| Objective:The clinical data of very low birth weight infants in the neonatology Department of Foshan Maternal and Child Health Hospital were retrospectively analyzed to understand the occurrence,nutritional status,complications and the influence of short-term prognosis of very low birth weight infants,and to explore the incidence of intrauterine growth retardation and extrauterine growth retardation,influencing factors and their relationship.To provide possible theoretical basis and intervention strategies for preventing intrauterine growth retardation and/or extrauterine growth retardation in very low birth weight infants.Methods:1.Maternal data,perinatal data,nutrition,physical development,laboratory indicators,complications and diagnosis and treatment information of 272 very low birth weight infants admitted to the neonatology Department of Foshan Maternal and Child Health Hospital from January 1,2018 to December 31,2020 were retrospectively collected.2.Grouping the subjects according to gestational age,birth weight,intrauterine growth retardation and non-intrauterine growth retardation,extrauterine growth retardation and non-extrauterine growth retardation were studied and analyzed.3.According to the conditions at birth and postnatal growth and development,to explore the influencing factors of intrauterine and extrauterine growth and development delay and their relationship.4.The t test,Chi-square test or rank sum test were used to compare between groups,and the intrauterine growth retardation or extrauterine growth retardation was taken as the dependent variable to establish a logistic regression model to explore the risk factors of intrauterine growth retardation or extrauterine growth retardation.Results:1.A total of 272 VLBWIs were selected,with birth weight of(1285.33±138.44)g,birth length of(38.33±12.45)cm,birth head circumference of(26.94± 1.63)cm and gestational age of(30.28± 1.93)weeks.The length of hospitalization was(47.24± 13.26)d,and the adjusted gestational age of discharge was(37.06± 1.74)weeks.The age to reach the minimum weight was(3.86±1.89)d,the average daily weight growth rate was(10.04±2.34)(g/kg/d)。2.the milk opening volume was(6.51±2.28)(ml/kg/d),the time to start intestinal feeding was(34.37±28.37)h,The total calorific time was 110kca/kg/d(12.77±4.12)d,the parenteral nutrition duration was 23.99±7.79)d,the total intestinal feeding time was 32.20±7.76 d,and the cumulative fasting time was 3.29±2.12)d.3.In this study,the incidence of intrauterine growth retardation(body weight)in very low birth weight infants was 15.44%,and severe intrauterine growth retardation(body weight)2.57%;Intrauterine growth retards(body weight)were 11.11%in male infants and 20.31%in female infants.The incidence of intrauterine growth retards(body weight)was statistically significant between male and female groups(Chi-square value=4.39,P=0.036).(1)Incidence of intrauterine growth retardation at different gestational age:Divided into 4 groups according to gestational age:At<28 weeks,28-32 weeks,32-34 weeks and 34-36 weeks,the incidence of intrauterine growth retarding was 0%,6.38%,90%and 42.86%based on birth weight,respectively,and the incidence was different among the groups(Chi-square value=151.12,P<0.001).The incidence of intrauterine growth retardation increases gradually.The incidence of intrauterine growth retardation based on birth length was 17.02%,15.43%,66.67%and 100%,respectively.The rates of intrauterine growth retardation based on birth head circumference were 2.13%,10.64%,50%and 71.43%,respectively.(2)Incidence of intrauterine growth retardation at different birth weights:Divided into 5 groups according to birth weight:In 1000-1099g,1100-1199g,1200-1299g,1300-1399g and 1400-1499g,the incidence of intrauterine growth retarding was 16.67%,10.42%,16.67%,21.88%and 12.20%,respectively,and there was no difference between groups.The incidence of intrauterine growth retardation by birth length was 26.67%,12.50%,27.08%,23.43%and 20.70%,respectively.The incidence rates of intrauterine growth retardation based on birth head circumference were 26.67%,12.50%,20.83%,12.50%and 10.98%,respectively.(3)Comparison of various data between intrauterine growth retardation and non-intrauterine growth retardation:Sex,gestational age at birth,head circumference at birth,caesarean section rate,length of hospital stay,age at minimum weight,average daily weight increase rate,time to start intestinal feeding,time to reach total intestinal feeding,after admission(hemoglobin,glutamic oxalacetic transaminase,total protein,prealbumin,albumin,uric acid,blood creatinine),albumin at discharge,neonatal respiratory distress syndrome,neonatal pneumonia,and blood chi There were significant differences between the two groups in the incidence of tubulopulmonary dysplasia,patent ductus arteriosus,thyroid dysfunction,anemia,invasive ventilator ventilation,pregnancy hypertension and prenatal glucocorticoid use.4.In this study,the overall incidence of extrauterine growth retards from very low birth weight to discharge was 69.48%,the incidence of extrauterine growth retards was 97.61%in the intrauterine growth retards group,and the incidence of extrauterine growth retards was 64.34%in the non-intrauterine growth retards group,and the difference between the two groups was statistically significant(Chi-square value=18.54,P<0.001).(1)The incidence of extrauterine growth retardation at different gestational age was divided into 4 groups according to gestational age:At<28 weeks,28-32 weeks,32-34 weeks and 34-36 weeks,the incidence of extragalinal growth retarded by discharge weight was 42.55%,70.21%,100%and 100%,respectively,and the incidence was different among groups(Chi-square value=20.43,P<0.001).The incidence of extrauterine growth retardation increases gradually.(2)Incidence of extrauterine growth retardation at different birth weights:Divided into 5 groups according to birth weight:In 1000-1099g,1100-1199g,1200-1299g,1300-1399g and 1400-1499g,the incidence of extrauterine growth retarding was 80%,77.08%,58.53%,75%and 63.41%,respectively,and there was no difference between groups.(3)Comparison of various data between extrauterine growth retardation group and non-extrauterine growth retardation group:Gestational age at birth,head circumference at birth,cesarean section rate,daily weight growth rate,cumulative fasting time,admission(serum creatinine,serum calcium),before discharge(alanine aminotransferase,aspartate aminotransferase,total cholesterol),prenatal or perinatal infection of pregnant mothers,advanced age,premature rupture of membranes and≥18 hours,incidence of hypertensive diseases during pregnancy,and pregnancy times were statistically different between the two groups.5.Hypertensive disease during pregnancy,gestational age(OR=2.94,95%CI=1.04-9.26;OR=4.55,95%CI=2.83-7.32)was an independent risk factor for intrauterine growth retardation.Gestational hypertension(OR=3.91,95%CI=1.18-12.94),gestational age(OR=5.25,95%CI=1.17-23.58),milk opening volume(OR=1.24,95%CI=1.02-1.55),and time to start intestinal feeding(OR=3.06.95%CI=1.11-8.45)and cumulative fasting time(OR=1.58,95%CI=1.21-2.06)were independent risk factors for extrauterine growth retardation.Conclusions:1.The incidence of intrauterine growth retardation and extrauterine growth retardation was 15.44%and 69.48%in very low birth weight infants.2.Very low birth weight infants with intrauterine growth retardation at birth have an increased probability of extrauterine growth retardation at discharge.3.Gestational age and pregnancy-induced hypertension are independent risk factors for IUGR.4.Gestational hypertension,gestational age,milk opening volume,intestinal feeding time and cumulative fasting time were independent risk factors for the occurrence of EUGR.5.Optimize maternal health care during pregnancy,strengthen early postnatal nutrition assessment and intervention,and actively prevent and treat postnatal complications to reduce intrauterine growth retardation and extrauterine growth retardation of very low birth weight infants. |
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