摘要
目的了解我国早产儿在出生后早期的营养状况和影响其生长的高危因素。方法采用回顾性调查的方法，收集2005年1月1日至2006年6月30日10所医院早产儿的临床资料，对影响早产儿生长的危险因素进行分析。组间行X2检验，计量资料行t检验。结果入选对象1000例，收集合格调查表974份。中位胎龄32．6周，中佗小生体重1732．2g。开始喂养时间为2（1，3）d。早产配方奶喂养占77．0％，母乳＋早产配方奶喂养占13．6％。肠外营养应用氨基酸占87．3％，开始使用时间为2．5（2，3）d；平均使用时间为11（6，17）d；应用脂肪乳剂占56．9％，开始使用时间为3（2，5）d；平均使用时间为12（7，18）d。住院期间总热卡达120kcal/（kg·d）者占74．1％，达标日龄平均为（16．3±9．4）d；口服热卡达100kcaY（kg·d）者占84．1％，达标口龄平均为（17．0±9．4）d。早产儿平均生理性体重下降幅度为出生体重的7．54％±4．7％，恢复体重日龄（10．92±5．10）d，住院期间平均体重增长速度（13．4±6．0）g/（kg·d）。对696例单胎早产儿在出院时以相应胎龄的百分位数进行评价，分别有60．0％、58．9％、29．5％的早产儿其体晕、身高和头同低于第10百分位，较出生时有较大幅度的提高。结论出生体重小于第10百分位、开始喂养时间晚和体重增长速度慢是导致早产儿生后生长迟缓的危险因素。积极的营养支持策略对改善我国早产儿的营养状况及远期预后有重要意义。
Objective Extrauterine growth restriction ir preterm infants secondary to suboptimal nutrition is a major problem in neonatal intensive care units （NDUs）. This study was designed to investigate the nutritional support and growth of premature infants who were discharged from 10 tertiary NICUs in different areas in China and evaluate the effects of high risk factors on their growth. Methods Data of 1000 premature infants （100 infants from each hospital） were retrospectively collected, the data included their gestational age, the growth parameters at birth, complications, enteral and parenteral nutritional support strategies, the growth parameters at discharge and length of hospital stay from Jan. 1, 2005 to Jun. 30, 2006. The growth parameters, including body weight, length and head circumference, were evaluated according to growth curve of newborns in China with their gestational age at birth and corrected gestational age on discharge. Growth retardation was defined as less than the 10th percentile of the expected value. The risk factors which might result in growth retardation of premature infants were assessed with logistic regression. P 〈0. 05 was considered as significant. Results Of the 1000 premature infants enrolled in this study, the data of 974 premature infants were finally eligible. The median gestational age of the 974 premature infants was 32. 6 （ 31.0-34. 1 ） weeks and median birth weight was 1732. 2 （ 1447.9-2030. 3 ） g. Three hundred and seventy-eight premature infants were born at 〈 32 weeks of gestational age and the body weight of 285 premature infants was 〈 1500 g at birth. The median time for initial enteral feeding was 2. 0 （ 1,3） days of life, 77.0% of the premature infants were fed with formulas for low birth weight, and 13.6% were fed with human milk mixed with the formulas for low birth weight. For parenteral nutrition, amino acid solutions were administered in 87.3% of premature infants and median time to begin was 2. 5 （2, 3） days of life, median duration of administration was 11 （ 6,17 ） days. Lipid emulsions were supplied in 56. 9% of premature infants and median time to begin was 3 （ 2, 5 ） days of life, median duration of administration was 12 （7, 18） days. During hospital stay,74. 1% of the premature infants achieved recommended diet indexes of 120 kcal/（ kg , d） （including both enteral and parenteral intakes） and mean time for achieving was （16. 3 ±9.4） days of life, 84. 1% of the premature infants reached enteral feeding of 100 kcal/（ kg · d） and the mean time to achieve was （ 17. 0 ± 9. 4 ） days of life. The lower the gestational age of premature infants was, the longer the time for achieving these goals was. Mean loss of weight was 7.54% ±4. 7% of birth weight and the day for regaining to birth weight was （10. 92 ±5. 10） days. The lower the gestational age at birth, the more the loss of weight, and the longer the time for regaining to birth weight. Mean growth velocity after regaining to birth weight during hospital stay was （13.4± 6. 0 ） g/（ kg · d）. Mean length of hospital stay was （26.4 ± 12. 9） days. Of the 696 singletons, 60. 0%, 58.9% and 29.5% of the infants had growth retardation by weight, length and head circumference respectively on discharge, while the morbidity increased by 32.7%, 30.9% and 10.2%, respectively, compared with those at birth. Conclusions Morbidity of growth retardation was high among premature infants at birth by weight, length and head circumference. Such growth retardation was further worsened before discharge. Birth weight below the 10th percentile of expected value, later introduction of enteral feeding and lower growth velocity during hospital stay were risk factors for postnatal growth retardation of premature infants. More aggressive nutritional support strategy needs to be considered for improving the nutritional status and development of premature infants in China.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2009年第1期12-17,共6页
Chinese Journal of Pediatrics
关键词
婴儿
早产
肠道营养
重症监护病房
新生儿
宫外生长迟缓
Infant, premature
Enteral nutrition
Intensive care units, neonatal
Extrauterine growth restriction
