本文選題：早產(chǎn)兒 + 體格發(fā)育��； 參考：《南方醫(yī)科大學(xué)》2014年碩士論文

【摘要】：[研究背景] 隨著現(xiàn)代醫(yī)學(xué)的迅速發(fā)展,我國(guó)早產(chǎn)兒的成活率和治愈率顯著提高,早產(chǎn)兒出院后更多的挑戰(zhàn)也隨之而來(lái)：胎齡小、出生體重低的早產(chǎn)兒由于其解剖生理特點(diǎn),各系統(tǒng)器官功能發(fā)育不成熟,生活能力低下,易發(fā)生各種并發(fā)癥及營(yíng)養(yǎng)不良等問(wèn)題。一歲內(nèi)是兒童生長(zhǎng)發(fā)育最快的時(shí)期,也是早產(chǎn)兒追趕性生長(zhǎng)的關(guān)鍵期,研究表明早產(chǎn)兒嬰兒期的生長(zhǎng)發(fā)育是其成年后身體健康與疾病的重要影響因素。對(duì)出院后的早產(chǎn)兒進(jìn)行干預(yù)能提高早產(chǎn)兒學(xué)齡期的智力分?jǐn)?shù),減輕養(yǎng)育人的心理壓力,減少營(yíng)養(yǎng)不良與死亡率的發(fā)生,減少早產(chǎn)兒成年后的行為問(wèn)題：提高早產(chǎn)兒及其家庭的生活質(zhì)量。為此,衛(wèi)生部組織了17家醫(yī)療單位,開(kāi)展“早產(chǎn)(兒)干預(yù)研究項(xiàng)目”,制定了“早產(chǎn)兒保健服務(wù)指南”,指南強(qiáng)調(diào)管理的日標(biāo)應(yīng)當(dāng)基于不同出生體重和不同年齡階段,營(yíng)養(yǎng)策略應(yīng)隨不同體重標(biāo)準(zhǔn)、年齡段不同而不同,早產(chǎn)兒干預(yù)應(yīng)講求“個(gè)體化”,出院后的隨訪與干預(yù)內(nèi)容包括神經(jīng)、體格發(fā)育監(jiān)測(cè),早期發(fā)現(xiàn)生長(zhǎng)發(fā)育相關(guān)問(wèn)題,防治營(yíng)養(yǎng)不良,糾正營(yíng)養(yǎng)性疾病等。按照以上原則,2012年3月到2013年12月期問(wèn),我們對(duì)本院出生的272名早產(chǎn)兒進(jìn)行了累計(jì)1243次監(jiān)測(cè)隨訪,探討早產(chǎn)兒整體和“個(gè)體化”的營(yíng)養(yǎng)狀況與生長(zhǎng)發(fā)育規(guī)律。 [目的和意義] 為了解早產(chǎn)兒生長(zhǎng)發(fā)育特點(diǎn),探討不同出生胎齡及不同出生體重早產(chǎn)兒體格生長(zhǎng)規(guī)律、營(yíng)養(yǎng)狀況及其影響因素,分析其中關(guān)系。 防法] 1.研究對(duì)象 選擇2012年3月～2013年10月在深圳市婦幼保健院出生且愿意在兒童保健科隨訪的早產(chǎn)兒,經(jīng)口喂養(yǎng)順利,調(diào)查前2周內(nèi)無(wú)喂養(yǎng)不耐受、無(wú)肺炎、腹瀉等疾病情況,長(zhǎng)期深圳市居住,口頭知情同意時(shí)接受調(diào)查者。排除患有嚴(yán)重影響生長(zhǎng)發(fā)育的疾病或不接受調(diào)查的早產(chǎn)兒。共納入272名早產(chǎn)兒,出生胎齡(32.90±2.43)周,出生體重(1.93±0.49)kg,男嬰153人,女?huà)?19人。其中雙胎41對(duì)(82人)；73名SGA早產(chǎn)兒；60名極低出生體重兒。共計(jì)1243次隨訪記錄。 2.分組 ①根據(jù)出生胎齡分為二組,晚期早產(chǎn)兒(34周≤出生胎齡37周,Late preterm infant, LPI)和早期早產(chǎn)兒(出生胎齡34周,Early preterm infant, EPI); EPI148人,出生胎齡(31.17±1.93)周,出生體重(1.66±0.41)kg; LPI124人,出生胎齡(35.00±0.84)周,出生體重(2.25±0.39)kg。 ②根據(jù)出生體重分三組,分為極低出生體重兒(出生體重1000g～1499g,Very low birth weight, VLBW),低出生體重兒(1500g出生體重2499g, Low birth weight, LBW),正常出生體重兒(出生體重≥2500g,Normal birth weight, NBW); VLBW60人,出生胎齡(30.03±2.48)周,出生體重(1.23±0.16)Kg；LBW178人,出生胎齡(33.44±1.87)周,出生體重(1.99±0.27) kg; NBW34人,出生胎齡(34.69±1.18)周,出生體重(2.75±0.20)kg。 ③根據(jù)早產(chǎn)兒喂養(yǎng)的乳品量占總奶量的比例分為三組：母乳組[母乳占一日奶量的75%以上(不包含用母乳強(qiáng)化劑的8例)]；普奶組(普通配方奶占一日總奶量的75%以上)；早奶組[早產(chǎn)兒(出院后)配方奶占一日總奶量的75%以上]。