| [background]With the rapid development of modern medicine,survival and cure rates of preterm infants have significantly improved in our country, and coming with more challenges after they discharged, particularly the smaller gestational age and low birth weight preterm infants. The preterm infants are vulnerable to various complications and malnutritiononaccountof their immature systems and poor life skills,while all that due to their anatomical and physiological characteristics. The first year is the fastest period of growth and development of the children, and is the key time for preterm infants to "catch up", in addition, many researches revealed that the growth and development of preterm infants was an important factor that would affect their adult health. Following up and intervening preterm infants after discharge can improve intelligence scores,reduce parents’ psychological pressure, decrease not only malnutrition and mortality but also behavioral problems of preterm infants, all in all, that can increase the quality of life of preterm infants and their families. Therefore, the Ministry of Health had organized17medical units, to carry out "preterm (infants) intervention research project",and developed a "preterm infants care services guide ".The guide emphasized that the preterm management target should be based on different birth weight and different ages, then the nutritional strategies should vary from different born weight and different ages.Therefore, that preterm intervention should emphasize "individual ", and post-discharge follow-up and intervention should include neurological, physical growth monitoring, early detection of growth and development related issues, combating malnutrition, curing nutrition diseases. In accordance with the above principles, we followed272preterm infants born in our hospital and had accumulated thedate ofl243times follow-up to discuss the overall and "individual " nutritional status and growth pattern from March,2012to December,2013.[Objective]To find the regular pattern of preterm infants’growth and development, discuss physical development and nutritional status among different gestational age, and different birth weight infants, and analyzethe factors and the relation-ship.[Methods]1. Research objectThe preterm infants were born and willing to be followed-up in ShenZhen Maternal and Child Health Care hospital.Smoothly oral feeding, no feeding in tolerance,no pneumonia,no diarrhea and other problems in two weeks before following-up.They should be long staying in Shenzhen City, agreeing with follow up. Excluding suffering from serious diseases that affected the growth and development of preterm infants or not to accept the survey. A total of272preterm children(gestational age32.90±2.43weeks, birth weight1.93±0.49kg),and in them, there were153boys,119girls, and41pairs of twins(82infants),73SGA preterm infants,60very low birth weight infants. A total of1243follow-up records were collected.2Grouping①divided into two groups according to gestational age.Late preterm infants (born34weeks≤gestational age<37weeks, LPI) and early preterm infants (gestational age<34weeks, EPI); there were148EPI,(gestational age31.17±1.93weeks, birth weight1.66±0.41kg);124LPI(gestational age35.00±0.84weeks, birth weight2.25±0.39kg).②divided into three groups according to birth weight,very low birth weight infants (birth weight1000g～1499g, VLBW), low birth weight infants(birth weigh1500g～2499g, LBW), and normal birth weight infants(birth weight≥2500g, NBW);60VLBW (gestational age30.03±2.48weeks,birth weight1.23±0.16Kg);178LBW (gestational age33.44±1.87weeks,birth weight1.99±0.27kg);34NBW,(gestational age34.69±1.18weeks, birth weight2.75±0.20kg).③Divided into three groups according to the proportion of milk volume in total dairy feeding volume, human-milkgroup (human-milk accounted for more than75%of the daily total milk,excluding8cases of human-milk fortifier, HM); preterm (discharge) formula group(preterm formula accounted for more than75%of the daily total milk, PF); infant formula group (infant formula accounts for more than75%of the daily total milk,IF).There were54infants in HM group,(gestational age33.34±2.18weeks,birth weight2.04±0.55kg);61infants in PF group,(gestational age31.41±2.38weeks, birth weight1.75±0.44kg);61infants in IF group,(gestational age33.79±2.15weeks birth weight2.06±0.47kg). Gestational age, birth weight in PF group infants were less than IF group infants and HM group infants (P<0.01).Length, weight, head circumference, BMI, LAZ, BMIZ, WAZ, WLZ, HCZ had same case number in each groups at each correction. Gender ratio, corrected month age among each group in three groups were not statistically significant (P>0.1)3.Analysis variables①Physical development, including length and length-for-age Z score (LAZ), weight and weight-for-age Z score(WAZ), head circumference and head circumference Z score(HCZ), body mass index(BMI) and Z score(BMIZ), and length, weight and head circumference growth rates.