极低出生体质量儿宫外生长迟缓的危险因素分析

Risk factors of extrauterine growth retardation among infants with very low birth weight

摘要:

目的：回顾极低出生体质量儿（very low birth weight infant，VLBWI）宫外生长迟缓（extrauterine growth retardation，EU－GR）发生情况并分析发生EUGR的相关因素。方法：选择2009年9月至2011年6月在重庆医科大学附属儿童医院新生儿重症监护病房住院成活VLBWI 87例进行回顾性分析。入选标准：出生体质量<1 500 g，入院时间<24 h且住院天数≥14 d，不伴有影响生长发育的先天畸形或遗传代谢性疾病。排除标准：住院天数<14 d，住院期间放弃治疗或死亡。将入选病例分为EUGR组和非EUGR组。计数资料比较采用卡方检验，正态分布的计量资料比较用t检验，非正态分布计量资料采用秩和检验，EUGR相关危险因素用二元logistic回归分析。结果：2009年9月至2011年6月符合纳入标准的VLBWI 87例，其中EUGR为74例（85.1%），非EUGR为13例（14.9%）；EUGR组宫内生长迟缓（intrauterine growth retardation，IUGR）发生率（27.6%）比非EUGR组（0%）高，平均出生胎龄（31.21周/29.27周）和出院日龄（36.82周/34.00周）较大，恢复至出生体质量时间（10.54 d/6.69 d）和开始肠内营养时间（3.82 d/1.85 d）较长（P<0.05），而出院时口服热卡[91.96 kcal/（kg·d）/146.23 kcal/（kg·d）较低（P＜0.05）]；logistic回归结果显示IUGR（OR=0.77）、开始肠内营养时间晚（OR=12.081）、恢复至出生体质量时间长（OR=48.404）是EUGR发生的危险因素（P<0.05）。结论：IUGR、开始肠内营养时间晚、恢复至出生体质量时间长是VLBWI发生EUGR的危险因素。

Abstract:

Objective：To review the phenomenon of extrauterine growth retardation（EUGR） and to analyze its risk causing factors a－mong very low birth weight infants（VLBWI）. Methods：A retrospective review was conducted for hospitalized premature infants from September 2009 to June 2011 in neonatal intensive care unit in the Children’s Hospital of Chongqing Medical University. Inclusion criteria：birth weight <1 500 g，admission time <24 h，hospital stays ≥14 d and free of congenital anomalies and heredity metabolic diseases which have a bad impact on individual growth and development. Exclusion criteria：hospital stays <14 d，abandoning treat－ment or dying before discharge. Selected infants were divided into EUER group and non-EUGR group. Chi-square test，t-test，rank-sum test and binary logistic regression were adopted for statistical analysis. Results：Among included 87 cases of VLBWI，there were 74 cases（85.1%） of EUGR and 13 cases（14.9%） of non-EUGR. Incidence of intrauterine growth retardation（IUGR） was higher in EUGR group（27.6%） than in non-EUGR group（0%）. Average gestational age，average discharge age，time of returning to birth weight and time of starting enteral nutrition were longer in EUGR group than in non-EUGR group（P<0.05），however discharge oral energy was lower in EUGR group than in non-EUGR group（P<0.05）. According to the logistic regression，risk factors causing EUGR includ－ed：IUGR（OR=0.77），delayed enteral nutrition（OR=12.081），delayed returning to birth weight（OR=48.404）（P<0.05）. Conclusions：IUGR，delayed enteral nutrition and delayed returning to birth weight are risk factors of EUGR among VLBWI.