影响极早产儿出院后早期追赶生长的相关因素分析

doi:10.12372/jcp.2025.25e0660

临床儿科杂志 ›› 2025, Vol. 43 ›› Issue (11): 816-822.doi: 10.12372/jcp.2025.25e0660

影响极早产儿出院后早期追赶生长的相关因素分析

宦鹏¹^,², 王小玲¹, 高强³, 罗丽娟¹, 董文斌¹, 雷小平¹()

1.西南医科大学附属医院儿童医学中心新生儿科西南医科大学附属医院围产医学中心四川省出生缺陷临床医学研究中心（四川泸州 646000）
2.江油市第二人民医院儿童保健科（四川绵阳 621700）
3.自贡市第一人民医院儿科（四川自贡 643000）

收稿日期:2025-06-10 录用日期:2025-09-16 出版日期:2025-11-15 发布日期:2025-11-06
通讯作者: 雷小平电子信箱：leixiaoping2020@swmu.edu.edu.cn
基金资助:
（泸州-医科大）合作应用基础（2021）(ZXX-2021LZXNYD-J21);出生缺陷与相关妇儿疾病教育部重点实验室开放课题资助(SCU2023D006);重庆市妇幼疾病预防控制与公共卫生研究中心(CQFYJB01002);江油市2025年度社会科学研究规划项目(JY2025ZC020)

Risk factors of post-discharge catch-up growth in very preterm infants

HUAN Peng¹^,², WANG Xiaoling¹, GAO Qiang³, LUO Lijuan¹, DONG Wenbin¹, LEI Xiaoping¹()

1. Department of Neonatology, Children's Medical Center; Department of Perinatology; Sichuan Clinical Research Center for Birth Defects, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
2. Department of Pediatric Health Care, Jiangyou Second People's Hospital, Mianyang 621700, Sichuan, China
3. Department of Pediatrics, Zigong First People's Hospital, Zigong 643000, Sichuan, China

Received:2025-06-10 Accepted:2025-09-16 Published:2025-11-15 Online:2025-11-06

摘要/Abstract

摘要：

目的探讨影响极早产儿出院后至校正6月龄时体重追赶生长的相关因素。方法回顾分析2019年8月至2022年6月新生儿科124例胎龄<32周极早产儿临床数据。追赶生长判定标准为校正6月龄时年龄别体重Z值较出院时上升≥0.67。根据是否达成追赶生长分组，采用logistic逐步回归分析影响追赶生长的相关危险因素。结果 124例极早产儿中，男70（56.5%）例，胎龄为30.14（28.86~31.11）周，出生体重1 330（1 170~1 607）g，出生年龄别体重Z值0.10±0.61，校正6月龄达到追赶生长的比例为62.1%（77/124）。与未追赶组比较，追赶组出生体重、生后第7天和第14天的体重及年龄别体重、出院时年龄别体重及校正胎龄40周血碱性磷酸酶均较低（P均<0.05）；而出院时胎龄、住院天数、院外日均体重增长显著高于未追赶组（P均<0.05）。多因素回归分析发现多胎（OR=0.294，95%CI：0.088~0.982）、住院天数（OR=1.082，95% CI：1.032~1.134）、出院时年龄别体重（OR=0.385，95%CI：0.167~0.890）、院外日均体重增长（OR=1.928，95% CI：1.483~2.506）、校正胎龄40周血碱性磷酸酶（OR=0.995，95%CI：0.990~0.999）为出院至校正胎龄6个月追赶生长的独立相关因素。结论多胎、出院时年龄别体重、院外生长速率、住院天数、及校正胎龄40周血碱性磷酸酶是影响极早产儿出院后至校正6月龄追赶生长的相关因素。

关键词: 极早产儿, 追赶生长, 校正年龄

Abstract:

