极低出生体重早产儿校正月龄12个月内体格生长情况及影响因素分析
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摘要
目的探究极低出生体重(very low birth weight,VLBW)早产儿校正月龄12个月内体重、身长、头围追赶生长特征及相关影响因素,为临床干预提供依据。方法采用回顾性研究,摘录2014年1月—2016年3月就诊于上海市某妇婴保健院新生儿重症监护室(neonatal intensive care unit,NICU)符合纳入和排除标准的VLBW早产儿的临床资料。分别与Fenton(2003)早产儿生长曲线及疾病预防控制中心(Centers for Disease Control and Prevention,CDC)足月儿生长曲线进行比较,探究VLBW早产儿校正月龄6个月及12个月体格生长发育的影响因素。结果共纳入113例VLBW早产儿,其中106例随访至校正月龄3个月及以上。与早产儿及足月儿相比,VLBW早产儿的身长、体重、头围差异均有统计学意义(P<0.05)。单因素分析显示,校正月龄6个月时,VLBW男婴身长发育不良与住院时间长、开始经口喂养月龄大、全经口喂养月龄大、开始经口母乳喂养月龄大相关,其体重发育不理想与住院时间长、开始经口母乳喂养月龄大相关(P<0.05)。校正月龄12个月时,VLBW女婴头围发育与母亲年龄和校正月龄6个月纯配方奶喂养有关,其体重发育不良与母亲年龄有关(P<0.05)。VLBW男婴头围发育不良与开始经口喂养及全经口喂养胎龄大有关,其身长发育不良与住院期间纯母乳喂养有关(P<0.05)。结论尽早过渡到全经口喂养,住院及随访期间母乳和早产儿配方奶混合喂养对VLBW早产儿体格生长起积极作用,提示患儿NICU住院期间及随访期间喂养指导的重要性。
Objective To identify the features of catch-up growth of weight,length and head circumference in very low birth weight(VLBW) preterm infants in 12 months of corrected age and to explore the influencing factors.Methods We conducted a retrospective review of medical records of the VLBW preterm infants who were in compliance with inclusion and exclusion criteria and admitted to neonatal intensive care unit(NICU) from January2014 to March 2016 in one maternity and infant hospital in Shanghai. Infants' growth chat from Fenton(2003)and Centers for Disease Control and Prevention(CDC) were used for development outcome comparison. We also analyzed the influencing factors of physical growth outcome at 6 and 12 months corrected age. Results A total of113 VLBW preterm infants were included in this study,of which 106 cases were followed up to 3 months. The outcomes of physical growth in VLBW preterm infants showed significant difference(P<0.05),comparing with other preterm and term infants. For male VLBW preterm infants at 6 months corrected age,longer length of stay,initiating oral feeding later,achieving full oral feeding later and initiating oral feeding with breast milk later were associated with non-optimal length growth;non-optimal weight growth was associated with prolonged length of stay and initiation of oral feeding later(P<0.05). For female VLBW preterm infants at 12 months corrected age,older maternal age and feeding with preterm formulas had negative association with the growth of head circumference(P<0.05);older maternal age in NICU was factors influencing weight growth(P<0.05). For male VLBW preterm infants at 12 months corrected age,initiating oral feeding and achieving full oral feeding later negatively impacted on the growth of head circumference(P<0.05),while exclusively feeding with breast milk in NICU was negatively related to length growth(P<0.05). Conclusion Transition to full oral feeding earlier and providing mixed feeding both in-hospital and post-discharge period played important role in VLBW infants' physical growth. The results suggested feeding counselling in NICU and during follow-up periods is essential for successful catch-up growth in VLBW preterm infants.
Objective To identify the features of catch-up growth of weight,length and head circumference in very low birth weight(VLBW) preterm infants in 12 months of corrected age and to explore the influencing factors.Methods We conducted a retrospective review of medical records of the VLBW preterm infants who were in compliance with inclusion and exclusion criteria and admitted to neonatal intensive care unit(NICU) from January2014 to March 2016 in one maternity and infant hospital in Shanghai. Infants' growth chat from Fenton(2003)and Centers for Disease Control and Prevention(CDC) were used for development outcome comparison. We also analyzed the influencing factors of physical growth outcome at 6 and 12 months corrected age. Results A total of113 VLBW preterm infants were included in this study,of which 106 cases were followed up to 3 months. The outcomes of physical growth in VLBW preterm infants showed significant difference(P<0.05),comparing with other preterm and term infants. For male VLBW preterm infants at 6 months corrected age,longer length of stay,initiating oral feeding later,achieving full oral feeding later and initiating oral feeding with breast milk later were associated with non-optimal length growth;non-optimal weight growth was associated with prolonged length of stay and initiation of oral feeding later(P<0.05). For female VLBW preterm infants at 12 months corrected age,older maternal age and feeding with preterm formulas had negative association with the growth of head circumference(P<0.05);older maternal age in NICU was factors influencing weight growth(P<0.05). For male VLBW preterm infants at 12 months corrected age,initiating oral feeding and achieving full oral feeding later negatively impacted on the growth of head circumference(P<0.05),while exclusively feeding with breast milk in NICU was negatively related to length growth(P<0.05). Conclusion Transition to full oral feeding earlier and providing mixed feeding both in-hospital and post-discharge period played important role in VLBW infants' physical growth. The results suggested feeding counselling in NICU and during follow-up periods is essential for successful catch-up growth in VLBW preterm infants.
