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超早产儿校正月龄24月龄内体格生长分析

Post-discharge growth of extremely premature infants within corrected age of 24 months

摘要目的:分析超早产儿校正月龄24月龄内体格的生长特点和规律。方法:选择2013年8月至2020年4月南方医科大附属深圳妇幼保健院新生儿出院后门诊或高危儿门诊随访的超早产儿311例的临床资料进行回顾性分析。按照出生胎龄(23~24 +6周、25~26 +6周、27~27 +6周)以及出生体重(<750 g、750~999 g、≥1 000 g)进行分组,观察超早产儿校正月龄24月龄内体重、身长及头围变化,并分别按照实际月龄及校正月龄对体重、身长及头围进行拟合曲线分析,绘制生长曲线并与世界卫生组织(WHO,2006年版)足月儿生长曲线进行对比并分析。 结果:共纳入311例超早产儿,其中男184例、女127例,出生胎龄23~27 +6周,出生体重480~1 430 g。按不同出生胎龄及出生体重分组,各组随访至校正月龄24月龄,实际月龄与校正月龄曲线均未达到重叠。生长曲线看无论实际还是校正月龄,各体格指标出生胎龄27~27 +6周组曲线均高于25~26 +6周组,23~24 +6周组曲线均最低;出生体重≥1 000 g组曲线均高于750~999 g组,<750 g组曲线最低;出生胎龄分组较出生体重分组追赶趋势差异更明显。生长曲线看超早产儿男女体重、身长在校正月龄24月龄内均达到适宜追赶;头围女童在校正月龄24月龄内均达到适宜追赶,男童在校正月龄9月龄内可达适宜追赶,校正月龄9月龄后落后于同期同性别胎龄儿第25百分位数(P 25)。男女童实际24月龄体格曲线均落后于WHO(2006年版)P 25水平,各体格指标无论校正或实际月龄,女童均低于男童指标。 结论:校正月龄6月龄内为超早产儿的快速追赶期,出生体重及出生胎龄越小,各月龄段对应的体格指标越低,完成追赶所需要的时间越长。出生胎龄较出生体重对超早产儿童持续追赶影响更大。在校正月龄24月龄后超早产儿仍需要校正月龄。女童的体格发育水平整体低于男童。

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abstractsObjective:To demonstrate the post-discharge catch-up growth of extremely premature infants (EPI) within 24 months of corrected age.Methods:This study retrospectively collected the anthropomorphic measurements of 311 EPI who visited Shenzhen Maternity and Child Healthcare Hospital from August 2013 to April 2020. These infants were stratified according to gestational age at birth (GA): 23-24 +6weeks, 25-26 +6weeks, 27-27 +6weeks; and birth weight:<750 g, 750-999 g, ≥1 000 g. The anthropomorphic measurements, including weight, length, and head circumference for age, were recorded timely from discharge to 24 months of corrected age. And the growth curve stratified by GA and birth weight were fitted in both chronological age and corrected age, which were then compared with the World Health Organization Child Growth Standards for term infant (2006 version), to investigate the catch-up growth pattern of EPI. And appropriate catch-up was defined as the measurements reached the 25 th percentile of WHO growth curve. Results:In these 311 EPI, 184 were males and 127 females, with gestational age of 23-27 +6 weeks and birth weight of 480-1 430 g. Regardless of the GA and birth weight, the growth curves fitted in corrected age failed to overlap with that in chronological age by 24 months of corrected age. The growth velocity of weight, length and head circumference in both corrected and chronological age were all positively correlated with GA and birth weight: the 27-27 +6weeks group showed a preferable growth pattern than the 25-26 +6weeks group, and the curve of the 23-24 +6weeks group was most unfavorable; and the same pattern was observed between the subgroups of different birth weight. Furthermore, the GA had more significant impact on the catch-up growth pattern than birth weight did. When assessed with corrected age curve, the weight and length of both male and female EPIs achieved appropriate catch-up by 24 months, as well as the head circumference of girls; whereas, boys′ head circumference reached appropriate catch-up at the corrected age of 9 months, but fell behind the 25 th percentile after that. However, when assessed with chronological age curve, both boys and girls failed to achieve appropriate catch-up in weight, length and head circumference by age 24 months. And no matter in corrected or chronological age, all physical measurements of girls were lower than those of boys. Conclusions:The rapid catch-up growth of EPI happens within 6 months of corrected age. The lower the birth weight and gestational age, the lower the physical measurements at each corresponding month of age, and the longer it takes to achieve appropriate catch-up. Gestational age has a greater impact on the longitudinal catch-up growth than birth weight does. And girls generally grow slower than boys in either correct or actual age. Before 24 months of corrected age, the growth should be assessed with corrected age rather than chronological age.

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中华儿科杂志

中华儿科杂志

2020年58卷12期

982-988页

MEDLINEISTICPKUCSCDCA

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