母乳組54人,出生胎齡(33.34+2.18)周,出生體重(2.04±0.55)kg；早奶組61人,出生胎齡(31.41±2.38)周,出生體重(1.75±0.44)kg；普奶組有61人,出生胎齡(33.79±2.15)周,出生體重(2.06±0.47)kg。早奶組出生胎齡、出生體重小于母乳組和普奶組(P0.01)。 各組早產(chǎn)兒在各矯正月齡身長(zhǎng)、體重、頭圍、BMI、LAZ、BMIZ、WAZ、 WLZ、HCZ例數(shù)相同。以上三種分組方法中各組內(nèi)評(píng)估時(shí)月齡、性別比例差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.1) 3.分析及觀察指標(biāo) ①體格發(fā)育指標(biāo)：早產(chǎn)兒身長(zhǎng)及其Z值,體重及其Z值,頭圍及其Z值,身體質(zhì)量指數(shù)及其Z值；身長(zhǎng)、體重、頭圍增長(zhǎng)速率； ②血液指標(biāo)：末梢血血紅蛋白值、微量元素銅、鋅、鈣、鎂、鐵及血鉛； ③膳食分析指標(biāo)：攝入膳食中的能量、蛋白質(zhì)、碳水化合物、脂肪、元素鐵、鈣、鋅； ④營(yíng)養(yǎng)評(píng)價(jià)指標(biāo)：體重、身長(zhǎng)、頭圍EUGR發(fā)生率,低體重、生長(zhǎng)遲緩、消瘦、超重、頭圍小于2個(gè)標(biāo)準(zhǔn)差發(fā)生率。 4.膳食調(diào)查 抽取600人次早產(chǎn)兒進(jìn)行膳食調(diào)查,分為兩組：①矯正胎齡0月～6月早產(chǎn)兒組：300人次：采用24小時(shí)回顧性膳食調(diào)查法。矯正月齡0-6月：300人次：采用三天食物記錄法。剔除比基礎(chǔ)消耗能量更少的數(shù)據(jù)后,得到矯正胎齡0-6月早產(chǎn)兒(出生胎齡33.97±4.50周,出生體重2.00±0.51kg)282人次；矯正月齡6月～1歲(出生胎齡31.92±6.46周,出生體重1.83-0.51kg)80人次。計(jì)算每天攝入的能量、蛋白質(zhì)、脂肪、碳水化合物、元素鐵、鋅、鈣值。 5.隨訪 矯正月齡6月內(nèi)每月隨訪1次,矯正月齡6月后每2月隨訪1次。記錄早產(chǎn)兒隨訪時(shí)的體格測(cè)量結(jié)果,收集早產(chǎn)兒出生時(shí)情況、既往史、家庭史、出院診斷等相關(guān)資料；干預(yù)內(nèi)容包括體格監(jiān)測(cè)、營(yíng)養(yǎng)評(píng)估與指導(dǎo),預(yù)防性用藥。對(duì)早產(chǎn)兒矯正月齡0～2月、3月、6月、12月測(cè)量末梢血血常規(guī),矯正月齡6月、12月測(cè)量末梢血微量元素。 6.統(tǒng)計(jì)學(xué)分析 用Epidata3.1錄入,建立數(shù)據(jù)庫(kù)。用SPSS13.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。首先進(jìn)行正態(tài)性和方差齊性檢驗(yàn),符合方差齊性的正態(tài)分布資料兩組均數(shù)比較采用t檢驗(yàn),多組數(shù)據(jù)比較之間用方差分析,兩兩比較用SNK方法；不符合正態(tài)分布的數(shù)據(jù)經(jīng)對(duì)數(shù)轉(zhuǎn)換后用參數(shù)分析,若仍不符合的用非參數(shù)檢驗(yàn)。發(fā)生率比較采用卡方檢驗(yàn)和fisher確切概率法檢驗(yàn)。logistic回歸、多元線性回歸分析分析數(shù)據(jù)相關(guān)性。營(yíng)養(yǎng)素的計(jì)算在SPSS里用compute程序?qū)崿F(xiàn)。 [結(jié)果] 1.身長(zhǎng)生長(zhǎng)規(guī)律 矯正月齡1歲內(nèi)早產(chǎn)兒身長(zhǎng)生長(zhǎng)趨勢(shì)與正常足月兒相似,身長(zhǎng)50%生長(zhǎng)曲線較WHO足月兒50%標(biāo)準(zhǔn)生長(zhǎng)曲線左移。自矯正胎齡40周起,每個(gè)矯正月齡早產(chǎn)兒的LAZ均值均大于0.2,在矯正月齡2月達(dá)到高峰。 不同出生胎齡早產(chǎn)兒分析結(jié)果顯示,矯正胎齡40周、矯正月齡2月,EPI的LAZ均值小于LPI,而在矯正月齡8～12月,EPI的LAZ均值大于LPI(P0.05)。EPI和LPI的LAZ高峰分別在矯正月齡10月、2月。 不同出生體重早產(chǎn)兒分析結(jié)果顯示,在矯正月齡0-5月、8月,VLBW的LAZ比LBW、NBW的均小(P0.01)。LBW的LAZ峰在矯正月齡2月,VLBW的LAZ高峰在矯正月齡10月。 2.體重生長(zhǎng)規(guī)律 矯正月齡1歲內(nèi)早產(chǎn)兒體重生長(zhǎng)趨勢(shì)與正常足月兒相似,早產(chǎn)兒體重50%生長(zhǎng)曲線較WHO足月兒50%標(biāo)準(zhǔn)生長(zhǎng)曲線左移。早產(chǎn)兒每個(gè)矯正月齡段的WAZ值均值均大于0,WAZ高峰在矯正月齡2月。 