引文
[1]Shan HM,Cai W,Cao Y,et al.Extrauterine growth retardation in premature infants in Shanghai:a multicenter retrospective review[J].Eur J Pediatr,2009,168(9):1055-1059.
[2]朱燕.出生早产儿流行病学特征的前瞻性多中心调查[D].上海:复旦大学,2012.
[3]Goisbault M,Simon L,Hanf M,et al.Neonatal length growth and height at two years[J].Neonatology,2016,110(2):125-128.
[4]中国医师协会新生儿专业委员会-营养专家委员会协作组.极低出生体质量早产儿院内营养现状多中心调查[J].临床儿科杂志,2015,33(1):32-37.
[5]Wang PW,Fang LJ,Tsou KI.The growth of very-low-birth-weight infants at 5 years old in Taiwan[J].Pediatr Neonatol,2014,55(2):114-119.
[6]Scharf RJ,Stroustrup A,Conaway MR,et al.Growth and development in children born very low birthweight[J].Arch Dis Child Fetal Neonatal Ed,2016,101(5):F433-F438.
[7]Lima PA,Carvalho MD,Costa AC,et al.Variables associated with extra uterine growth restriction in very low birth weight infants[J].J Pediatr(Rio J),2014,90(1):22-27.
[8]Fenton TR.A new growth chart for preterm babies:Babson and Benda's chart updated with recent data and a new format[J].BMC Pediatr,2003,3(1):13.
[9]刘颖钏,贲晓明.早产儿生长监测与随访[J].中华实用儿科临床杂志,2015,30(2):92-96.
[10]桑田,王颖,胡秀丽,等.极低出生体重儿体格发育与神经发育关系的研究[J].中国新生儿科杂志,2016,31(3):161-167.
[11]Larroque B,Ancel PY,Marret S,et al.Neurodevelopmental disabilities and special care of 5-year-old children born before 33 weeks of gestation(the EPIPAGE study):a longitudinal cohort study[J].Lancet,2008,371(9615):813-820.
[12]王丹华,刘喜红,丁宗一.早产/低出生体重儿喂养建议[J].中国儿童保健杂志,2011,47(9):868-870.
[13]何玥,文师吾,谭红专,等.妊娠高血压综合征对新生儿出生体重的影响及其与其他因素的交互作用研究[J].中华流行病学杂志,2014,35(4):397-400.
[14]《中华儿科杂志》编辑委员会,中华医学会儿科学分会新生儿学组,中华医学会儿科学分会儿童保健学组.早产/低出生体重儿喂养建议[J].中华儿科杂志,2009,47(7):508-510.
[15]刘喜红,丁宗一.早产低出生体重儿的营养喂养研究[J].中国儿童保健杂志,2011,19(9):817-820.
[16]张亚钦,李辉.早产儿生长评价的相关问题及研究进展[J].中国儿童保健杂志,2013,21(8):820-822.
[17]Cooke RJ.Postnatal growth and development in the preterm and small for gestational age infant[J].Nestle Nutr Workshop Ser Pediatr Program,2010,65(65):85-95.
[18]成磊,陆春梅,张玉侠,等.提升早产儿出院家庭准备度最佳循证实践方案的制订和应用[J].中华护理杂志,2016,51(7):787-791.
[19]刘桂华,钱小芳,欧萍.延续护理干预对极低及超低出生体重早产儿生长发育的影响[J].中华护理杂志,2015,50(6):697-703.
[20]詹兴星,包蕾.早产儿宫外发育迟缓及相关危险因素分析[J].临床儿科杂志,2015,33(12):1016-1020.
[21]White-Traut R,Pham T,Rankin K,et al.Exploring factors related to oral feeding progression in premature infants[J].Adv Neonatal Care,2013,13(4):288-294.
