关于小于胎龄儿追赶生长的争议

由于宫内不良环境的去除及出生后营养的补充,大部分小于胎龄儿在出生后会出现追赶生长。追赶生长展现了小于胎龄儿的生长潜力,弥补了其宫内发育迟缓的缺陷。然而小于胎龄儿及追赶生长的界定标准是什么,哪些因素影响追赶生长却尚无定论。本文通过对小于胎龄儿及追赶生长的定义、追赶生长的影响因素目前存在争议进行系统综述,强调了统一标准的重要性。     

小于胎龄儿的追赶生长与脂肪追赶

小于胎龄儿生后出现追赶生长与脂肪追赶的倾向,经历快速追赶生长的小于胎龄儿其脂肪重聚发生时间提前,存在脂肪追赶现象。目前尚不清楚这种倾向是由于低体重本身、出生后快速追赶性生长还是两者的结合。研究多聚焦于不同的追赶生长模式将会影响长期健康结局。本文通过回顾已发表的最新研究进展,报告了可能的小于胎龄儿最佳追赶生长模式。     

小于胎龄儿过快追赶生长与儿童期肥胖关系的研究

由于宫内生长受限的解除以及出生后的营养环境改变，大部分小于胎龄(SGA)儿都会出现追赶生长。追赶生长可以促进SGA儿的体格发育，提高生存质量。近年来许多研究表明SGA儿过快追赶生长与儿童期肥胖密切相关，母乳喂养可降低肥胖的发生率。本文就SGA儿过快追赶生长与儿童期肥胖关系、可能机制的研究进展做一综述。     

2255例早产小于胎龄儿0～36月龄生长状况分析

目的描述上海市0～36月龄早产小于胎龄儿的生长发育特点,为开展该人群的发育监测和制定相应儿童保健措施提供依据。方法对所有2007年9月-2011年9月出生、在上海各区县儿童保健所接受系统管理的早产小于胎龄儿体格发育资料进行分析,评价其0～36月龄平均体质量、身长(高)和头围所反应的生长情况。结果早产小于胎龄儿平均体质量、身长(高)和头围在矫正胎龄足月时可赶上正常足月儿均值,显示了出生后赶上生长的潜能;但短期追赶后不论出生胎龄和性别以均值表示的早产小于胎龄儿各生长指标均落后于正常足月儿。结论早产和小于胎龄对儿童生长发育有明显影响,早产小于胎龄儿3岁前的生长水平未能赶上正常儿童。     

新型冠状病毒感染疫情防控时期低出生体重儿追赶生长的影响因素

【目的】了解新冠疫情防控时期江苏省宿迁市宿豫区12个月龄的低出生体重儿（LBWI）追赶生长的影响因素，为更好地指导LBWI追赶生长提供依据。【方法】在授权使用的数据库中，整群选取2020年1月—2021年5月在宿迁市宿豫区定期参加体检和随访至12个月的全部301例LBWI为研究对象，收集儿童基本信息、婴儿出生情况、出生及12个月的体重测量值，同时使用调查问卷收集母亲孕期情况、婴儿出生后喂养与疾病情况。计算Z评分，以评价时的Z评分和出生时的Z评分之差（△Z）≥0.67将所有对象分为追赶生长组（284例）和未达追赶生长组（17例），比较2组相关因素的差异，分析其追赶生长的影响因素。【结果】2组婴儿的小于胎龄儿、早产、宫内发育迟缓、出生后营养强化、喂养方式比例差异有统计学意义，多因素logistic回归分析显示，宫内发育迟缓（OR=0.070,95%CI:0.015～0.327）是妨碍追赶生长的因素；出生后营养强化（OR=6.518,95%CI:1.215～34.955）是追赶生长的促进因素。【结论】LBWI出生后营养强化对追赶生长有益，宫内发育迟缓是未达追赶生长的因素。     

1岁以内不同胎龄儿生长速度的比较及与FGF21、瘦素的相关性

目的探讨1岁内不同胎龄儿生长速度的差异,了解早产儿及小于胎龄儿追赶生长的特点,明确FGF21、瘦素与体格发育的相关性。方法将95例1岁以内不同胎龄儿分为早产小于胎龄儿、早产适于胎龄儿、足月小于胎龄儿组、足月适于胎龄儿组,4组分别在生后0月、3月、6月、9月及12月测量身长、头围及体重。ELISA法检测脐血FGF-21和瘦素水平。结果早产小于胎龄儿,早产适于胎龄儿及足月小于胎龄儿的身长、体重、头围生长速度与足月适于胎龄儿比较差异有统计学意义(P0.05)。脐血FGF-21与身长呈负相关,与体重无明显相关性(P=0.07),瘦素对身长及体重的影响呈正相关(P0.05)。结论早产儿及足月小样儿在1年内总体上呈追赶性生长趋势,后半年生长速度放缓,不同胎龄儿的身长及体重增速不平衡。FGF-21及Leptin共同参与生长发育调节。     

