<32周早产儿4~6岁体格生长随访研究

A Follow-Up Study on Physical Growth of Preterm Infants Born < 32 Weeks Gestation at 4~6 Years Old

摘要: 目的：探讨<32周早产儿4~6岁时体格生长特点，评估其体格生长相关指标是否与足月儿存在差距，以促进早产儿适宜的体格生长。方法：随访2016年12月~2019年11月出生、在青岛大学附属医院某院区新生儿重症监护室(neonatal intensive care unit, NICU)治疗并出院的137例胎龄 < 32周的早产儿队列，回访年龄为4~6岁，采用电话、微信回访和到院回访方式收集数据。出生胎龄 ≥ 37周来院进行健康体检的4~6岁儿童为对照组。采集身高、体重数据，应用WHO Anthro和WHO Anthro Plus软件计算体重、身高和体重指数(body mass index, BMI)的Z评分和百分位数。统计学分析：正态分布计量资料组间比较采用独立样本t检验和F检验分析；计数资料描述采用构成比，组间比较用χ²检验。P < 0.05为差异有统计学意义。结果：1) 一般资料结果：随访137例早产儿队列，收集到体格生长资料98例，男52例，女46例；足月儿对照组126例，男75例，女51例；共224例。2) 体格生长指标分析：早产儿组与足月儿组儿童身高、体重和BMI的百分位分布比较，差异有统计学意义(P < 0.05)，早产儿组身高、体重和BMI位于P0~25比例明显高于足月儿组，而位于P75~100比例均低于足月儿组。早产儿组男童身高Z评分(−0.09 ± 1.04)低于足月儿组(0.46 ± 0.93)，男童体重Z评分(−0.11 ± 1.33)低于足月儿组(0.60 ± 1.12)，男童BMI Z评分(−0.13 ± 1.64)低于足月儿组(0.46 ± 1.18)，两组间差异均有统计学意义(t = −3.13, −3.27, −2.38, P < 0.05)；早产儿组女童身高、体重和BMI 的Z评分与足月儿组比较，均无统计学意义(P > 0.05)。早产儿组内比较：出生体重 < 1000 g、出生体重 ≥ 1000 g~<1500 g和出生体重 ≥ 1500 g儿童的体重Z评分分别为−0.46 ± 1.26、−0.12 ± 1.23、0.69 ± 1.18三者间差异有统计学意义(F = 4.77, P < 0.05)。结论：<32周早产儿男童4~6岁时身高、体重和BMI仍落后于同龄足月儿童。4~6岁时，极低出生体重儿童的体重仍低于出生体重≥1500 g早产儿童。

Abstract: Objective: To investigate the physical growth characteristics of preterm infants aged 4~6 years with gestational age < 32 weeks, and to evaluate whether there are differences in physical growth between preterm infants and full-term infants, so as to promote appropriate physical growth of preterm infants. Methods: A cohort of 137 preterm infants with gestational age < 32 weeks who were born from December 2016 to November 2019 and discharged from the neonatal intensive care unit (NICU) of a branch of the Affiliated Hospital of Qingdao University was followed up. The follow-up age was 4-6 years old, and the data were collected by telephone and hospital visit. Children aged 4 to 6 years old with gestational age ≥ 37 weeks who came to the hospital for physical examination were enrolled as the control group. The height and weight data were collected, and the Z scores and percentiles of weight, height and body mass index (BMI) were calculated by WHO Anthro and WHO Anthro Plus software. Statistical analysis: independent sample t test and F test were used for comparison of normal distribution measurement data between groups. The enumeration data were described by constituent ratio, and the χ² test was used for comparison between groups. P < 0.05 was considered statistically significant. Results: 1) Results of general information: 137 preterm infants were followed up, 8 cases were lost to follow-up, and the physical growth data of 98 cases were collected, including 52 males and 46 females. The control group consisted of 126 full-term infants, including 75 males and 51 females. A total of 224 subjects were included. A total of 66 subjects were included in the study of cognition and behavior, including 42 cases in the preterm group, 27 males and 15 females; The control group consisted of 24 full-term infants, including 15 males and 9 females. 2) Analysis of physical growth data: There were significant differences in the percentile distribution of height, weight and BMI between the preterm group and the full-term group (P < 0.05). The proportion of children with height, weight and BMI at P0~25 in the preterm group was significantly higher than that in the full-term group, while the proportion of children with height, weight and BMI at P75~100 was significantly lower than that in the full-term group. The Z-score of height (−0.09 ± 1.04), weight (−0.11 ± 1.33) and BMI (−0.13 ± 1.64) in the male preterm group were lower than those in the full-term group (0.46 ± 0.93, 0.60 ± 1.12 and 0.46 ± 1.18, respectively). The differences between the two groups were statistically significant (t=−3.13, −3.27, −2.38, P < 0.05). There was no significant difference in Z scores of height, weight and BMI between the female preterm group and the full-term group (P > 0.05). Within the preterm group, the Z-score of birth weight < 1000 g, birth weight ≥ 1000 g~< 1500 g and birth weight ≥ 1500 g were −0.46 ± 1.26, −0.12 ± 1.23, 0.69 ± 1.18, respectively, and the difference was statistically significant (F = 4.77, P < 0.05). Conclusion: The height, weight and BMI of preterm boys < 32 weeks were still lower than those of full-term boys at the age of 4 to 6 years. VLBW children still had lower body weight than preterm children with birth weight ≥ 1500 g.