[22]Pickler RH,Reyna BA,Wetzel PA,et al.Effect of four approaches to oral feeding progression on clinical outcomes in preterm infants[J].Nurs Res Pract,2015,2015:716828.
[23]丁国芳.极低出生体重儿尽早达到足量肠内营养喂养策略---《极低出生体重儿喂养指南》解读[J].中国实用儿科杂志,2016,31(2):85-89.
[24]陈静,蒋琦,富林宝,等.母乳及早产儿配方奶对早产儿生长发育影响的研究[J].中国儿童保健杂志,2006,14(3):293-294.
[2]朱燕.出生早产儿流行病学特征的前瞻性多中心调查[D].上海:复旦大学,2012.
[3]Goisbault M,Simon L,Hanf M,et al.Neonatal length growth and height at two years[J].Neonatology,2016,110(2):125-128.
[4]中国医师协会新生儿专业委员会-营养专家委员会协作组.极低出生体质量早产儿院内营养现状多中心调查[J].临床儿科杂志,2015,33(1):32-37.
[5]Wang PW,Fang LJ,Tsou KI.The growth of very-low-birth-weight infants at 5 years old in Taiwan[J].Pediatr Neonatol,2014,55(2):114-119.
[6]Scharf RJ,Stroustrup A,Conaway MR,et al.Growth and development in children born very low birthweight[J].Arch Dis Child Fetal Neonatal Ed,2016,101(5):F433-F438.
[7]Lima PA,Carvalho MD,Costa AC,et al.Variables associated with extra uterine growth restriction in very low birth weight infants[J].J Pediatr(Rio J),2014,90(1):22-27.
[8]Fenton TR.A new growth chart for preterm babies:Babson and Benda's chart updated with recent data and a new format[J].BMC Pediatr,2003,3(1):13.
[9]刘颖钏,贲晓明.早产儿生长监测与随访[J].中华实用儿科临床杂志,2015,30(2):92-96.
[10]桑田,王颖,胡秀丽,等.极低出生体重儿体格发育与神经发育关系的研究[J].中国新生儿科杂志,2016,31(3):161-167.
[11]Larroque B,Ancel PY,Marret S,et al.Neurodevelopmental disabilities and special care of 5-year-old children born before 33 weeks of gestation(the EPIPAGE study):a longitudinal cohort study[J].Lancet,2008,371(9615):813-820.
[12]王丹华,刘喜红,丁宗一.早产/低出生体重儿喂养建议[J].中国儿童保健杂志,2011,47(9):868-870.
[13]何玥,文师吾,谭红专,等.妊娠高血压综合征对新生儿出生体重的影响及其与其他因素的交互作用研究[J].中华流行病学杂志,2014,35(4):397-400.
[14]《中华儿科杂志》编辑委员会,中华医学会儿科学分会新生儿学组,中华医学会儿科学分会儿童保健学组.早产/低出生体重儿喂养建议[J].中华儿科杂志,2009,47(7):508-510.
[15]刘喜红,丁宗一.早产低出生体重儿的营养喂养研究[J].中国儿童保健杂志,2011,19(9):817-820.
[16]张亚钦,李辉.早产儿生长评价的相关问题及研究进展[J].中国儿童保健杂志,2013,21(8):820-822.
[17]Cooke RJ.Postnatal growth and development in the preterm and small for gestational age infant[J].Nestle Nutr Workshop Ser Pediatr Program,2010,65(65):85-95.
[18]成磊,陆春梅,张玉侠,等.提升早产儿出院家庭准备度最佳循证实践方案的制订和应用[J].中华护理杂志,2016,51(7):787-791.
[19]刘桂华,钱小芳,欧萍.延续护理干预对极低及超低出生体重早产儿生长发育的影响[J].中华护理杂志,2015,50(6):697-703.
[20]詹兴星,包蕾.早产儿宫外发育迟缓及相关危险因素分析[J].临床儿科杂志,2015,33(12):1016-1020.
[21]White-Traut R,Pham T,Rankin K,et al.Exploring factors related to oral feeding progression in premature infants[J].Adv Neonatal Care,2013,13(4):288-294.
[22]Pickler RH,Reyna BA,Wetzel PA,et al.Effect of four approaches to oral feeding progression on clinical outcomes in preterm infants[J].Nurs Res Pract,2015,2015:716828.
[23]丁国芳.极低出生体重儿尽早达到足量肠内营养喂养策略---《极低出生体重儿喂养指南》解读[J].中国实用儿科杂志,2016,31(2):85-89.
[24]陈静,蒋琦,富林宝,等.母乳及早产儿配方奶对早产儿生长发育影响的研究[J].中国儿童保健杂志,2006,14(3):293-294.