Objective To investigate the factors influencing weight catch-up growth in very preterm infants (VPIs) from discharge to corrected age 6 months. Methods A retrospective analysis was conducted on 124 VPIs (gestational age <32 weeks) admitted to the Department of Neonatology between August 2019 and June 2022. Catch-up growth was defined as Z-score of weight-for-age (WAZ) increase of ≥0.67 from discharge to corrected age 6 months. Infants were divided into catch-up and non-catch-up groups on this criterion. A forward stepwise logistic regression model was used to identify independent predictive factors. Results Among the 124 VPIS, there were 70 males (56.5%), with a median gestational age of 30.14 (28.86-31.11) weeks, birth weight of 1330.0 (1170-1607) g, birth WAZ of 0.10 ± 0.61, and a catch-up growth rate of 62.1% (77/124) at corrected 6 months. Compared to the non-catch-up infants, the catch-up group exhibited significantly lower birth weight, WAZ at day 7, day 14 and discharge, and serum alkaline phosphatase (ALP) at corrected 40 weeks (P<0.05), while showing longer hospital stay, greater postmenstrual age at discharge, and higher daily weight gain post-discharge (P<0.05). Multivariate regression analysis identified multiple pregnancy (OR=0.294, 95%CI: 0.088-0.982), hospital stay (OR=1.082, 95% CI: 1.032-1.134), WAZ at discharge (OR=0.385, 95%CI: 0.167-0.890), daily weight gain post-discharge (OR=1.928, 95% CI: 1.483-2.506), and ALP at corrected 40 weeks (OR=0.995, 95% CI: 0.990-0.999) as independent influencing factors for post-discharge catch-up growth. Conclusion Post-discharge weight catch-up growth in VPIs is synergistically modulated by multiple pregnancy, WAZ at discharge, growth rate post-discharge, hospital stay duration and ALP at corrected 40 weeks.

Key words: very preterm infants, catch-up growth, corrected age

中图分类号:

宦鹏, 王小玲, 高强, 罗丽娟, 董文斌, 雷小平. 影响极早产儿出院后早期追赶生长的相关因素分析[J]. 临床儿科杂志, 2025, 43(11): 816-822.

HUAN Peng, WANG Xiaoling, GAO Qiang, LUO Lijuan, DONG Wenbin, LEI Xiaoping. Risk factors of post-discharge catch-up growth in very preterm infants[J]. Journal of Clinical Pediatrics, 2025, 43(11): 816-822.

图/表 3

表1

表2

极早产儿两组院内外体重和血生化指标比较"

