaluation at discharge (OR=4.586,95%CI:1.712-12.288,P=0.002) was the major risk factor for failing in catch-up growth in preterm infants at the corrected age of one year.High-risk of nutritional risk(OR=4.815,95%CI:1.860-12.467,P<0.001),hypertensive diseases of the mother during pregnancy(OR=2.861,95%CI:1.384-5.914,P=0.005) were risk factors for EUGR with weight evaluation, High birth weight (OR=0.151,95%CI:0.065-0.348,P<0.001) was the protective factor for EUGR with weight evaluation.Moreover, the smaller the birth weight was when the gestational age was lower than 32 weeks,the later preterm infant catches up growth would be.The smaller the gestation age,the head circumference of preterm infant reaches the target more slowly. Conclusion Strengthening the management of premature infants in hospital,especially to giving aggressive and reasonable nutritional support strategies for premature infants,reducing the incidence of EUGR and adhering to regular follow-up guidance can help decrease the occurrence of failed catch-up growth in infants.