不同出生胎齡早產(chǎn)兒分析結(jié)果顯示,在矯正月齡2、3、5月,EPI的WAZ均值小于LPI(P0.05)；EPI的WAZ高峰在矯正月齡6月,LPI的WAZ高峰在矯正月齡2月。 不同出生體重早產(chǎn)兒分析結(jié)果顯示,矯正胎齡40周,矯正月齡2～5月,VLBW的WAZ小于LBW、NBW(P0.05):矯正月齡2～5月、8月,LBW的WAZ值小于NBW(P0.05):LBW的WAZ高峰在矯正月齡2月,VLBW的LAZ高峰在矯正月齡10月。 3.頭圍生長(zhǎng)規(guī)律 早產(chǎn)兒頭圍生長(zhǎng)趨勢(shì)與足月兒相似。HCZ高峰值在矯正胎齡40周,除矯正胎齡40周外,每月Z值均值都在0以下。 不同出生胎齡早產(chǎn)兒分析結(jié)果顯示,在矯正月齡2月、3月,EPI的HCZ均值小于LPI,在矯正月齡10～12月,EPI的HCZ高于LPI(P0.05)。EPI的HCZ高峰在矯正月齡10月,LPI的HCZ高峰在矯正月齡2月。 不同出生體重早產(chǎn)兒分析結(jié)果顯示,在矯正胎齡40周、矯正月齡2～5月,VLBW的HCZ小于NBW早產(chǎn)兒(P0.05)；矯正胎齡40周、矯正月齡2～3月、5月,VLBW的HCZ值小于LBW早產(chǎn)兒(P0.05)。VLBW的HCZ高峰在矯正胎齡10月,LBW的HCZ高峰在矯正胎齡40周。 4.BMI規(guī)律 各矯正月齡早產(chǎn)兒BMI生長(zhǎng)趨勢(shì)與足月兒基本相似。BMI50%曲線較WHO足月兒50%標(biāo)準(zhǔn)生長(zhǎng)曲線左移。BMIZ在矯正月齡2月達(dá)高峰。 不同出生胎齡早產(chǎn)兒分析結(jié)果顯示,在矯正月齡2、3、5月,EPI的BMIZ均值低于LPI(P0.05)。LPI的BMIZ高峰值出現(xiàn)在矯正月齡3月,EPI的BMIZ高峰值在矯正月齡1月。 不同出生體重早產(chǎn)兒分析結(jié)果顯示,在矯正月齡2月～5月、8月,VLBW和LBW的BMIZ殖均小于NBW(P0.05)。VLBW的BMIZ高峰在矯正月齡1月,LBW的BMIZ高峰在矯正月齡2月。其他矯正月齡各組WAZ、LAZ、HCZ、BMIZ比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 5.EUGR情況及影響因素 272例早產(chǎn)兒體重EUGR發(fā)生率26.5%；身長(zhǎng)EUGR發(fā)生率12.1%；頭圍EUGR發(fā)生率7.1%。其中EPI的體重EUGR發(fā)生率為29.73%,明顯高于LPI的16.13%(P0.01)；VLBW早產(chǎn)兒的體重EUGR發(fā)生率58.33%、身長(zhǎng)EUGR發(fā)生率31.67%高于LBW早產(chǎn)兒的體重EUGR發(fā)生率16.38%與身長(zhǎng)EUGR發(fā)生率7.34%(P0.05)；SGA早產(chǎn)兒的體重EUGR發(fā)生率43.84%、身長(zhǎng)EUGR發(fā)生率27.40%高于AGA早產(chǎn)兒的18.59%、6.53%(P0.001)。身長(zhǎng)EUGR危險(xiǎn)因素：出生身長(zhǎng)、身長(zhǎng)增長(zhǎng)速率、是否是SGA；體重EUGR的危險(xiǎn)因素：出生體重,生長(zhǎng)速度,是否是SGA；頭圍EUGR的危險(xiǎn)因素:頭圍增長(zhǎng)速率、出生身長(zhǎng)(P0.05)。 6.營(yíng)養(yǎng)狀況 272名早產(chǎn)兒中有154名測(cè)量血常規(guī),95名兒童測(cè)量微量元素.貧血發(fā)生率為16.88%,鋅缺乏癥發(fā)生率為88.42%,鐵缺乏癥發(fā)生率為24.21%。微量元素銅、鈣、鎂和血鉛都在正常范圍。 7.攝入膳食情況及對(duì)體格發(fā)育影響 矯正月齡6月～矯正月齡12月早產(chǎn)兒攝入能量、蛋白質(zhì)、碳水化合物、鈣、鐵、鋅均比矯正月齡0～6月早產(chǎn)兒攝入多(P0.05)。矯正月齡0～6月早產(chǎn)兒攝入能量／體重、蛋白質(zhì)/體重比較矯正月齡6月～矯正月齡12月早產(chǎn)兒較多。矯正月齡0-6月早產(chǎn)兒攝入能量、脂肪、蛋白質(zhì)、元素鐵、鋅、鈣均超過(guò)我國(guó)居民膳食營(yíng)養(yǎng)素參考攝入標(biāo)準(zhǔn)(P0.01),矯正月齡6月～矯正月齡12月早產(chǎn)兒攝入能量、元素鐵、鋅、鈣均未達(dá)到參考攝入量(P0.01)。母乳組、早奶組、普奶組三組EUGR發(fā)生率差異無(wú)統(tǒng)計(jì)學(xué)意義,由出生體重、頭圍矯正后早奶組評(píng)估時(shí)體重、頭圍高于母乳組(P0.05)。VLBW早產(chǎn)兒中母乳組早產(chǎn)兒EUGI發(fā)生率85.7%高于早奶組的40%。 [結(jié)論] 本研究中早產(chǎn)兒整體在1歲內(nèi)完成追趕性生長(zhǎng)；干預(yù)后早產(chǎn)兒生長(zhǎng)趨勢(shì)與正常足月兒相似；矯正胎齡2月左右是追趕性生長(zhǎng)的關(guān)鍵期。