CAJ | 학술논문

目的调查我国新生儿出生体重状况,制定新的新生儿出生体重标准,绘制不同出生胎龄新生儿出生体重曲线.方法在全国范围内建立新生儿协作网,收集产科出生的新生儿数据.在全国七大区域23个省、市、自治区,共有63家医院设立监测点.研究对象为2011-2014年各监测点出生的单胎活产儿,采用连续收集的方法收集产科出生新生儿的胎龄和出生体重数据.新生儿生后2h内用电子秤进行裸身体重测量,胎龄判断为母亲末次月经、孕早期超声检查和出生后胎龄评分相结合的方法.出生体重曲线拟合方法采用LMSP方法,利用R2.11.1软件中的基于位置、尺度、形状的广义可加模型(GAMLSS) 1.9-4软件包进行曲线绘制和检验.结果共收集单胎新生儿159 334名,其中男84 447名,女74 907名,平均出生体重(3 232±555)g,其中男性平均体重(3 271±576)g,女性平均出生体重(3 188±528)g.对新生儿出生体重数据的正态分布进行检验,结果提示胎龄和体重数据分布均不符合正态分布,BCT分布拟合度最优.用虫形图检测和拟合模型残差图检验,提示本曲线较好拟合了本研究的数据分布.采用同样的方法分别绘制男性新生儿和女性新生儿出生体重曲线.结论对我国不同出生胎龄新生儿出生体重参考值进行了更新,使用GAMLSS方法建立新生儿出生体重曲线,分性别制定不同参考曲线,制定的出生体重曲线经统计学检验提示较为准确拟合实际情况.
목적 조사아국신생인출생체중상황,제정신적신생인출생체중표준,회제불동출생태령신생인출생체중곡선.방법 재전국범위내건립신생인협작망,수집산과출생적신생인수거.재전국칠대구역23개성、시、자치구,공유63가의원설립감측점.연구대상위2011-2014년각감측점출생적단태활산인,채용련속수집적방법수집산과출생신생인적태령화출생체중수거.신생인생후2h내용전자칭진행라신체중측량,태령판단위모친말차월경、잉조기초성검사화출생후태령평분상결합적방법.출생체중곡선의합방법채용LMSP방법,이용R2.11.1연건중적기우위치、척도、형상적엄의가가모형(GAMLSS) 1.9-4연건포진행곡선회제화검험.결과 공수집단태신생인159 334명,기중남84 447명,녀74 907명,평균출생체중(3 232±555)g,기중남성평균체중(3 271±576)g,녀성평균출생체중(3 188±528)g.대신생인출생체중수거적정태분포진행검험,결과제시태령화체중수거분포균불부합정태분포,BCT분포의합도최우.용충형도검측화의합모형잔차도검험,제시본곡선교호의합료본연구적수거분포.채용동양적방법분별회제남성신생인화녀성신생인출생체중곡선.결론 대아국불동출생태령신생인출생체중삼고치진행료경신,사용GAMLSS방법건립신생인출생체중곡선,분성별제정불동삼고곡선,제정적출생체중곡선경통계학검험제시교위준학의합실제정황.
Objective Since 1986,the reference of birth weight for gestational age has not been updated.The aim of this study was to set up Chinese neonatal network to investigate the current situation of birth weight in China,especially preterm birth weight,to develop the new reference for birth weight for gestational age and birth weight curve.Method A nationwide neonatology network was established in China.This survey was carried out in 63 hospitals of 23 provinces,municipalities and autonomous regions.We continuously collected the information of live births in participating hospitals during the study period of 2011-2014.Data describing birth weight and gestational age were collected prospectively.Newborn's birth weight was measured by electronic scale within 2 hours after birth when baby was undressed.The evaluation of gestational age was based on the combination of mother's last menstrual period,ultrasound in first trimester and gestational age estimation by gestational age scoring system.Statistical analysis:the growth curve was drawn by using LMSP method,which was conducted in GAMLSS 1.9-4 software package in R software 2.11.1.Result A total of 159 334 newborn infants were enrolled in this study.There were 84 447 male and 74 907 female.The mean birth weight was (3 232 ± 555) g,the mean birth weight of male newborn was (3 271 ±576) g,the mean weight of female newborn was (3 188 ±528)g.The test of the variables' distribution suggested that the distribution of gestational age and birth weight did not fit the normal distribution,the optimal distribution for them was BCT distribution.The Q-Q plot test and worm plot test suggested that this curve fitted the distribution optimally.The male and female neonatal birth weight curve was developed using the same method.Conclusion Using GAMLSS method to establish nationwide neonatal birth weight curve,and the first time to update the birth weight reference in recent 28 years.