目的 比较不同类型小于胎龄(SGA)儿生后至2岁追赶生长情况并对相关因素进行分析,以期为SGA儿的规范化管理提供参考依据。方法 采用回顾性研究,选取2018年1月-2021年7月在四川省妇幼保健院儿童保健科进行健康体检的SGA儿为研究对象,根据其出生时身高及体重评定将其分为SGA-1(出生时仅身长低于同性别同胎龄儿P10)、SGA-2(出生时仅体重低于同性别同胎龄儿P10)、SGA-3(出生时身长和体重均低于同性别同胎龄儿P10)三组,利用WHO Anthro软件、SPSS 27.0对三种不同类型SGA儿在不同月龄的追赶情况进行统计描述及差异性比较,并对影响追赶结局的产前、产时及新生儿期相关因素进行回归分析。结果 1)不同组别SGA儿各月龄追赶比率不同,SGA-1组身长追赶在(24±1)月龄人数占比最多(66.4%),SGA-2组体重追赶在(12±1)月龄占比最高(78.7%),SGA-3组身长追赶在(24±1)月龄占比达最大(66.9%),体重追赶在(3±1)月龄达最大(77.4%);各月龄身长追赶发生的比率低于体重追赶,差异有统计学意义(P＜0.05);2)同一组别SGA身长指标分别达P10、P25、P50的比率在(18±1)月龄与(24±1)月龄之间差异无统计学意义(P>0.05),同一组别SGA体重指标分别达P10、P25、P50的比率在(6±1)月龄、(12±1)月龄、(18±1)月龄、(24±1)月龄之间差异无统计学意义(P>0.05),SGA-3组无论是身长指标还是体重指标在各月龄达到P10的比率均低于SGA-1组,差异有统计学意义(P<0.05);SGA-1组实现身长和体重追赶的比率均高于其他两个组别,但部分月龄与SGA-2组比较差异无统计学意义(P>0.05);3)分娩方式、系统管理以及母亲孕期肝内胆汁淤积影响SGA身长追赶结局(P<0.05)。结论 不同类型SGA发生追赶的比率及高峰时期不同,体重追赶较身长追赶发生的时间更早,其发生追赶的比率也高于身长追赶,但身长追赶持续的时间更长,追赶效果更加理想。出生时身长、体重均未达到P10百分位的SGA生后追赶相对受限。自然分娩和系统管理是影响SGA儿童早期追赶生长的积极因素,母亲孕期肝内胆汁淤积是SGA儿童追赶生长的不利因素,重视不同类型SGA早期追赶生长特点及影响因素对后期SGA的管理及干预具有重要意义。
Abstract
Objective To compare the catch-up growth of different types of small for gestational age (SGA) children from birth to 2 years old,and to analyze related factors,in order to provide reference for the standardized management of SGA infants. Methods A retrospective study was performed on SGA infants who underwent health examination in the Department of Child Health Care of Sichuan Maternal and Child Health Hospital from January 2018 to July 2021 were selected as the study subjects,and were divided into three groups according to their birth weight and length:SGA-1(length at birth＜P10),SGA-2(weight at birth＜P10),and SGA-3(length and weight at birth＜P10).The differences of catch-up growth among three different types of SGA at different months of age were statistical described and compared by the WHO anthro software and SPSS 27.0,and regression analysis was used to analyze related factors that affect the outcome of catch-up growth. Results 1) The catch-up ratios of SGA at different ages in each group were different.The height catch-up ratio of SGA-1 group was the highest at (24±1) months old (66.4%),followed by the weight catch-up ratio of SGA-2 group at (12±1) months old (78.7%).The height catch-up ratio of SGA-3 group reached the maximum at (24±1) months old (66.9%),and the weight catch-up ratio reached the maximum at (3±1) months old (77.4%).The incidence of height catch-up was significantly lower than that of weight catch-up(P＜0.05).2) There was no significant difference in the ratios of SGA height indicators reaching P10,P25,and P50 between (18±1) months old and (24±1) months old in the same group (P>0.05),and there was no significant difference in the ratios of SGA weight indicators reaching P10,P25,and P50 at (6±1),(12±1),(18±1),and (24±1) months old in the same group (P>0.05).The ratios of SGA-3 group reaching P10 percentile of both body length and weight indicators at each month of age was significantly lower than those of SGA-1 group (P<0.05);the ratio of SGA-1 group achieving length and weight catch-up was higher than that of the other two groups,but there was no significant difference in some months of age compared with SGA-2 group (P>0.05).3) Delivery mode,systematic management,and mother's intrahepatic cholestasis during pregnancy were related factors affecting the outcome of SGA height catch-up growth (P<0.05). Conclusions Different types of SGA have different catch-up growth rates and peak periods.Weight catch-up occurs earlier than height catch-up,and its incidence rate is also higher than that of height catch-up,but height catch-up lasts longer with better catch-up effect.SGA children who are born with short height and weight below P10 have relatively limited catch-up growth after birth.Natural childbirth and systematic management are positive factors affecting the early catch-up growth of SGA children,while intrahepatic cholestasis during pregnancy is a risk factor for SGA children's catch-up growth.Attention should be paid to the early growth characteristics and influencing factors of different types of SGA,which is important for the later management and intervention of SGA.
关键词
小于胎龄儿 /
追赶生长 /
生长模式
Key words
small for gestational age infants /
catch-up growth /
growth patterns
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基金
四川省妇幼保健院普及应用项目(CXPJ2023-17)
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