EPI身長(zhǎng)、頭圍、體重在矯正月齡6月齡后趕上LPI。VLBW身長(zhǎng)、體重、頭圍追趕性生長(zhǎng)較困難。早產(chǎn)兒貧血,鋅、鐵缺乏癥發(fā)生率較高。強(qiáng)化營(yíng)養(yǎng)對(duì)早產(chǎn)兒的體格發(fā)育有積極促進(jìn)作用。VLBW、生長(zhǎng)速率慢、SGA等早產(chǎn)兒要加強(qiáng)管理,積極強(qiáng)化營(yíng)養(yǎng)。積極營(yíng)養(yǎng)強(qiáng)化的同時(shí),要全面評(píng)估早產(chǎn)兒的出生、住院情況,合理考慮早產(chǎn)兒的喂養(yǎng)耐受性,科學(xué)選擇設(shè)計(jì)強(qiáng)化方案。
[Abstract]:[research background]
With the rapid development of modern medicine, the survival rate and cure rate of preterm infants in our country have been greatly improved, and the more challenges of premature infants after discharge are followed: the premature infants with low birth weight and low birth weight are immature because of their anatomical and physiological characteristics, the function of each organ is immature, the living ability is low, and various complications and malnutrition are prone to occur. One year old is the fastest growing period of children's growth and development, and it is also the key period for the chasing growth of preterm infants. The study shows that the growth and development of preterm infants are the important factors affecting the health and disease of the children after their adulthood. Psychological pressure, reducing the occurrence of malnutrition and mortality, reducing the behavior problems of prematurity children: improving the quality of life of premature infants and their families. To this end, the Ministry of health organized 17 medical units, carried out the "premature birth (children) intervention research project", formulated the "preterm infant health care service guide", the guide stressed that the daily standard of management should be emphasized. Based on different birth weight and different age stages, nutritional strategies should vary with different weight standards and age groups. The intervention of premature infants should be "individualized". Follow-up and intervention after discharge include nerve, physical development monitoring, early discovery of growth and development related problems, prevention and treatment of malnutrition, and correction of nutritional diseases. According to the above principles, from March 2012 to December 2013, we conducted a total of 1243 follow-up visits to 272 preterm infants born in our hospital to explore the overall and "individualized" nutritional status and growth and development of preterm infants.