因素	无追赶生长组（n=47）	追赶生长组（n=77）	统计量	P
出生时体重[M(P₂₅~P₇₅)]/g	1 490(1 240~1 670)	1 270(1 125~1 490)	Z=2.79	0.006
出生时WAZ($\bar{x}±s$)	0.21±0.60	0.04±0.61	t=1.54	0.125
生后第7天体重[M(P₂₅~P₇₅)]/g	1 500(1 270~1 720)	1 300(1 160~1 615)	Z=2.63	0.009
生后第7天WAZ($\bar{x}±s$)	0.30±0.60	0.04±0.63	t=2.19	0.030
生后第14天体重[M(P₂₅~P₇₅)]/g	1 710(1 570~1 900)	1 510(1 300~1 770)	Z=2.96	0.003
生后第14天WAZ($\bar{x}±s$)	0.85±0.94	0.46±0.76	t=2.46	0.015
出院时体重[M(P₂₅~P₇₅)]/g	2 200(2 040~2 400)	2 150(2 010~2 300)	Z=1.22	0.222
出院时WAZ($\bar{x}±s$)	-0.61±0.644	-1.09±0.77	t=1.46	<0.001
院外日均体重增长[M(P₂₅~P₇₅)]/g·kg^－1·d^－1	11.63(10.16~13.13)	14.71(12.76~17.19)	Z=5.77	<0.001
住院天数($\bar{x}±s$)/d	35.57±12.62	42.56±14.86	t=2.68	0.008
出生时胎龄[M(P₂₅~P₇₅)]/周	30.6(29.3~31.3)	29.9(28.7~31.0)	Z=1.59	0.111
出院时胎龄($\bar{x}±s$)/周	35.3±1.4	35.9±1.6	t=2.06	0.042
禁食天数[M(P₂₅~P₇₅)]/d	1.00(1.00~4.00)	1.00(1.00~4.00)	Z=0.42	0.671
开奶时间[M(P₂₅~P₇₅)]/d	1.0(1.0~2.0)	1.0(1.0~2.0)	Z=0.16	0.871
恢复出生体重时间[M(P₂₅~P₇₅)]/d	5.00(2.00~8.00)	5.00(2.00~8.00)	Z=0.09	0.932
生后1周内血生化指标
前白蛋白[M(P₂₅~P₇₅)]/mg·L^－1	101(86~114)	101(89~113)	Z=0.04	0.966
总蛋白[M(P₂₅~P₇₅)]/g·L^－1	42.50(39.20~47.10)	44.30(41.10~47.20)	Z=0.84	0.403
白蛋白[M(P₂₅~P₇₅)]/g·L^－1	30.10(28.20~32.70)	30.70(28.90~33.05)	Z=0.70	0.482
血碱性磷酸酶[M(P₂₅~P₇₅)]/U·L^－1	214.80(177.30~264.10)	211.90(163.60~269.70)	Z=0.63	0.531
血磷($\bar{x}±s$)/mmol·L^－1	1.91±0.41	1.95±0.40	t=0.39	0.694
尿素[M(P₂₅~P₇₅)]/mmol·L^－1	3.91(2.71~6.55)	3.82(2.94~7.37)	Z=0.44	0.662
肌酐[M(P₂₅~P₇₅)]/μmol·L^－1	48.00(41.10~61.60)	49.70(42.50~61.60)	Z=0.73	0.463
总胆汁酸[M(P₂₅~P₇₅)]/μmol·L^－1	9.20(6.60~13.48)	10.50(6.50~15.75)	Z=0.98	0.327
校正胎龄40周血生化
前白蛋白($\bar{x}±s$)/mg·L^－1	125.75±28.72	121.61±30.59	t=0.62	0.538
总蛋白[M(P₂₅~P₇₅)]/g·L^－1	50.75(47.43~53.65)	48.75(43.15~52.60)	Z=1.36	0.173
白蛋白[M(P₂₅~P₇₅)]/g·L^－1	38.7(34.60~40.35)	37.95(34.50~39.65)	Z=0.63	0.526
血碱性磷酸酶[M(P₂₅~P₇₅)]/U·L^－1	374.80(293.10~442.60)	289.80(244.80~423.45)	Z=2.43	0.015
血磷[M(P₂₅~P₇₅)]/mmol·L^－1	2.03(1.91~5.20)	2.07(1.87~2.23)	Z=1.23	0.220
尿素[M(P₂₅~P₇₅)]/mmol·L^－1	4.02(2.79~4.57)	3.66(2.80~4.47)	Z=1.04	0.297
肌酐($\bar{x}±s$)/μmol·L^－1	17.86±4.58	16.65±4.03	t=1.24	0.220
总胆汁酸[M(P₂₅~P₇₅)]/μmol·L^－1	10.00(4.68~14.93)	8.05(4.38~20.53)	Z=0.26	0.797

