出生体重≤750g 的早产儿的产后生长情况。

Postnatal growth of preterm born children ≤ 750g at birth.

机构信息

Department of Obstetrics, University Medical Centre, Wilhelmina Children's Hospital, Utrecht, The Netherlands.

出版信息

Early Hum Dev. 2011 Jul;87(7):495-507. doi: 10.1016/j.earlhumdev.2011.04.009. Epub 2011 May 6.

DOI:10.1016/j.earlhumdev.2011.04.009

PMID:21550187

Abstract

BACKGROUND

Extremely low birth weight (ELBW) infants are at risk of impaired postnatal growth. Impaired postnatal growth has been reported to be associated with delayed cognitive and motor development.

AIMS

To describe postnatal growth patterns of appropriate and small for gestational age (AGA and SGA) ELBW children in relation to their cognitive and motor outcome at age 5.5.

STUDY DESIGN

Retrospective cohort study.

SUBJECTS

One hundred one children with a BW ≤ 750g, born between 1996 and 2005 in the University Hospital Utrecht, The Netherlands.

OUTCOME MEASURES

Height (Ht), weight (Wt), occipital-frontal circumference (OFC) at birth, 15 months and 2 years corrected age and 3.5 and 5.5 years. Cognitive and motor outcome at 5.5 years of age, classified as normal (Z-score ≥-1), mildly delayed (-2≤Z-score <-1) or severely delayed (Z-score <-2). AGA (Ht, Wt or OFC at birth ≥-2 SDS) infants were compared with SGA (Ht, Wt or OFC at birth <-2 SDS) infants.

RESULTS

Between birth and 5.5 years catch-up growth in Ht, weight for height (Wt/Ht), Wt and OFC was seen in 72.2%, 55.2%, 28.6% and 68.9% respectively of the SGA infants. For AGA infants we found substantial catch-down growth in Ht (15.4%) and Wt (33.8%). Cognitive and motor outcome was normal in 76.2% and 41.6% of the 101 children. A significantly higher percentage of normal cognitive outcome was found in AGA infants with Wt growth remaining at ≥-2 SDS compared to AGA infants with catch-down growth (83% vs 63%). Next, SGA infants who caught-up in OFC had a higher prevalence of normal cognitive outcome compared to SGA infants who did not catch-up in OFC. Furthermore, a higher percentage of severely delayed motor outcome was found in SGA infants without catch-up growth in Wt compared to SGA infants who caught-up in Wt (61.5% vs 32.2%).

CONCLUSIONS

Catch-up growth in Ht, Wt/Ht and OFC occurred in the majority of the SGA infants with a BW ≤ 750 g, but was less common in Wt. AGA children who remained their Wt at ≥-2 SDS have a better cognitive and motor developmental outcome at 5.5 years of age. Catch-up growth in OFC was associated with a better cognitive outcome at 5.5 years of age.

摘要

背景

极低出生体重（ELBW）婴儿有生长发育迟缓的风险。有研究报道，生长迟缓与认知和运动发育延迟有关。

目的

描述适当体重和小于胎龄（AGA 和 SGA）ELBW 婴儿的出生后生长模式与他们在 5.5 岁时的认知和运动结果之间的关系。

研究设计

回顾性队列研究。

受试者

101 名出生体重≤750g 的婴儿，于 1996 年至 2005 年在荷兰乌得勒支大学医院出生。

观察指标

出生时的身高（Ht）、体重（Wt）、头围（OFC），校正 15 个月和 2 岁时的身高、体重和头围，以及 3.5 岁和 5.5 岁时的身高、体重和头围。5.5 岁时的认知和运动结果，分为正常（Z 分数≥-1）、轻度延迟（-2≤Z 分数<-1）或重度延迟（Z 分数<-2）。AGA（出生时 Ht、Wt 或 OFC≥-2 SDS）婴儿与 SGA（出生时 Ht、Wt 或 OFC<-2 SDS）婴儿进行比较。

结果

在 SGA 婴儿中，72.2%、55.2%、28.6%和 68.9%分别出现 Ht、体重与身高比值（Wt/Ht）、体重和 OFC 的追赶性生长。AGA 婴儿则出现大量的 Ht（15.4%）和 Wt（33.8%）下降。101 名儿童中，76.2%和 41.6%的认知和运动结果正常。与体重下降的 AGA 婴儿相比，体重保持在≥-2 SDS 的 AGA 婴儿的正常认知结果百分比显著更高（83%比 63%）。接下来，OFC 追赶生长的 SGA 婴儿的认知结果正常的比例高于未追赶生长的 SGA 婴儿。此外，与 Wt 追赶生长的 SGA 婴儿相比，Wt 未追赶生长的 SGA 婴儿的运动结果严重延迟的比例更高（61.5%比 32.2%）。