摘要
目的分析出生体重<1500 g的小于胎龄儿(small for gestational age,SGA)住院期间的不良结局。方法收集2018年1月1日至2023年12月31日中国北方地区44家协作单位新生儿重症监护病房收治的极低出生体重儿(very low birth weight infant,VLBWI)的临床资料进行前瞻性研究,根据是否为SGA分为SGA组和非SGA组。比较两组住院期间不良结局。结果共纳入符合条件的VLBWI 6153例,其中SGA组605例(9.8%),非SGA组5548例(90.2%)。SGA组住院期间死亡(15.9%比10.5%)、宫外生长发育迟缓(extrauterine growth retardation,EUGR)(78.5%比24.8%)、先天性甲状腺功能减退症(congenital hypothyroidism,CH)(13.4%比5.9%)、胃肠外营养相关性胆汁淤积症(parenteral nutrition-associated cholestasis,PNAC)(15.4%比8.9%)、早产儿代谢性骨病(metabolic bone disease of prematurity,MBDP)(6.9%比2.2%)、晚发型脓毒症(late onset sepsis,LOS)(26.1%比9.2%)的发生率高于非SGA组,严重脑损伤(3.0%比5.0%)、II期及以上新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)(1.8%比3.4%)、Ⅱ期及以上早产儿视网膜病(retinopathy of prematurity,ROP)(10.1%比16.2%)的发生率低于非SGA组。多因素logistic回归分析显示,SGA是VLBWI住院期间死亡(OR=2.023,95%CI 1.184~3.457,P=0.010)、EUGR(OR=2.889,95%CI 2.099~3.977,P<0.001)、CH(OR=1.919,95%CI 1.339~2.749,P<0.001)、PNAC(OR=1.892,95%CI 1.202~2.976,P=0.006)、MBDP(OR=1.687,95%CI 1.041~2.735,P=0.034)、LOS(OR=3.961,95%CI 2.648~5.926,P<0.001)的独立危险因素。结论出生体重<1500 g的SGA住院期间除死亡风险增加外,也更容易并发EUGR、CH、PNAC、MBDP等多种生长发育代谢性疾病。
ObjectiveTo analyze the clinical features and adverse outcomes of small-for-gestational(SGA)infants with birth weight less than 1500 g.MethodsThis multicenter prospective study involved very low birth weight infants(VLBWI)admitted to neonatal intensive care units(NICUs)across 44 centers from January 1,2018 to December 31,2023.Infants were categorized into SGA and non-SGA groups during hospitalization.The study compared general data and perinatal conditions between two groups,using χ^(2) test,Mann-Whitney U tests,and multivariate logistic regression model to analyze adverse outcomes of SGA infants during hospitalization.ResultsA total of 6153 VLBWI were included.Among these participants,1312(21.3%)were classified as extremely preterm infants,and 1412(22.9%)were extremely low birth weight infants.The study comprised 605 SGA infants(9.8%)and 5548 non-SGA infants(90.2%).The incidences of mortality(15.9%vs.10.5%),extrauterine growth retardation(EUGR)(78.5%vs.24.8%),congenital hypothyroidism(CH)(13.4%vs.5.9%),periventricular leukomalacia(PNAC)(15.4%vs.8.9%),metabolic bone disease of prematurity(MBDP)(6.9%vs.2.2%),and late-onset sepsis(LOS)(26.1%vs.9.2%)were significantly higher in the SGA group compared to the non-SGA group.The incidence of severe brain injury(3.0%vs.5.0%),stageⅡand above necrotizing enterocolitis(1.8%vs.3.4%),stageⅡand above retinopathy of prematurity(10.1%vs.16.2%)were lower.Multivariate logistic regression analysis showed that SGA was an independent risk factor for death(OR=2.023,95%CI 1.184-3.457,P=0.010),EUGR(OR=2.899,95%CI 2.099-3.977,P<0.001),CH(OR=1.919,95%CI 1.339-2.749,P<0.001),PNAC(OR=1.892,95%CI 1.202-2.976,P=0.006),MBDP(OR=1.687,95%CI 1.041-2.735,P=0.034)and LOS(OR=3.961,95%CI 2.648-5.926,P<0.001).ConclusionsSGA infants are at an increase risk of mortality during hospitalization,and are more vulnerable to complications such as EUGR,CH,PNAC and MBDP,which can adversely affect growth,development,and metabolism.
作者
中国北方新生儿协作网多中心协作组
张鸣
于永慧
Sino-northern Neonatal Network Collaborative Group;Zhang Ming;Yu Yonghui(不详;Department of Pediatrics,Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University,Jinan 250014,China;Department of Pediatrics,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China)
基金
国家自然基金(82470824)
山东省自然科学基金(ZR2023MH175)
山东省医学会临床科研资金-齐鲁专项(YXH2022DZX02001)。
关键词
极低出生体重儿
小于胎龄儿
预后
Very low birth weight infant
Small for gestational age
Prognosis