表2

表3

参考文献 32

[1]	Liang X, Lyu Y, Li J, et al. Global, regional, and national burden of preterm birth, 1990-2021: a systematic analysis from the global burden of disease study 2021[J]. EClinicalMedicine, 2024, 76: 102840.
[2]	张沂洁, 朱燕, 陈超. 早产儿发生率及变化趋势[J]. 中华新生儿科杂志, 2021, 36(4): 74-77.
	Zhang YJ, Zhu Y, Chen C. Incidence and Trend of Premature Infants[J]. Zhonghua Xinshengerke Zazhi, 2021, 36(4): 74-77.
[3]	Van Goudoever JB, Carnielli V, Darmaun D, et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: amino acids[J]. Clini Nutr, 2018, 37(6): 2315-2323.
[4]	Gounaris AK, Sokou R, Gounari EA, et al. Extrauterine growth restriction and optimal growth of very preterm neonates: state of the art[J]. Nutrients, 2023, 15(14): 3231.
[5]	Gerritsen L, Lindeboom R, Hummel T. Prescribed protein intake does not meet recommended intake in moderate- and late-preterm infants: contribution to weight gain and head growth[J]. Nutr Clin Pract, 2020, 35(4): 729-737. doi: 10.1002/ncp.10464 pmid: 32125013
[6]	《中华儿科杂志》编辑委员会, 中华医学会儿科学分会儿童保健学组, 中华医学会儿科学分会新生儿学组. 早产/低出生体重儿出院后喂养建议[J]. 中华儿科杂志, 2016, 54(1): 6-12.
	The Editorial Board, Chinese Journal of Pediatrics, Chinese Journal of Pediatrics, The Editorial Board, The Subspecialty Group of Neonatology, the Society of Pediatrics, Chinese Medical Association. Feeding recommendations for premature and low birth weight infants after discharge[J]. Zhonghua Erke Zazhi, 2016, 54(1): 6-12.
[7]	中国医师协会新生儿科医师分会营养专业委员会, 中国医师协会新生儿科医师分会早产儿专业委员会,《中国当代儿科杂志》编辑委员会. 新生儿肠外营养管理专家共识(2025)[J]. 中国当代儿科杂志, 2025, 27(03):247-261.
	Nutritional Committee of Neonatology Branch of Chinese Medical Doctor Association, Preterm Committee of Neonatology Branch of Chinese Medical Doctor Association, Editorial Committee of Chinese Journal of Contemporary Pediatrics. Expert consensus on parenteral nutrition management in neonates (2025)[J]. Zhongguo Dangdai Erke Zazhi, 2025, 27(3): 247-261.
[8]	山东省多中心极低出生体重儿预后评估协作组. 极低出生体重儿宫外生长发育迟缓危险因素的多中心研究[J]. 中华儿科杂志, 2020, 58(8): 653-660.
	Multicenter Study Collaborative Group for Evaluation of Outcomes in Very Low Birth Weight Infants. Risk factors for extrauterine growth retardation in very low birth weight infants: a multicenter study[J]. Zhonghua Erke Zazhi, 2020, 58(8): 653-660.
[9]	吕岩玉, 曹云, 陈彦香, 等. 新生儿重症监护病房极早产儿宫外生长受限状况调查[J]. 中华儿科杂志, 2023, 61(09): 811-819.
	Lyu YY, Cao Y, Chen YX, et al. Investigation of extrauterine growth restriction in very preterm infants in Chinese neonatal intensive care units[J/OL]. Zhonghua Erke Zazhi, 2023, 61(9): 811-819.
[10]	熊菲, 毛萌. 早产儿生后体格生长评价[J]. 中华儿科杂志, 2019, 57(4): 756-758.
	Xiong F, Mao M. Evaluation of postnatal physical growth of premature infants[J]. Zhonghua Erke Zazhi, 2019, 57(4): 756-758.
[11]	Azhar M, Yasin R, Hanif S, et al. Nutritional management of low birth weight and preterm infants in low- and low middle-income countries[J]. Neonatol, 2025, 122(Suppl 1): 209-223.
[12]	Lan S, Fu H, Zhang R, et al. Extrauterine growth restriction in preterm infants: postnatal growth pattern and physical development outcomes at age 3-6 years[J]. Front Pediatr, 2022, 10: 945422.
[13]	高晓燕, 冯琳, 许靖. 早产儿出院后追赶生长的随访观察及宫外发育迟缓的影响因素[J]. 中国当代儿科杂志, 2018, 20(6): 438-443.
	Gao XY, Feng L, Xu J, et al. Follow-up observation of catch-up growth of preterm infants after discharge and risk factors for extrauterine growth retardation[J]. Zhongguo Dangdai Erke Zazhi, 2018, 20(6): 438-443.
[14]	Maheshwari A, Bagga N, Panigrahi N, et al. Extrauterine growth restriction: need for an accurate definition[J]. Newborn, 2023, 2(3): 198-202.
[15]	Shrikant KN, Gracy NB, Pournami F, et al. Reducing extrauterine growth restriction in very preterm neonates: a before-after intervention study[J]. Nutr Clin Pract. 2024, 39(5): 1239-1246. doi: 10.1002/ncp.11165 pmid: 38837805
[16]	蓝思源, 洪莉. 早产儿宫外生长发育迟缓的研究进展[J]. 国际儿科学杂志, 2022, 49(03): 149-153.
	Lan SY, Hong L. Progress on extrauterine growth restriction in preterm infants[J]. Guoji Erkexue Zazhi, 2022, 49(3): 149-153.
[17]	Batista RFL, Silva AAM, Barbieri MA, et al. Factors associated with height catch-up and catch-down growth among schoolchildren[J]. PloS One, 2012, 7(3): e32903.
[18]	Chou JH, Roumiantsev S, Singh R. PediTools electronic growth chart calculators: applications in clinical care, research, and quality improvement[J]. Medi Inter Res, 2020, 22(1): e16204.
[19]	Investigators of The Delhi Neonatal Infection Study (Denis) Collaboration. Characterisation and antimicrobial resistance of sepsis pathogens in neonates born in tertiary care centres in Delhi, India: a cohort study[J]. Lancet Global Health, 2016, 4(10): e752-e760.
[20]	Thébaud B, Goss K N, Laughon M, et al. Bronchopulmonary dysplasia[J]. Nat Revi. Dis Prim, 2019, 5(1): 78.
[21]	乔杰. 人工智能与辅助生殖[J]. 中华生殖与避孕杂志, 2025, 45(1): 1-4.
	Qiao J. Artificial intelligence and assisted reproductive technology[J]. Zhonghua Shengzhi Yu Biyun Zazhi, 2025, 45(1): 1-4.
[22]	曹云. 极早/超早产儿救治及预后:从提高存活率到关注生存质量[J]. 中华围产医学杂志, 2018, 21(6): 367-375.
	Cao Y. Treatment and outcome of very/extremely preterm infants:from survival rate increse to living quality improvement[J]. Zhonghua Weichan Yixue Zazhi, 2018, 21(6): 367-375.
[23]	González-López C, Solís-Sánchez G, Lareu-Vidal S, et al. Variability in definitions and criteria of extrauterine growth restriction and its association with neurodevelopmental outcomes in preterm infants: a narrative review[J]. Nutrients, 2024, 16(7): 968.
[24]	Ordóñez-Díaz MD, Pérez-Navero JL, Flores-Rojas K, et al. Prematurity with extrauterine growth restriction increases the risk of higher levels of glucose, low-grade of inflammation and hypertension in prepubertal children[J]. Front Pediatr, 2020, 8: 180. doi: 10.3389/fped.2020.00180 pmid: 32373566
[25]	Ong KK. Catch-up growth in small for gestational age babies: good or bad?[J]. Curr Opin Endocrinol Diabets Obes, 2007, 14(1): 30-34.
[26]	单春荣, 冯琪, 王颖, 等. 小于胎龄早产儿早期追赶生长状况及其影响因素[J]. 中华新生儿科杂志(中英文), 2018, 33(3): 175-181.
	Shan CR, Feng Q, Wang Y, et al. Early catch-up growth status and its influencing factors in small for gestational age preterm infants[J]. Zhonghua Xinshengerke Zazhi, 2018, 33(3): 175-181.
[27]	Yazici A, Buyuktiryaki M, Sari FN, et al. Comparison of different growth curves in the assessment of extrauterine growth restriction in very low birth weight preterm infants[J]. Arch Pediatr, 2023, 30(1): 31-35.
[28]	吴琦, 朱奕名, 孙小凡, 等. 出生体重<1 500 g极早产儿宫外发育迟缓危险因素分析[J]. 中华新生儿科杂志, 2023, 38(3):141-145.
	Wu Q, Zhu YM, Sun XF, et al. Risk factors of extrauterine growth retardation in very preterm infants with birth weight less than 1 500 g.[J]. Zhonghua Xinshengerke Zazhi, 2023, 38(3): 141-145.
[29]	Zhang H, Jia Q, Piao M, et al. Screening of serum alkaline phosphatase and phosphate helps early detection of metabolic bone disease in extremely low birth weight infants[J]. Front Pediatr, 2021, 23(8): 1-8.
[30]	Liu X, Wang L, Qian M. Analysis of clinical risk factors for metabolic bone disease of prematurity[J]. Front Pediatr, 2024, 12: 1345878.
[31]	常艳美, 林新祝, 张蓉, 等. 早产儿代谢性骨病临床管理专家共识(2021)[J]. 中国当代儿科杂志, 2021, 23(8): 761-772.
	Chang YM, Lin XZ, Zhang R, et al. Expert consensus on clinical management of metabolic bone disease of prematurity (2021)[J]. Zhongguo Dangdai Erke Zazhi, 2021, 23(8): 761-772.
[32]	Perrone M, Casirati A, Stagi S, et al. Don't forget the bones: incidence and risk factors of metabolic bone disease in a cohort of preterm infants[J]. Int J Mol Sci, 2022, 23(18): 10666.

