摘要
目的探讨极低出生体重儿(very low birth weight infant,VLBWI)早期营养支持与早产儿视网膜病(retinopathy of prematurity,ROP)发生的关系。方法回顾性选择徐州医科大学附属医院新生儿重症监护病房2020年1月至2024年5月收治的胎龄<32周、出生体重<1500 g的早产儿为研究对象,根据是否发生ROP分为ROP组和非ROP组,比较两组患儿的临床资料并分别计算两组出生后第1周和第2周总能量、单位液体能量,采用多因素logistic逐步回归分析VLBWI发生ROP的独立危险因素,并利用受试者工作特征曲线分析VLBWI早期营养支持与ROP发生的相关性。结果共纳入238例VLBWI,ROP组59例(24.8%),非ROP组179例(75.2%)。ROP组胎龄、出生体重、1 min、5 min Apgar评分低于非ROP组,氧疗时间、禁食时间、有创机械通气时间≥7 d、早期持续静脉营养时间≥14 d的比例高于非ROP组,ROP组生后第1周葡萄糖、氨基酸、脂肪乳摄入量、初始葡萄糖输注速率(glucose infusion rate,GIR)、生后第1周、第2周总能量、单位液体能量均低于非ROP组,差异有统计学意义(P<0.05)。多因素logistic回归分析显示胎龄小(OR=1.973,95%CI 1.525~2.554,P<0.001)、初始GIR低(OR=2.357,95%CI 1.206~4.607,P=0.012)、第1周脂肪乳摄入总量少(OR=1.174,95%CI 1.025~1.344,P=0.021)是VLBWI发生ROP的独立危险因素。ROC曲线分析显示胎龄、初始GIR、生后第1周脂肪乳摄入总量联合预测VLBWI发生ROP的曲线下面积为0.820(95%CI 0.761~0.879),敏感度89.8%,特异度62.0%。结论VLBWI胎龄小、初始GIR低、生后第1周脂肪乳摄入总量少可能与ROP发生风险增高有关,三者联合预测ROP价值更高。
Objective To study the correlation of early nutritional support and retinopathy of prematurity(ROP)in very low birth weight infants(VLBWIs).Methods From January 2020 to May 2024,preterm infants with gestational age(GA)<32 week and birth weight(BW)<1500 g admitted to NICU of our hospital were retrospectively studied.The infants were assigned into ROP group and non-ROP group.Clinical data of the two groups were compared.Total energy intake and energy density of liquid intake in each group during week1 and week2 after birth were calculated.Multivariate logistic regression analysis was used to determine independent risk factors of ROP in VLBWIs.Receiver operating characteristic(ROC)curve was drawn to evaluate the correlation between early nutritional support and the incidence of ROP.Results A total of 238 VLBWIs were enrolled,including 59(24.8%)in the ROP group and 179(75.2%)in the non-ROP group.Compared with the non-ROP group,the ROP group showed significantly lower GA,BW,1 min and 5 min Apgar scores,longer duration of oxygen therapy and fasting,higher incidences of invasive mechanical ventilation≥7 d and early total parenteral nutrition≥14 d.During week1 and week2 after birth,the ROP group had significantly lower intake of glucose,amino acids,lipid emulsions,initial glucose infusion rate(iGIR),total energy intake and energy density of liquid intake than the non-ROP group(P<0.05).Multivariate logistic regression analysis showed that smaller GA(OR=1.973,95%CI 1.524-2.554,P<0.001),lower iGIR(OR=2.357,95%CI 1.206-4.607,P=0.012)and reduced total lipid emulsion intake during week1 after birth(OR=1.174,95%CI 1.025-1.344,P=0.021)were independent risk factors of ROP in VLBWIs.ROC curve analysis showed that prediction model combining GA,iGIR and total lipid emulsion intake during week1 had area-under-the-curve of 0.820(95%CI 0.761-0.879),with 89.8%sensitivity and 62.0%specificity.Conclusions Smaller GA,lower iGIR and reduced total lipid emulsion intake during week1 after birth may increase the risk of ROP in VLBWIs and the combination of the three has greater predictive value.
作者
周蒙
张雅丽
杨倩倩
徐艳
王军
Zhou Meng;Zhang Yali;Yang Qianqian;Xu Yan;Wang Jun(Department of Neonatology,Hospital of Xuzhou Medical University,Xuzhou 221000,China)
关键词
早产儿视网膜病
营养支持
早产儿
极低出生体重儿
危险因素
Retinopathy of prematurity
Nutritional support
Premature infant
Very low birth weight infant
Risk factors
