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

Abstract

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

CLC Number:

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.

Figures/Tables 3

Table 1

Table 2

Comparison of weight and blood biochemical indicators between the two groups"

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

Table 2

Table 3

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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

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

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