[purpose and significance]
In order to understand the growth and development characteristics of preterm infants, the physical growth regularity, nutritional status and influencing factors of premature infants with different birth gestational age and different birth weight were discussed, and the relationship between them was analyzed.
Anti Law]
1. research objects
The premature infants who were born in Shenzhen maternal and child health care hospital from March 2012 to October 2013 and were willing to be followed up in the children health care department were fed smoothly through oral feeding. There was no feeding intolerance, no pneumonia, diarrhea and other diseases within the first 2 weeks of the investigation. The long-term Shenzhen city lived and the oral and informed consent was received by the investigators. A total of 272 preterm infants, birth gestational age (32.90 + 2.43) weeks, birth weight (1.93 + 0.49) kg, 153 male baby and 119 baby, 41 pairs of twins (82 people), 73 SGA preterm infants and 60 very low birth weight infants. Total follow-up records were included in the follow-up.
2. grouping
(1) according to the birth gestational age, it is divided into two groups: Advanced preterm infants (34 weeks less than birth gestational age 37 weeks, Late preterm infant, LPI) and early preterm infants (34 weeks of birth gestational age, Early preterm infant, EPI); EPI148, birth gestational age (31.17 + 1.93) weeks, birth weight (1.66 + 0.41) kg; LPI124 people, birth gestational age (35 + 0.84) weeks, birth weight (2.25 + 0.39) kg.
(2) according to the birth weight of three groups, divided into very low birth weight infants (birth weight 1000g to 1499g, Very low birth weight, VLBW), low birth weight infants (1500g birth weight 2499g, Low birth weight), normal birth weight infants (birth weight > 2.48) weeks, birth body age (30.03 + 2.48) weeks, birth body Heavy (1.23 + 0.16) Kg; LBW178 people, birth gestational age (33.44 + 1.87) weeks, birth weight (1.99 + 0.27) kg; NBW34 people, birth gestational age (34.69 + 1.18) weeks, birth weight (2.75 + 0.20) kg.
