中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2014年
1期
23-28
,共6页
李月凤%刘方%张敏%肖善秋%黄上明%卢光进
李月鳳%劉方%張敏%肖善鞦%黃上明%盧光進
리월봉%류방%장민%초선추%황상명%로광진
婴儿,极低出生体重%营养状况%肠道营养%胃肠外营养%婴儿,小于胎龄%危险因素
嬰兒,極低齣生體重%營養狀況%腸道營養%胃腸外營養%嬰兒,小于胎齡%危險因素
영인,겁저출생체중%영양상황%장도영양%위장외영양%영인,소우태령%위험인소
Infant,very low birth weight%Nutritional status%Enteral nutrition%Parenteral nutrition%Infant,small for gestational age%Risk factors
目的 探讨极低出生体重儿(very low birth weight infant,VLBWI)住院期间营养状况和出院时发生宫外发育迟缓(extrauterine growth retardation,EUGR)的危险因素. 方法 本研究为回顾性研究.选取2007年1月10日至2011年10月1日在深圳市宝安妇幼保健院新生儿重症监护病房住院、入院日龄＜12 h、住院时间＞14d的VLBWI为研究对象.根据是否发生EUGR,将患儿分为EUGR组和非EUGR组.收集患儿围产期情况、住院期间每周营养供给情况、体重变化和新生儿并发症的发生情况,评估住院期间营养状况.采用卡方检验、t检验和多因素Logistic回归分析出院时EUGR的危险因素. 结果 共256例VLBWI纳入本研究,其中小于胎龄儿(small for gestationalage,SGA)61例,占23.8％.EUGR组172例,非EUGR组84例.EUGR组的平均胎龄为(29.3±1.2)周,出生体重为(1 240±170)g;其中严重EUGR占53.5％(92/172).EUGR组生后7d总能量和蛋白质供给及肠内能量所占比例[分别为(84.9±20.9)kcal/(kg·d)、(2.6±0.5)g/(kg·d)和(26.1±15.3),1 kcal=4.184 kJ]均低于非EUGR组[分别为(92.4±20.2) kcal/ (kg·d)、(2.8±0.5) g/(kg·d)和(30.2±l 3.2)％],差异均有统计学意义(t=-2.71,P=0.007; t=-2.19,P=0.030;t=-2.10,P=0.037),且EUGR组恢复到出生体重时肠内能量供给及其后的体重增长和生后14d肠内能量所占比例[分别是(36.4±21.6) kcal/(kg·d)、(15.5±4.1) g/(kg·d)和(44.6±16.6)％]亦明显低于非EUGR组[分别是(44.2±24.1)kcal/(kg·d)、(17.3±3.3)g/(kg·d)和(49.5±14.4)％](t=-2.58,P=0.011;t=-3.61,P=0.000;t=-2.42,P=0.016),但肠外营养持续时间则长于非EUGR组[(39.6±13.8)d与(34.1±8.6)d,t=3.94,P=0.000)].多元Logistic回归显示,SGA、生后7d蛋白质供给量和肠内能量所占比例低及恢复到出生体重后体重增长慢是出院时EUGR发生的主要独立危险因素,其中SGA是EUGR发生的最主要危险因素(OR=42.66,95％CI:9.09～200.23). 结论 VLBWI住院期间EUGR发生率高.早期合理的营养支持可减少EUGR的发生,改善神经系统预后.
目的 探討極低齣生體重兒(very low birth weight infant,VLBWI)住院期間營養狀況和齣院時髮生宮外髮育遲緩(extrauterine growth retardation,EUGR)的危險因素. 方法 本研究為迴顧性研究.選取2007年1月10日至2011年10月1日在深圳市寶安婦幼保健院新生兒重癥鑑護病房住院、入院日齡＜12 h、住院時間＞14d的VLBWI為研究對象.根據是否髮生EUGR,將患兒分為EUGR組和非EUGR組.收集患兒圍產期情況、住院期間每週營養供給情況、體重變化和新生兒併髮癥的髮生情況,評估住院期間營養狀況.採用卡方檢驗、t檢驗和多因素Logistic迴歸分析齣院時EUGR的危險因素. 結果 共256例VLBWI納入本研究,其中小于胎齡兒(small for gestationalage,SGA)61例,佔23.8％.EUGR組172例,非EUGR組84例.EUGR組的平均胎齡為(29.3±1.2)週,齣生體重為(1 240±170)g;其中嚴重EUGR佔53.5％(92/172).EUGR組生後7d總能量和蛋白質供給及腸內能量所佔比例[分彆為(84.9±20.9)kcal/(kg·d)、(2.6±0.5)g/(kg·d)和(26.1±15.3),1 kcal=4.184 kJ]均低于非EUGR組[分彆為(92.4±20.2) kcal/ (kg·d)、(2.8±0.5) g/(kg·d)和(30.2±l 3.2)％],差異均有統計學意義(t=-2.71,P=0.007; t=-2.19,P=0.030;t=-2.10,P=0.037),且EUGR組恢複到齣生體重時腸內能量供給及其後的體重增長和生後14d腸內能量所佔比例[分彆是(36.4±21.6) kcal/(kg·d)、(15.5±4.1) g/(kg·d)和(44.6±16.6)％]亦明顯低于非EUGR組[分彆是(44.2±24.1)kcal/(kg·d)、(17.3±3.3)g/(kg·d)和(49.5±14.4)％](t=-2.58,P=0.011;t=-3.61,P=0.000;t=-2.42,P=0.016),但腸外營養持續時間則長于非EUGR組[(39.6±13.8)d與(34.1±8.6)d,t=3.94,P=0.000)].多元Logistic迴歸顯示,SGA、生後7d蛋白質供給量和腸內能量所佔比例低及恢複到齣生體重後體重增長慢是齣院時EUGR髮生的主要獨立危險因素,其中SGA是EUGR髮生的最主要危險因素(OR=42.66,95％CI:9.09～200.23). 結論 VLBWI住院期間EUGR髮生率高.早期閤理的營養支持可減少EUGR的髮生,改善神經繫統預後.