②Blood parameters:includinghemoglobin(Hb) trace elements copper, zinc, calcium, magnesium, iron and lead values in perpheral blood.③Dietary intake analysis, including dietary intake of energy, protein, carbohydrates, fat, elemental iron, calcium,zinc.④Nutritional evaluation variables, including weight, length, head circum-ference EUGR incidence and prevalence of underweight,stunting wasting,over-weight, HCZ<-2.4.Dietary survey600infants were drawn to conduct dietary survey,divided into two group s according to age,①0to6corrected months age. Including300person-time s, using24-hour retrospective dietary survey method.6to12corrected months age:including300person-time, using three days of food records method.Ex-clud-ing the cases that took less energy than the basic energy expenditure (BE E),obtaining0to6corrected months agepreterm infants (gestational age33.97±4.50weeks and birth weight2.00±0.51kg)282person-times,6to12cor-rected months age preterm infants (born gestational age31.92±6.46weeks, birth weight1.83±0.51kg)80person-times. Calculating daily intake of en-ergy,protein, fat, carbohydrates, and elemental iron, zinc, calcium.5.Follow-upFollowing up once time a month withinsix corrected months age, and once every two months after six corrected months age. Preterm infants’ physical measurements, birth information,past medical history, family information and discharge diagnosis were recorded. Post-discharge follow-up and intervention in cluded physical growth monitoring, nutritional evaluation and intervention, and prophylaxes. Measured the preterm infants’Hb of peripheral blood in0to2months,3months,6months and12months corrected age, and measured trace element of peripheral blood in6and12months corrected age.6. Statistical analysis Inputing information and established a database using Epidata3.1software. Statistical analysis was performed using SPSS13.0software. Firstly, normality and homogeneity of variance were tested, secondly, two groups were compared if the date meeted the normal distribution and homogeneity of variance, and analysis of variance comparison used ANOVA, using SNK method to analysis paiwise comparison.If the date didn’t meet the normal distribution andhomo-geneity of variance, using parameter analysis after logarithmic transformation, and the date that still didn’t meetstandards were analysed with non-parametric test. Comparing incidence using chi-square test and fisher method. The cor-relation among date were analysed by using multivariate logistic regression and linear regression analysis. Nutrients were calculated in the SPSS program[Results]1. Length growthLength growth pattern of preterm infants within corrected1year was similar to that in normal full-term children, the length of50%growth curve moved to the left compared with WHO50%standard growth curve. Since40weeks gestational age, each LAZ means were greater than0.2, and the peak value was at the two correctedmonths age. Analysis of different gestational age groups showed that EPI’s LAZ was smaller than LPI’s in40weeks gestational age, corrected2months age, while from8to12corrected months age, LAZ mean was greater in the EPI (P <0.05). LAZ peak of EPI and LPI were at the10corrected months age and2corrected months age, respectively. Analysis of different birth weight groups showed that the LAZ in VLBW infants was smaller than LBW and NBW infants from0to5corrected months age and8corrected months age(P<0.01). The LAZ peak was at corrected2months age inLBW infants, and at10corrected months age in VLBW infants.2. Weight growthThe weight growth pattern of preterm infants within corrected1year was similar to that in normal full-term children, the weight of50%growth curve moved to the left compared with WHO50%standard growth curve. Since40weeks gestational age, each WAZ means were greater than0, and the peak value was at the two corrected monthsage. Analysis of different gestational age groups showed that EPI’s WAZ was smaller than LPI’s at2,3,5corrected months age(P<0.05). LAZ peak of EPI and LPI were at the6corrected months age and2corrected months age, respectively. Analysis of different birth weight groups showed that the WAZ of VLBW infants was smaller than LBW and NBW infants at40weeks gestational age and from2-5corrected months age, and WAZ of LBW infants was smaller than NBW infants from2-5corrected months age and8corrected months age(P<0.01). The WAZ peak was at2corrected months age in LBW infants, and at10corrected months age in VLBW infants.3. Head circumference growthThe Head circumference growth patternof preterm infants within corrected1year was similar to that in