(3) three groups were divided according to the amount of milk that was fed by preterm infants: breast milk group [breast milk accounted for more than 75% of milk in one day (8 cases without breast milk fortifier); milk group (ordinary formula milk accounted for more than 75% of the total milk per day); early milk group [preterm infant (after discharge) formula milk accounted for more than 75% of the total milk volume of one day]. Breast milk group 54 people. Birth gestational age (33.34+2.18) week, birth weight (2.04 + 0.55) kg, early milk group 61, birth gestational age (31.41 + 2.38) weeks, birth weight (1.75 + 0.44) kg, milk group were 61, birth gestational age (33.79 + 2.15) weeks, birth weight (2.06 + 0.47) kg. early milk group birth birth age, birth weight is less than the breast milk group and the milk group (P0.01).
The number of preterm infants in each group was the same in length, weight, head circumference, BMI, LAZ, BMIZ, WAZ, WLZ, HCZ. There was no significant difference in sex ratio between each group in the three groups (P0.1).
3. analysis and observation index
(1) physical development indicators: premature infants' body length and Z value, body weight and Z value, head circumference and Z value, body mass index and Z value; body length, weight and head circumference growth rate;
Blood index: peripheral blood hemoglobin value, trace element copper, zinc, calcium, magnesium, iron and blood lead;
(3) dietary indicators: intake of energy, protein, carbohydrate, fat, iron, calcium and zinc in diet.
(4) nutritional assessment indicators: body weight, body length, head circumference EUGR incidence, low body weight, growth retardation, wasting, overweight, and head circumference less than 2 standard deviation rates.
4. dietary survey
600 cases of preterm infants were investigated and divided into two groups: (1) the correction of fetal age from 0 months to June: 300 times: 24 hours retrospective dietary survey method. The correction of month old 0-6 months: 300 times: three days food recording method. After eliminating the data with less energy consumption than the base, the correction of fetal age 0-6 months premature infant (birth) was obtained. The gestational age was 33.97 + 4.50 weeks, the birth weight was 2 + 0.51kg) 282 person times, and the correction month was from June to 1 years (31.92 + 6.46 weeks and the birth weight 1.83-0.51kg) 80 times. The daily intake of energy, protein, fat, carbohydrate, element iron, zinc, calcium value were calculated.
5. follow up
The month of age of June was followed up 1 times a month and 1 times per month after the month of June. The results of physical measurement in the follow-up of preterm infants were recorded, the conditions of birth, previous history, family history and discharge diagnosis were collected. The contents of intervention included physical monitoring, nutritional assessment and guidance, and preventive medication. The correction of preterm infants was 0~2 months of age of 0~2. In March, June, December, the peripheral blood routine was measured, corrected in June, and the trace elements in peripheral blood were measured in December.
6. statistical analysis
Epidata3.1 input, set up a database and use SPSS13.0 software to carry out statistical analysis. First, the normal and variance homogeneity test is carried out. The average number of two groups of normal distribution data conforming to the homogeneity of variance is compared with the t test, the multi group data comparison is analyzed with variance, and 22 is compared with the SNK method; the data that do not conform to the normal distribution are logarithmic through the logarithm. After changing the parameter analysis, if the nonparametric test is still not consistent, the incidence rate is compared with the chi square test and the Fisher exact probability method to test the.Logistic regression, and the multivariate linear regression analysis is used to analyze the data correlation. The nutrient calculation is realized by the compute program in SPSS.
[results]
The growth law of 1. body long
The growth trend of premature infants within 1 years old is similar to that of normal feet. The growth curve of body length 50% is shifted left than the 50% standard growth curve of WHO foot. From 40 weeks of orthodontic gestational age, the mean LAZ mean of each correction month is more than 0.2, reaching the peak in February.
The analysis of preterm infants with different birth gestational age showed that the corrected gestational age was 40 weeks, and the LAZ mean of EPI was less than LPI in February, while the LAZ average of EPI was greater than LPI (P0.05).EPI and LPI at correction month of age in October, February, respectively.
The analysis of different birth weight premature infants showed that in August, the LAZ of VLBW was smaller than that of LBW and NBW (P0.01).LBW LAZ peak in the correction month of August, and the LAZ peak of VLBW was in February, and the LAZ peak of VLBW was corrected in October.
2. rule of body weight growth
The trend of weight growth of premature infants within 1 years old was similar to that of normal feet. The 50% growth curve of weight in premature infants shifted left than the 50% standard growth curve of WHO foot. The mean WAZ value of each correction month of preterm infants was more than 0, and the peak of WAZ was in February.
The analysis of preterm infants at different birth gestational age showed that the WAZ mean of EPI was less than LPI (P0.05) at 2,3,5 months of correction, and the peak of WAZ in EPI was in June, and the WAZ peak of LPI was corrected in February.
