目的 探讨胎龄<28周超早产儿住院期间发生宫外发育迟缓（extrauterine growth restriction,EUGR）的独立危险因素及其对校正12月龄体格发育的远期影响。方法 采用单中心回顾性队列研究设计,纳入2018年1月至2023年12月收治的102例超早产儿,依据Fenton生长曲线将出院体重Z评分<-1.28者纳入EUGR组（n=75）,余为非EUGR组（n=27）。通过多因素Logistic回归分析独立危险因素,并比较两组校正12月龄体格发育指标。结果 EUGR发生率为73.5%（75/102）。独立危险因素包括：出生体重Z评分降低（aOR=1.62,P=0.015）、中重度支气管肺发育不良（aOR=2.34,P=0.008）、败血症（aOR=2.18,P=0.023）、肠内营养启动延迟>24小时（aOR=3.12,P<0.001）、未使用母乳强化剂（aOR=2.78,P=0.001）、产前激素未完成标准疗程（aOR=2.45,P=0.002）及达全肠喂养时间>18天（aOR=2.16,P=0.006）;早期肠内营养（≤48小时）为保护性因素（aOR=0.41,P=0.003）。校正12月龄时,EUGR组体重Z评分（-1.32±0.54 vs -0.87±0.62）及身长Z评分（-1.15±0.48 vs -0.69±0.51）显著低于对照组（均P<0.01）。结论 超早产儿EUGR与出生营养储备不足、并发症叠加及营养管理延迟密切相关,可导致持续性生长偏离。建议围产期实施肠内营养24小时内启动、母乳强化5天内完成等个体化策略,并强化并发症综合管理以改善预后。
Abstract
Objective To investigate the independent risk factors for extrauterine growth restriction (EUGR) in extremely preterm infants (gestational age<28 weeks) during hospitalization and their long-term impacts on physical development at 12 months corrected age. Methods This single-center retrospective cohort study included 102 extremely preterm infants admitted between January 2018 and December 2023. Based on weight Z-scores at discharge using the Fenton growth curve, infants were stratified into EUGR group (Z-score<-1.28, n=75) and non-EUGR group (n=27). Multivariable logistic regression was used to identify independent risk factors, and physical development indicators at 12 months corrected age were compared between the two groups. Results The incidence of EUGR was 73.5% (75/102). Independent risk factors included lower birth weight Z-score (aOR=1.62, P=0.015), moderate-to-severe bronchopulmonary dysplasia (aOR=2.34, P=0.008), sepsis (aOR=2.18, P=0.023), delayed enteral nutrition initiation (>24 hours; aOR=3.12, P<0.001), non-use of human milk fortifier (aOR=2.78, P=0.001), incomplete antenatal corticosteroid therapy (aOR=2.45, P=0.002), and prolonged time to full enteral feeding (>18 days; aOR=2.16, P=0.006). Early enteral nutrition (≤48 hours) served as a protective factor (aOR=0.41, P=0.003). At 12 months corrected age, the EUGR group exhibited significantly lower weight Z-scores (-1.32±0.54 vs. -0.87±0.62) and length Z-scores (-1.15±0.48 vs. -0.69±0.51) compared to the non-EUGR group (all P<0.01). Conclusion EUGR in extremely preterm infants is driven by insufficient nutritional reserves, complication burden, and delayed nutritional management, resulting in sustained growth deviation. Perinatal strategies emphasizing enteral nutrition initiation within 24 hours, human milk fortification within 5 days, and comprehensive complication prevention are crucial for optimizing outcomes.
关键词
超早产儿 /
宫外发育迟缓 /
营养管理 /
危险因素 /
保护因素 /
追赶性生长
Key words
extremely preterm infants /
extrauterine growth restriction /
nutritional management /
risk factors /
protective factors /
catch-up growth
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基金
湖南省科技厅临床医疗技术创新引导项目“孕期解脲支原体感染对新生儿支气管肺发育不良的影响”（2021SK53208）
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