normal full-term children. The HCZ peak was at40weeks gestational age. Since1corrected months age, each HCZ means were smaller than0. Analysis of different gestational age groups showed that EPI’s HCZ was smaller than LPI’s at2and3corrected months age(P<0.05). While from10to12corrected months age, LAZ mean was greater in the EPI (P<0.05). HCZ peak of EPI and LPI were at the10corrected months age and2corrected months age, respectively. Analysis of different birth weight groups showed that the HCZ of VLBW infants was smaller than NBW infants at40weeks gestational age and in2-5corrected months age, and HCZ of VLBW infants was smaller than NBW infants from2to3and5corrected months age (P<0.01). The HCZ peak was at10correctedmonths age in VLBW infants, and at2corrected months age in LBW infants.4.BMIThe BMI growth pattern of preterm infants within corrected1year was similar to that in normal full-term children. The BMI of50%growth curve moved to the left compared with WHO50%standard growth curve. The BMIZ peak was at2corrected months age. Analysis of different gestational age groups showed that EPI’s BMIZ was smaller than LPI’s at2,3and5corrected months age(P<0.05), while BMIZ mean was greater in the EPI (P<0.05). BMIZ peak of EPI and LPI were at the3corrected months age and1corrected months age, respectively. Analysis of different birth weight groups showed that the BMIZ in VLBW and LBW infants were smaller than NBW infants from2to5corrected months age and at8corrected months age,(P<0.01). The BMIZ peak was at corrected1months age in VLBW infants, and at2in LBW infants. Each WAZ, LAZ, HCZ, BMIZ comparisonhad no statistical significance in other corrective months difference (P>0.05).5. EUGR and the factorsThe weight EUGR prevalence of272cases was26.5%, and length EUGR prevalence was12.1%, and head circumference EUGR prevalence was7.1%. What’s more, the weight EUGR prevalence was29.73%in EPI, significantly higher than16.13%in LPI(P<0.01). The weight and length EUGR prevalences that were58.33%and31.67%in VLBW infants and that were significantly higher than16.38%and7.34%in LBW infants(P<0.01). Weight and length EUGR prevalence of SGA preterm infants was43.84%,27.40%and that were higher than18.59%and6.53%in AGA infants. Birth length, length growth rate and that whether was SGA infants was length EUGR’s risk factors. Birth weight, growth rate, and that whether was SGA were risk factors for weight EUGR, the head circumference growth rate, birth length were risk factors for head circumference EUGR(P<0.05).6.Ntritional status154infants had been measured blood routine in272preterm infants,95children had been measured trace element.The anemia incidence was16.88%, zinc deficiency incidence was88.42%, iron deficiency incidence was24.21%. Copper, calcium, magnesium and blood lead levels were in the normal range.7.Dietary intake and the factors on physical developmentIntake of energy, protein, carbohydrates, calcium, iron, zinc in infants from6to12corrected months age were more than infants from0to6corrected months age (P <0.05). Intake of energy/weight, protein/weight from0to6corrected months age were more than infants from6to12corrected months age (P<0.05). Intake of energy, fat, protein, calcium, iron, zinc in infants from0to6corrected months age were more than the standard(.P<0.01). While intake of energy, calcium, iron, zinc in infants from6to12corrected months age were less than the standard(P<0.01).The EUGR prevalence were not statistical significance among HM, PF and IF groups. In VLBW infants, the EUGR prevalence in HM group was85.7%,and that was higher than40%in PF groups. WAZ, LAZ, HCZ, BMIZ were positively correlated with intake of energy, carbohydrates, birth weight, birth length, head circumference, and was negatively correlated with SGA (P<0.05).[Conclusion]In this study, the block of preterm infants complete "catching up" within1year. The growth trend of preterm infants after intervention is similar to normal full term infants. Around2corrected months age is the key time for catching-up.EPI’s length, head circumference and weight catch up LPI’s after6months corrected age.VLBW infants’ height, weight and head circumference catching-up are more difficult. Preterm children with anemia, zinc, iron deficiency are high.Fortified nutrition can positive promote preterm infants’ physical development. VLBW infants, smaller growth rates and SGA preterm infants should be strengthenedmanagement and actively intensify nutrition. At the same time for positive fortification, preterm infants should be fully assessed the gestational age, birth and hospitalization information, andfeeding tolerance should be reasonably considered. That’s all for designing a scientific fortifying scheme to the preterm infant. |
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