目的 探寻极低出生体重儿早期营养与体重、身长、头围的生长及远期神经运动发育的关系,为以后临床工作中对极低出生体重儿治疗护理提供帮助。方法 在本院NICU住院的出生体重低于1 500 g的新生儿86例,以出院时体重分为宫外生长迟缓(EUGR)、非EUGR组,出院后定期在高危儿随访门诊进行随访。定期测量体重,身长,头围,进行GMs质量评估,头颅MRI检查,发育商(DQ)评估。观察不同组别出院后体重、身长、头围的增长及运动、神经发育情况。结果 EUGR组纠正胎龄6、12月身长、头围均明显低于非EUGR组,差异有统计学意义(P<0.05)。纠正胎龄6月时EUGR组体重明显低于非EUGR组,差异有统计学意义(P<0.05),纠正胎龄12月时EUGR组体重与非EUGR组,差异无统计学意义(P>0.05),EUGR组GMs质量评估,头颅MRI检查阳性率均明显高于非EUGR组,差异有统计学意义(P<0.05)。两组发育商<85的比例差异无统计学意义(P>0.05),但EUGR组的平均发育商明显低于非EUGR组,差异有统计学意义(P<0.05)。极低出生体重儿EUGR组出院后体格、智能发育均明显低于非EUGR组。结论 需重视极低出生体重儿生后营养管理,降低极低出生体重儿宫外生长迟缓的发生率。同时需注重极低出生体重儿出院后管理,关注出院后生长发育情况,加强营养指导,使EUGR出现明显的追赶性生长态势。

Objective To explore the relationship of early nutrition and weight,height,head circumference growth and long-term neurological motor development,for the future clinical work in the very low birth weight infants (VLBWI). Methods A total of 86 VLBWI were selected in Nantong Maternal and Child Health Care Hospital NICU.According to the weight of hospital discharge,the cases were divided into extrauterine growth restriction (EUGR) and non-EUGR group,and followed up regularly at high risk infants follow-up clinic.Measurement of weight,length,head circumference,GMs quality assessment,head MRI examination,developmental quotient (DQ) assessment were operated regularly.Weight,length,head circumference growth and movement,neural development were observed in different groups. Results In EUGR group,when they were corrected for gestational age 6 months and 12 months,their length,head circumference were significantly lower than those in non EUGR group,the differences were statistically significant (P<0.05).The weight of EUGR group was lower than that of non EUGR group at corrected for gestational age 6 months,and the difference was statistically significant (P<0.05).The weight of EUGR group was not different from that of the non EUGR group at corrected for gestational age 12 months (P>0.05).The positive rates of GMs,head MRI in EUGR group were significantly higher than those in non-EUGR group (P<0.05).Developmental quotient <85 patients in the EUGR group had no difference than that in the non-EUGR group (P>0.05).But the average developmental quotient of EUGR group was significantly lower than that of non-EUGR group (P<0.05).The physical and intelligence development of the EUGR group of very low birth weight infants was significantly lower than that of the non EUGR group. Conclusion Much attention should be paid to their nutrition management to reduce the incidence of EUGR in very low birth weight infants.At the same time we need to pay attention to the management of the very low birth weight infants after discharge,to strengthen nutrition guidance of EUGR,and to make obvious catch-up growth trend.