목적 탐토겁저출생체중인(very low birth weight infant,VLBWI)주원기간영양상황화출원시발생궁외발육지완(extrauterine growth retardation,EUGR)적위험인소. 방법 본연구위회고성연구.선취2007년1월10일지2011년10월1일재심수시보안부유보건원신생인중증감호병방주원、입원일령＜12 h、주원시간＞14d적VLBWI위연구대상.근거시부발생EUGR,장환인분위EUGR조화비EUGR조.수집환인위산기정황、주원기간매주영양공급정황、체중변화화신생인병발증적발생정황,평고주원기간영양상황.채용잡방검험、t검험화다인소Logistic회귀분석출원시EUGR적위험인소. 결과 공256례VLBWI납입본연구,기중소우태령인(small for gestationalage,SGA)61례,점23.8％.EUGR조172례,비EUGR조84례.EUGR조적평균태령위(29.3±1.2)주,출생체중위(1 240±170)g;기중엄중EUGR점53.5％(92/172).EUGR조생후7d총능량화단백질공급급장내능량소점비례[분별위(84.9±20.9)kcal/(kg·d)、(2.6±0.5)g/(kg·d)화(26.1±15.3),1 kcal=4.184 kJ]균저우비EUGR조[분별위(92.4±20.2) kcal/ (kg·d)、(2.8±0.5) g/(kg·d)화(30.2±l 3.2)％],차이균유통계학의의(t=-2.71,P=0.007; t=-2.19,P=0.030;t=-2.10,P=0.037),차EUGR조회복도출생체중시장내능량공급급기후적체중증장화생후14d장내능량소점비례[분별시(36.4±21.6) kcal/(kg·d)、(15.5±4.1) g/(kg·d)화(44.6±16.6)％]역명현저우비EUGR조[분별시(44.2±24.1)kcal/(kg·d)、(17.3±3.3)g/(kg·d)화(49.5±14.4)％](t=-2.58,P=0.011;t=-3.61,P=0.000;t=-2.42,P=0.016),단장외영양지속시간칙장우비EUGR조[(39.6±13.8)d여(34.1±8.6)d,t=3.94,P=0.000)].다원Logistic회귀현시,SGA、생후7d단백질공급량화장내능량소점비례저급회복도출생체중후체중증장만시출원시EUGR발생적주요독립위험인소,기중SGA시EUGR발생적최주요위험인소(OR=42.66,95％CI:9.09～200.23). 결론 VLBWI주원기간EUGR발생솔고.조기합리적영양지지가감소EUGR적발생,개선신경계통예후.
Objective To evaluate nutritional status during hospitalization of very low birth weight infant (VLBWI) and to analyze the risk factors for extrauterine growth retardation (EUGR) at discharge.Methods VLBWIs in neonatal intensive care unit (NICU),＜12 hours after birth on admission and length of hospital stay over 14 days from January 10,2007 to October 1,2011,were retrospectively studied.Relevant information,including perinatal data,weekly nutrition supplements and weight gain,and neonatal complications were collected.Data were analyzed by Chi-square test,t-test and multivariate Logistic regression analysis.Results In all 256 VLBWIs recruited,61 (23.8％) were small for gestational age at birth.One hundred and seventy-two cases,who were EUGR by weight at discharge,were divided into EUGR group.While the other 84cases were divided into non-EUGR group.The mean gestational age and mean birth weight of EUGR infants were (29.3± 1.2) weeks and (1 240± 170) g,among them,53.5％ (92/172) were extreme EUGR.Univariate analysis showed that the total energy intake [(84.9±20.9) kcal/(kg · d)],protein intake [(2.6±0.5) g/(kg · d)] and proportion ofenteral nutrition [(26.1 ± 15.3) ％] on day 7 of EUGR infants were lower than those ofnon-EUGR ones [(92.4±20.2) kcal/(kg · d),(2.8±0.5) g/(kg · d) and (30.2± 13.2) ％,respectively,t=-2.71,P=0.007; t=-2.19,P=0.030; t=-2.10,P=0.037].The enteral nutrition at the time to regain birth weight in EUGR group was lower than those in non-EUGR group [(36.4±21.6) kcal/(kg · d)vs (44.2±24.1) kcal/(kg · d),t=-2.58,P=0.011],the average growth rate after regaining birth weight and enteral nutrition proportion on day 14 were lower [(15.5±4.1) g/(kg · d) vs (17.3±3.3) g/(kg · d),(44.6± 16.6) ％ vs (49.5± 14.4) ％,respectively; t=-3.61,P=0.000; t=-2.42,P=0.016].The duration of parenteral nutrition in EUGR infants was longer than that in the non-EUGR infants [(39.6± 13.8) d vs (34.1 ±8.6) d,t=3.94,P=0.000].Multivariable logistic regression showed that small for gestational age at birth,low protein intake and low enteral nutrition proportion on day 7,low rate of weight gain after regaining birth weight were associated with EUGR on discharge,and small for gestational age at birth was the leading risk factor (OR=42.66,95％CI:9.09-200.23).Conclusions The incidence of EUGR among VLBWIs is high on discharge.Enhancing perinatal health care and early rational nutrition support are critical to reduce the incidence of EUGR and improve the neuro-developmental prognosis of these babies.
