目的 通过对早产儿能量和营养素摄入以及体格发育状况调查,了解早产儿出生早期和出院后能量和营养素摄入的特点以及与体重增长的关系。方法 选取2014年1月－2016年1月在汕头大学医学院第一附属医院新生儿重症监护室住院的141名早产儿为研究对象,计算住院期间恢复至出生体重所需的时间及恢复出生体重后体重增长速率;计算达到早产儿能量推荐摄入标准(RDIs)的时间,比较宫内发育迟缓(IUGR)与宫外发育迟缓(EUGR)的发生率;按照出生胎龄≥34 周或<34 周分为两组,分别比较两组之间体重增长情况、EUGR 的发生率;对所有新生儿出院后3个月内进行门诊随诊,比较不同喂养组发生EUGR的情况。结果 1)该组早产儿恢复至出生体重的中位时间为13.2 d,恢复至出生体重后体重增长速率中位数为16.7 g/(kg·d),达到RDIs的中位时间为10.6 d;2)出院时EUGR 的发生率明显高于出生时IUGR发生率(46.1% vs.17.7%,P<0.01),出院时胎龄<34 周组EUGR 的发生率高于胎龄≥34 周组(P<0.05);3)141名早产儿出院3个月时EUGR 的发生率与出院时相比差异无统计学意义(χ²＝0.05,P>0.05),出院后母乳+母乳强化剂喂养以及母乳+早产儿出院后配方奶PDF喂养的早产儿在出院3个月时EUGR发生率低于纯早产儿出院后配方奶、纯母乳、纯足月儿配方奶、母乳+足月儿配方奶喂养的早产儿(P<0.05),胎龄<34 周与胎龄≥34 周早产儿在出院3个月时EUGR 的发生率差异无统计学意义(χ²＝2.75,P>0.05)。结论 早产儿在生后早期容易出现EUGR,且不能在短期内改善,胎龄越小EUGR发生率越高,出院后以母乳加母乳强化剂或母乳加早产儿出院后配方奶喂养者EUGR发生率低。

Objective To investigate the energy and nutrients intake as well as physical development,and to explore the characteristics of the energy and nutrients intake,and their relationships with the weight gain in preterm infants at the early period of life. Methods Clinical data of 141 preterm infants were collected,who were hospitalized in the Department of Neonatology in the First Affiliated Hospital of Shantou University Medical College from January 2014 to January 2016 and were followed up for 3 months.The time for weight reaching to the birth weight and the caloric intakes reached to the reference dietary intakes (RDIs) were collected.The velocity of weight gain was calculated.The rate of intrauterine growth retardation (IUGR) and extrauterine growth retardation (EUGR) were recorded.And the weight gain and incidence of EUGR were compared between preterm infants with gestational age (GA)＜34 weeks and ≥34 weeks.The feeding status and the weight,length and head circumference were recorded after discharge. Results 1) The median days of weight reaching to the birth weight were 13.2 days.The median velocity of weight gain after reaching to birth weight was 16.7g/(kg·d).The median days of caloric intakes reaching to the RDIs were 10.6 days.2) The incidence of EUGR at discharge was higher than that of IUGR during at birth (46.1% vs.17.7%, P<0.01).The incidence of EUGR at discharge in infants with GA＜34 weeks was significantly higher than that in infants with GA≥34 weeks(P<0.05).3) The incidence of EUGR between preterm infants before and after 34 weeks of GA in 141 preterm infants at the third month after discharge was not significantly different from that during hospitalization (χ²=0.05,P>0.05). The incidence of EUGR was lower in preterm infants fed by breast milk combined with human milk fortifier (HMF) or post-discharge formula(PDF) (P＜0.05).The difference on the incidence of EUGR between preterm infants before and after 34 weeks of GA in the third month after discharge was not significant (χ²=2.75,P>0.05). Conclusions Preterm infants,especially those with lower GA,are easier to suffer from EUGR and it is difficult to be solved during a short period after discharge.If the preterm infants are fed by breast milk combined with HMF or PDF,the EUGR might be improved.