目的 探讨早产小于胎龄儿(SGA)出生后24个月内体格生长特点,为早产SGA的临床管理及生长干预提供相关参考。方法 采用前瞻性队列研究方法,选取2020年1月—2022年2月期间在简阳市人民医院出生且出生后2年内定期在本院随访体检的60例早产(胎龄<37周)SGA作为研究对象,分别按照1∶2的比例选择同期足月(胎龄37~40周)SGA和早产适于胎龄儿(AGA)作为对照组,在出生时和3、6、12、18、24月龄(早产儿为校正月龄)测量其体重、身长、头围,采用Z评分法评价其生长水平和生长速度。结果 纳入完成随访研究的婴幼儿276例,其中早产SGA组56例、足月SGA组109例、早产AGA组111例。早产SGA组、足月SGA组在3、6、12、18月龄的年龄别体重Z值(WAZ)、年龄别身长Z值(LAZ)、年龄别头围Z值(HCZ)均分别低于早产AGA组,差异有统计学意义(P<0.05),早产SGA组3、6月龄的WAZ低于足月SGA组,早产SGA组6月龄的LAZ低于足月SGA组,早产SGA组3、6、12月龄的HCZ低于足月SGA组,差异有统计学意义(P<0.05)。早产SGA组、足月SGA组、早产AGA组的体重追赶峰值分别出现在12月龄、18月龄、3月龄; 三组的身长在12月龄内追赶明显,之后均呈平缓增长趋势;早产SGA组和早产AGA组头围表现为追赶生长,其追赶峰值分别出现在6月龄和12月龄。三组在3月龄体重生长速度比较,差异有统计学意义(P<0.05)。结论 SGA婴幼儿生命早期(前12月龄)体格发育的整体水平低于AGA婴幼儿,足月SGA的体格生长优于早产SGA,校正0~3月龄可能是早产SGA婴幼儿生长快速变化的窗口时期,加强该阶段的营养干预喂养指导可有效保证早产SGA婴幼儿的生长速度。
Abstract
Objective To investigate the physical growth characteristics of small for gestational age(SGA) premature infants within the first 24 months after birth, so as to provide relevant references for clinical management and growth intervention of premature SGA infants. Methods A prospective cohort study design was adopted. A total of 60 premature(gestational age <37 weeks) SGA infants born in Jianyang People′s Hospital between January 2020 and February 2022 and who underwent regular follow-up physical examinations at the hospital within 2 years after birth were selected as the study subjects. Full-term(gestational age 37 - 40 weeks) SGA infants and premature appropriate for gestational age(AGA) infants during the same period were selected as the control groups in a 1∶2 ratio. Their weight, length, and head circumference were measured at birth and at 3, 6, 12, 18, and 24 months of age(corrected age for premature infants), and the Z-score method was used to assess their growth level and growth rate. Results A total of 276 infants completed the follow-up study, including 56 in the premature SGA group, 109 in the full-term SGA group, and 111 in the premature AGA group. The weight-for-age Z-scores(WAZ), length-for-age Z-scores(LAZ), and head circumference-for-age Z-scores(HCZ) of the premature SGA group and the full-term SGA group at 3, 6, 12, and 18 months of age were significantly lower than those of the premature AGA group(P<0.05). The WAZ of the premature SGA group at 3 and 6 months of age were lower than those of the full-term SGA group, the LAZ of the premature SGA group at 6 months of age was lower than that of the full-term SGA group, and the HCZ of the premature SGA group at 3, 6 and 12 months of age were lower than those of the full-term SGA group, with statistically significant differences(P<0.05). The peak catch-up growth in weight for the premature SGA group, full-term SGA group, and premature AGA group occurred at 12, 18, and 3 months of age, respectively. The length catch-up growth was significant within the first 12 months of age in all three groups, followed by a gradual increase. The head circumference showed catch-up growth in both the premature SGA and premature AGA groups, with peak catch-up occurring at 6 months and 12 months of age, respectively. There were statistically significant differences in weight growth velocity among the three groups at 3 months of age(P<0.05). Conclusions The overall level of physical development in the early life(first 12 months of age) of SGA infants is lower than that of AGA infants. The physical growth of full-term SGA infants is better than that of premature SGA infants. The corrected age of 0 - 3 months may be a window period of rapid growth changes in premature SGA infants. Strengthening nutritional intervention and feeding guidance during this stage can effectively ensure the growth rate of premature SGA infants.
关键词
小于胎龄儿 /
适于胎龄儿 /
早产 /
体格生长 /
生长速度
Key words
small for gestational age /
appropriate for gestational age /
preterm /
physical growth /
growth velocity
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