34周以下早产儿宫外生长发育迟缓发生的影响因素

Risk factors for extrauterine growth restriction in preterm infants with gestational age less than 34 weeks

摘要:

目的 研究34周以下早产儿宫外生长发育迟缓(EUGR)发生的相关因素。方法 选取<34周早产儿694例, 根据出院时体重分为EUGR组和非EUGR组, 回顾性分析两组早产儿的围生期资料、住院期间生长、营养摄入情况及相关合并症等资料。结果 694例早产儿中, 发生EUGR 284例(40.9%)。宫内生长发育迟缓(IUGR)患儿发生EUGR的比例明显高于非IUGR组(P<0.01); 极低出生体重儿发生EUGR比例明显高于非极低出生体重儿(P<0.01)。胎龄越小、出生体重越低的早产儿EUGR的发生率越高(P<0.01)。EUGR组早产儿禁食天数、静脉营养持续天数、首次肠内营养的日龄、全肠内营养的日龄均大于非EUGR组(P<0.01)。EUGR组患儿生后第1周蛋白质累积损失量与热卡累积损失量均大于非EUGR组(P<0.05)。EUGR组生后发生呼吸窘迫综合征、呼吸暂停、坏死性小肠结肠炎、败血症等并发症的比例高于非EUGR组(P<0.05)。Logistic回归分析显示, 出生体重、出生胎龄及IUGR是EUGR发生的独立危险因素。结论 34周以下早产儿EUGR发生率较高, 尤其是已经存在IUGR的早产儿或极低出生体重儿; 生后早期积极的营养支持, 预防呼吸暂停、败血症等并发症将会在一定程度上减少EUGR的发生。

Abstract:

Objective To investigate the correlated factors contributed to extrauterine growth restriction (EUGR) in preterm infants with the gestational age less than 34 weeks. Methods A total of 694 preterm infants with the gestational ages less than 34 weeks were enrolled. They were classified into EUGR and non-EUGR groups by weight on discharge. The perinatal data, growth data, nutritional information and morbidities during hospitalization were compared between the two groups. Results EUGR on discharge occurred in 284 (40.9%) out of the 694 infants. The incidence of EUGR in intrauterine growth restriction (IUGR) infants was significantly higher than in non-IUGR infants (P<0.01). The very low birth weight (VLBW) infants had a higher incidence of EUGR than non-VLBW infants (P<0.01). The incidence of EUGR increased with the decreases of gestational age at birth and birth weight (P<0.01). Compared with the non-EUGR group, the fasting time, the duration of parenteral nutrition, the time beginning to feed and the age to achieve full enteral feeds were significantly greater in the EUGR group (P<0.01). The cumulative protein deficit and cumulative caloric deficit in the first week of life in the EUGR group were higher than in the non-EUGR group (P<0.05). The incidences of respiratory distress syndrome, apnea, necrotizing enterocolitis and septicemia in the EUGR group were higher than in the non-EUGR group (P<0.05). The logistic regression analysis showed that birth weight, gestational age at birth and IUGR were the independent risk factors for EUGR. Conclusions The incidence of EUGR in infants with gestational age less than 34 weeks is high, especially in IUGR or VLBW infants. Early and aggressive nutritional strategy and prevention of apnea and septicemia may facilitate to reduce the occurrence of EUGR.