一般资料	总例数（n=124）	无追赶生长组（n=47）	追赶生长组（n=77）	χ²值	P
剖宫产	75(60.5)	30(63.8)	45(58.4)	0.36	0.552
前置胎盘	11(8.9)	2(4.3)	9(11.7)	1.18	0.277
产前类固醇	115(92.7)	42(89.4)	73(94.8)	0.60	0.437
妊娠高血压	14(11.3)	7(14.9)	7(9.1)	0.98	0.322
妊娠糖尿病	45(36.3)	21(44.7)	24(31.2)	2.31	0.068
辅助生殖	48(38.7)	23(48.9)	25(32.5)	3.34	0.477
胎膜早破	37(29.8)	10(21.3)	27(35.1)	2.65	0.104
妊娠胆汁淤积	5(4.0)	3(6.4)	2(2.6)	0.32	0.569
妊娠合并甲状腺功能异常	16(12.9)	9(19.1)	7(9.1)	2.63	0.105
绒毛膜羊膜炎	55(44.4)	19(40.4)	36(46.8)	0.47	0.491
多胎	40(32.3)	20(42.6)	20(26.0)	3.67	0.055
男性	70(56.5)	30(63.8)	40(51.9)	1.68	0.195
小于胎龄儿	6(4.8)	1(2.1)	5(6.5)	0.45	0.504
5分钟Apgar<7分	8(6.5)	0(0.0)	8(10.4)	-	0.024^1）
低血糖	23(18.5)	12(25.5)	11(14.3)	2.44	0.118
有创机械通气	38(30.6)	13(27.7)	25(32.5)	0.32	0.573
败血症	67(54.0)	22(46.8）	45（58.4）	1.59	0.207
坏死性小肠结肠炎	7(5.6)	5(10.6)	2(2.6)	2.19	0.139
颅内出血	19(15.3)	7(14.9)	12(15.6)	0.01	0.917
支气管肺发育不良	41(33.1)	11(23.4)	30(39.0)	3.19	0.074
出院时宫外生长发育迟缓	64(51.6)	19(40.4)	45(58.4)	3.79	0.051
校正胎龄40周强化营养喂养	100(85.5)	36(83.7)	64(86.5)	0.68	0.787
校正6月龄强化营养喂养	93(75.0)	37(78.7)	56(72.7)	0.56	0.454
居住农村	48(38.7)	20(42.6)	28(36.4)	0.47	0.492

