高危早产儿宫外生长迟缓的危险因素分析

摘要

目的 探讨我院高危早产儿宫外生长迟缓(EUGR)的发生率和相关危险因素.方法 回顾性调查2011年1月至2012年12月我院收治并存活至出院的高危早产儿(出生体重＜1500 g或出生胎龄＜33周)及其母亲的住院资料.根据“中国15城市不同胎龄新生儿出生体重值”,出生体重位于同胎龄儿第10百分位以下定义为宫内生长受限(IUGR)早产儿,出院体重位于校正胎龄儿第10百分位以下定义为EUGR早产儿.并根据此表计算出生体重的Z值(Z1)、出院体重的Z值(Z2),比较Z值的变化.比较EUGR组及非EUGR组围产期及出生后危险因素的差异,根据Logistic回归分析得出EUGR的高危因素.结果 共194例早产儿纳入本研究,IUGR发生率为29.9％ (58/194),EUGR发生率为51.5％(100/194).出院时Z2(-1.27±0.83)较出生时Z1(-0.83±0.78)显著下降(P＜0.001).IUGR早产儿发生EUGR比例明显高于非IUGR早产儿(93.1％比33.8％,P＜0.001),但Z值下降幅度却小于非IUGR早产儿[(-0.31±0.58)比(-0.50±0.53),P=0.039].根据Logistic回归分析,高危早产儿发生EUGR的高危因素为出生体重＜1500 g、IUGR、住院天数超过6周及CRP升高.结论 EUGR是极低出生体重儿及小胎龄早产儿的重要并发症,针对相关的围产因素进行积极的营养管理,有可能减少其发生率,改善早产儿的结局.%Objective To study the incidences of intrauterine growth restriction (IUGR),extrauterine growth restriction (EUGR) and associated risk factors in preterm infants.Methods A cohort of very immature preterm infants [birth weight (BW) ＜ 1500 g or gestational age (GA) ＜ 33weeks] in our NICU from January 2011 to December 2012 was studied.The information of their mothers was also collected.IUGR was defined as BW less than 10 percentile of the same gestational age at birth,and EUGR was defined as BW less than 10 percentile of corrected GA at discharge.The Z scores at birth (Z1) and discharge (Z2) were also calculated and compared.The perinatal and post-natal risk factors were analyzed between EUGR group and non-EUGR group.Results A total of 194 infants were included in this study,and the incidences of IUGR and EUGR were 29.9％ (58/194) and 51.5％(100/194).The Z score on discharge (Z2) was-1.27 ±0.83,which was significantly lower than that on admission (Z1) (-0.83 ±0.78,t =-11.05,P ＜0.001).The IUGR infants were more likely to become EUGR than the non-IUGR infants,but the differences of Z scores in IUGR infants were lower than non-IUGR babies [(-0.31 ±0.58) vs.(-0.50 ±0.53),t =2.089,P =0.039].Lower birth weight,IUGR,prolonged hospital stay,elevated C-reactive protein were risk factors associated with EUGR in these infants.Conclusions Very immature preterm infants are in high risk of EUGR during their hospital stay.Proactive nutritional management may reduce the incidence of EUGR and improve the outcome in these infants.