目的 分析足月小于胎龄(SGA)儿早期生长轨迹,探讨追赶生长的影响因素,为SGA儿的临床管理提供科学依据。方法 选取 2022年1—12月于南京医科大学第一附属医院儿童保健科门诊定期随访体检的足月(37周≤胎龄＜42周)SGA儿纳入研究组,按1∶1比例匹配同期出生的足月适于胎龄(AGA)儿纳入对照组,采用Z评分比较生长速度及有无追赶生长,并分析追赶生长的影响因素。结果 本研究共纳入研究对象154例,其中SAG儿76例,AGA儿78例,两组间胎龄、性别、分娩方式及喂养方式比较,差异均无统计学意义(P>0.05)。0月龄期间两组△WAZ、△LAZ比较,差异无统计学意义(t＝-1.158、-1.149,P＞0.05)。在1～6月龄及7～12月龄间SGA儿生长加速显著,△WAZ、△LAZ均大于AGA组,差异有统计学意义(t=3.114、2.494、4.170、3.587,P＜0.01)。SGA组在1岁内追赶生长发生率为81.6%,且主要出现在6个月以内。追赶组儿童6月龄内体重增长速度为(0.71±0.16)kg/月、身长增长速度为(3.29±0.33)cm/月,显著高于无追赶组(0.47±0.06)kg/月、(2.75±0.48)cm/月(t＝-6.790、-2.341, P＜0.05);出生后7～12月龄阶段,两组间体重和身长增长速度差异无统计学意义(P>0.05)。追赶组男童占比高,且在生后6月龄时骨密度Z值(-1.56±0.87)低于无追赶组(0.51±1.13,t=2.071,P=0.046),而在12月龄时两组间骨密度Z值差异无统计学意义(P>0.05)。结论 足月SGA出生后存在加速追赶生长且呈现动态变化,追赶高峰期发生在生后6月龄内,且男童追赶比例更高;快速追赶生长期骨矿物积聚不足。
Abstract
Objective To analyze the early growth trajectory of full-term small for gestational age(SGA) infants, and to discuss the influencing factors of catch-up growth, so as to provide scientific basis for clinical management of SGA. Methods Full-term(37 weeks ≤ gestational age <42 weeks) SGA infants who took physical examination and follow-up regularly in the Department of Child Health Care in the First Affiliated Hospital of Nanjing Medical University from January to December 2022 were selected in the study group. Full-term appropriate for gestational age(AGA) infants born in the same period were selected in the control group according to 1∶1 match based on gestational age and gender. Z score was used to calculate growth rate and Logistic regression was used to analyze the influencing factors of catch-up growth. Results A total of 154 infants were included, including 76 SAG cases and 78 AGA cases. There were no statistical differences in gestational age, gender, delivery and feeding mode between the two groups(P＞0.05). No differences in △WAZ and △LAZ were observed between SGA and AGA at 0 months of age(t＝-1.158,-1.149, P＞0.05). The growth accelerated remarkably at 1 - 6 months old and 7 - 12 months old, △WAZ and △LAZ were significantly higher than those of AGA group(t=3.114, 2.494, 4.170, 3.587, P＜0.001). The rate of catch-up growth in SGA group was 81.6%at 12 months of age, which mainly ccurred within 6 months old when the weight growth rate was (0.71±0.16)kg/month and the length growth rate was (3.29±0.33)cm/month, significantly higher than those of the non catch-up group [(0.47±0.06)kg/month,(2.75±0.48)cm/month, t＝-6.790,-2.341, P＜0.05]. No difference was observed in the growth rate of body weight and length at 7 - 12 months of age between the two groups(P>0.05). The proportion of boys was higher in the catch-up group and their bone mass density(BMD) Z score(-1.56±0.87) was lower than that in the non catch-up group at 6 months(0.51±1.13,t=2.071, P=0.046), while no statistical difference existed at 12 months of age(P＞0.05). Conclusions Full-term SGA infants show accelerated catch-up growth and dynamic changes in growth indicators. Catch-up growth occurrs obviously in the first 6 months after birth, more in boys and possibly results in early bone mineral deficiency.
关键词
小于胎龄 /
足月 /
追赶生长
Key words
small for gestational age /
full-term /
catch-up growth
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基金
江苏省妇幼健康科研基金(F202112);江苏省妇幼健康重点学科基金(FXK202104)
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