The results of different birth weight preterm infants showed that the corrected gestational age was 40 weeks, and the correction of the month was 2~5 months. The WAZ of VLBW was less than LBW, NBW (P0.05): the correction of month age 2~5 months, in August, the WAZ value of LBW was less than NBW (P0.05): LBW WAZ peak was in February of month of correction, and the peak of VLBW was in October of orthodontic month.
The growth law of 3. head circumference
The growth trend of the head circumference of premature infants is similar to that of full term infants. The peak value of.HCZ is at 40 weeks of corrected gestational age, except for 40 weeks of corrected gestational age, the mean value of Z per month is below 0.
The analysis of preterm infants with different birth gestational age showed that the HCZ mean of EPI was less than LPI in February and March. The HCZ of EPI was higher than LPI (P0.05).EPI in October, and HCZ peak of LPI was in February of month.
The results of different birth weight premature infants showed that the HCZ of VLBW was less than NBW premature infant (P0.05) at 40 weeks of corrected gestational age and 2~5 months of age, and 40 weeks of orthodontic gestational age, 2~3 months of correction month, and in May, the HCZ value of VLBW was less than LBW preterm infant (P0.05).VLBW in October, LBW HCZ peak was 40 weeks of gestational age.
4.BMI law
The basic similar.BMI50% curve of BMI growth trend and foot moon in each correction month of preterm infants is higher than that of WHO foot 50% standard growth curve of.BMIZ at the peak of the month of February.
The analysis of preterm infants with different birth gestational age showed that the peak value of the BMIZ mean of EPI was lower than the BMIZ peak value of LPI (P0.05).LPI at the month of 2,3,5 months of age correction, and the peak value of EPI's BMIZ was in the month of January.
The analysis results of different birth weight premature infants showed that in February to May, the BMIZ colonization of VLBW and LBW was less than the BMIZ peak of NBW (P0.05).VLBW in January, and the BMIZ peak of LBW was corrected in February. There was no statistical difference between the WAZ, LAZ, HCZ, and HCZ.
5.EUGR situation and influencing factors
The incidence of weight EUGR in 272 preterm infants was 26.5%, the incidence of body length EUGR was 12.1%, and the incidence of EPI was 29.73% in head circumference EUGR rate 7.1%., significantly higher than 16.13% (P0.01) of LPI, 58.33% in VLBW preterm infant and 31.67% in EUGR incidence rate of 31.67%. The birth rate of 7.34% (P0.05); the incidence of weight EUGR in SGA preterm infants was 43.84%, the incidence of long EUGR 27.40% was 27.40% higher than that of AGA preterm infants, 6.53% (P0.001). The risk factors of long EUGR: birth length, growth rate, SGA, risk factors for weight EUGR: birth weight, growth speed, SGA; head circumference EUGR risk factor: head: head circumference EUGR: head The rate of peri growth, the length of birth (P0.05).
6. nutritional status
Of the 272 preterm infants, 154 were measured in the blood routine, and 95 children measured trace elements. The incidence of anemia was 16.88%, the incidence of zinc deficiency was 88.42%, and the incidence of iron deficiency was 24.21%. trace element copper, calcium, magnesium and blood lead were in normal range.
7. dietary intake and its effect on physical development
After correction month of age from June to December, the intake of energy, protein, carbohydrate, calcium, iron, zinc are more than that of 0~6 month old infants (P0.05). The correction of month old 0~6 month premature infant intake energy / weight, protein / body weight correction month old and correction month of December preterm infants are more. Correction of 0-6 months of age 0-6 months premature infant. The intake of energy, fat, protein, iron, zinc and calcium all exceeded the dietary dietary intake standard (P0.01) of our residents (P0.01) and corrected the energy intake from June to the month of December. The elements of iron, zinc and calcium were not reached the reference intake (P0.01). There was no statistical difference between the three groups of breast milk group, early milk group and general milk group. Body weight, head circumference correction, early milk group evaluation, weight, head circumference is higher than breast milk group (P0.05).VLBW premature infant in premature infant EUGI rate of 85.7% is higher than the early milk group 40%.
[Conclusion]
In this study, the preterm infants completed the catch-up growth at the age of 1, and the growth trend and prematurity of the preterm infants after intervention.

【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R722.6

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本文編號(hào)：1893198