Factors associated with growth of extremely premature infants during initial hospitalization.
Factors associated with growth of extremely premature infants during initial hospitalization.
复制标题
与极早产儿初次住院期间生长相关的因素。
作者：
Margaret A. Berry;Michal Abrahamowicz;Usher Rh
目的
量化与极小早产儿初次住院期间生长相关的因素。
人口
研究对象为109名适合胎龄的婴儿，出生时体重<1000 g，根据方案先静脉高营养，然后补充钙81千卡早产儿配方奶粉。
分析
对0 - 56、0 - 14和15 - 56日龄进行多元回归分析。生长被确定为在此期间的重量变化。在初始模型中评估的变量为热量摄入、蛋白质摄入、呼吸支持持续时间、动脉导管未闭、地塞米松使用、感染、出生体重比（体重除以妊娠期预期宫内体重）、胎龄、性别、研究开始后的日历时间、母体倍他米松给药和坏死性小肠结肠炎。在0 - 14天期间，呼吸窘迫综合征的最大需氧量取代了呼吸支持持续时间，并增加了5分钟Apgar评分，而地塞米松和坏死性小肠结肠炎被删除。
结果
0 - 56天的平均体重变化为785 g，0 - 14天为-16 g，15 - 56天为770 g。出生时平均体重为宫内平均体重的94%（13 SD），14天时为73%（10 SD），56天时为73%（12 SD）。回归模型分别解释了85%、43%和80%的生长变异。在评估的初始变量中，以下是生长的独立预后决定因素。0 ~ 56天和15 ~ 56天的热量摄入与0 ~ 14天的蛋白质摄入呈正相关。出生体重比与0 ~ 56天和0 ~ 14天的胎龄呈负相关。呼吸支持持续时间在15至56天呈负相关，地塞米松在0至56天和15至56天呈负相关。根据最终的回归模型建立了预测生长的公式。
结论
适合胎龄、出生体重<1000 g的婴儿的生长障碍可能部分与地塞米松的使用和呼吸支持持续时间有关。增加热量摄入和早期蛋白质摄入可以促进生长。然而，对于这些患者中的大多数，使用目前推荐的摄入量，早期损失在56天内无法完全纠正。
OBJECTIVE
To quantify the factors associated with growth of very small premature infants during initial hospitalization.
POPULATION
Study patients were 109 infants who were appropriate for gestational age, weighed <1000 g at birth, and were fed intravenous hyperalimentation then calcium-supplemented 81-kcal preterm formula according to a protocol.
ANALYSIS
Multiple regression analysis was performed for periods of 0 to 56, 0 to 14, and 15 to 56 days of age. Growth was determined as change in weight during the period. Variables assessed in the initial model were caloric intake, protein intake, respiratory support duration, patent ductus arteriosus, dexamethasone use, infection, birth weight ratio (weight divided by expected intrauterine weight for gestation), gestational age, sex, calendar time from study start, maternal betamethasone administration, and necrotizing enterocolitis. For the 0 to 14-day period, maximum oxygen requirement for respiratory distress syndrome replaced respiratory support duration, and 5-minute Apgar score was added, whereas dexamethasone and necrotizing enterocolitis were deleted.
RESULTS
Mean change in weight was 785 g for 0 to 56 days, -16 g for 0 to 14 days, and 770 g for 15 to 56 days. Mean weight was 94% (13 SD) of mean intrauterine at birth, 73% (10 SD) at 14 days, and 73% (12 SD) at 56 days. Regression models explained 85%, 43%, and 80%, respectively, of variation in growth. Of the initial variables assessed, the following were the independent prognostic determinants of growth. There was a positive association with caloric intake at 0 to 56 days and 15 to 56 days, and with protein intake at 0 to 14 days. Negative associations were found for birth weight ratio and gestational age at 0 to 56 and 0 to 14 days. Respiratory support duration was negatively associated at 15 to 56 days, and dexamethasone was negatively associated at 0 to 56 and 15 to 56 days. Formulas to predict growth were established from the final regression models.
CONCLUSION
The growth failure in appropriate-for-gestational-age, <1000-g birth weight infants can be related in part to dexamethasone use and respiratory support duration. Increasing caloric intake and early protein intake improves growth. However, for the majority of these patients, early losses are not corrected completely by 56 days using currently recommended intakes.