因素	β值	标准误差	χ²值	OR值	95%CI	P
多胎	－1.224	0.615	3.956	0.294	0.088~0.982	0.047
住院天数	0.079	0.024	10.599	1.082	1.032~1.134	0.001
出院时WAZ	－0.954	0.427	4.985	0.385	0.167~0.890	0.026
院外日均体重增长速度	0.656	0.134	24.041	1.928	1.483~2.506	<0.001
校正胎龄40周ALP	－0.005	0.002	4.839	0.995	0.990~0.999	0.028

影响极早产儿出院后早期追赶生长的相关因素分析

Risk factors of post-discharge catch-up growth in very preterm infants

RichHTML

PDF (PC)

赞

可视化

摘要/Abstract

引用本文

使用本文

图/表 3

参考文献 32

相关文章 4

Metrics

本文评价

推荐阅读 0

[1]	毛萌, 邵洁, 陈津津, 沈理笑. 《生长减缓婴幼儿的追赶生长：指导临床医师的专家建议》解读[J]. 临床儿科杂志, 2024, 42(5): 390-398.
[2]	许景林, 李华梅, 傅春燕, 王赫, 陈冬梅. 极早产儿生后1个月肠道菌群的动态变化及分布特征[J]. 临床儿科杂志, 2024, 42(4): 311-317.
[3]	王丽平, 尤优, 殷张华, 王依闻, 陈笋, 夏红萍. 支气管肺发育不良极早产儿合并肺静脉狭窄2例报告[J]. 临床儿科杂志, 2023, 41(4): 289-293.
[4]	位乐乐, 宋娟, 董会敏, 决珍珍, 李文冬, 徐发林, 王军. 极早产儿输血相关性坏死性小肠结肠炎危险因素分析[J]. 临床儿科杂志, 2022, 40(9): 666-671.