足月小于胎龄儿早期生长追赶与胰岛素抵抗相关性研究

目的旨在探讨2~4岁足月小于胎龄儿出生后早期生长追赶与胰岛素抵抗的关系。方法采用1∶1配对的研究方法,分析44对足月小于胎龄(small for gestational age,SGA)儿和足月适于胎龄(appropriate for gestational age,AGA)儿的生长发育情况及稳态模型的胰岛素抵抗指数、胰岛素敏感性指数、胰岛β细胞功能指数,及生长追赶与以上指标的关系。结果 SGA儿出生时生长发育指标、0~6月龄期生长追赶指标与AGA儿差异均有统计学意义(P0.05)。2~3岁组、3~4岁组SGA儿胰岛素抵抗指标低于AGA儿,胰岛素敏感指标高于AGA儿,差异均有统计学意义(P0.05)。小于4岁组0~6月龄期身长Z积分增值与Homa-IAI呈正相关;大于4岁组7~12月龄期体重Z积分增值与Homa-IR呈正相关。结论 SGA儿早期存在明显的生长追赶现象,尚未出现胰岛素抵抗,胰岛素敏感、胰岛素抵抗的改变都是随着时间的推移而出现逐渐变化的过程。     

胎儿宫内发育受限的现代观点

胎儿宫内发育受限(fetal growth restriction,FGR)是指胎儿在宫内由于一种或多种致病因素的作用,未能完成遗传所决定的生长潜能,其体重低于胎龄相应体重的第10百分位数,这些胎儿出生后属于小于胎龄儿(SGA)范畴,但FGR并不等同于小于胎龄儿,约70％的小于胎龄儿仅仅是由于体格遗     

IGFs在IU GR儿生后追赶生长中的作用

胰岛素样生长因子在胎儿宫内生长迟缓儿生后追赶生长中的作用,是目前胎儿学和儿童发育学中较为重要的课题。胰岛素样生长因子作用的确切机制目前尚未完全明了,但的确存在不同胎龄间胰岛素样生长因子的水平差异,以及在胎儿宫内生长迟缓儿及生后缺乏追赶生长的胎儿宫内生长迟缓儿的血胰岛素样生长因子水平降低的现象。本文拟通过这些现象重点说明胰岛素样生长因子在胎儿宫内生长迟缓儿生后追赶生长中的作用及与 Ｇ Ｈ 的关系。     

IGFs在IUGR儿生后追赶生长中的作用

胰岛素样生长因子在胎儿宫内生长迟缓儿生后追赶生长中的作用,是目前胎儿学和儿童发育学中较为重要的课题。胰岛素样生长因子作用的确切机制目前尚未完全明了,但的确存在不同胎龄间胰岛素样生长因子的水平差异,以及在胎儿宫内生长迟缓儿及生后缺乏追赶生长的胎儿宫内生长迟缓儿的血胰岛素样生长因子水平降低的。     

Statistical modelling of the seasonality of preterm delivery and intrauterine growth restriction in rural Gambia

We have developed a methodology for comparing the seasonal influences on two outcomes, when those influences may act cumulatively or instantaneously. We have used this to compare the seasonal pattern of intrauterine growth retardation (IUGR, as reflected by weight-for-gestational-age) and preterm delivery (as assessed by Dubowitz scoring) among 1718 infants born in rural Gambia. Both outcomes were analysed as binary variables: small-for-gestational-age (SGA, <10th centile of reference standard) and preterm (<37 weeks) respectively. Percentages of preterm and SGA babies show divergent seasonal patterns that might indicate separate aetiologies. However, seasonal effects influencing intrauterine growth are likely to be cumulative over the last few months of pregnancy. By modelling seasonality with truncated Fourier series we were able to deconvolve the underlying seasonal influences on fetal growth from the pattern for SGA. This enabled us to use seemingly unrelated biprobit regression to compare the underlying seasonal pattern of intrauterine growth with that governing the incidence of preterm delivery. We conclude that, if the seasonal factors affecting intrauterine growth operate over more than the last 2 months of pregnancy, then the seasonal patterns of the factors causing IUGR and preterm delivery are indistinguishable if the factors are assumed to trigger preterm delivery immediately, but differ if preterm delivery is assumed to be programmed by factors acting at conception.     

南宁市武鸣区壮族人群小于胎龄儿的影响因素研究

  目的  了解壮族人群小于胎龄儿（small for gestational age，SGA）的流行情况，并探讨SGA的影响因素。  方法  选择2016年1月~2018年1月在南宁市武鸣区人民医院及武鸣区妇幼保健院产检并分娩的孕妇共3 839例，收集所有研究对象基本信息和相关研究因素的资料，采用随机森林算法、χ2检验和多因素Logistic回归对资料进行分析。  结果  武鸣区壮族人群SGA发生率为9.6%（368/3 839），其中男婴的发生率为6.9%（142/2 049），女婴的发生率为12.6%（226/1 790）。随机森林显示孕中期胎儿宫内生长受限（intrauterine growth retardation，IUGR）的重要性评分最高，孕周最低，并筛选了7个最重要的变量纳入多因素Logistic回归。多因素分析显示，初产妇、孕妇身高<1.55 m、孕期增重不足及孕中期IUGR是SGA的危险因素；孕前BMI ≥ 18.5 kg/m2及男婴则为SGA的保护因素。  结论  南宁市壮族人群SGA的发生率较高，且受多因素影响，应及时评估胎儿生长发育情况，采取综合措施以减少SGA的发生。     

The impact of maternal education on intrauterine growth: a comparison of former West and East Germany

BACKGROUND: Objective of this re-analysis of datasets from former East and West Germany was to examine the influence of maternal education on intrauterine growth in two different political and social systems. METHODS: Information on socio-demographic or lifestyle factors and pregnancy outcome was available for 3374 liveborn singletons from West Germany (1987/88) and 3070 from East Germany (1990/91). Multiple logistic regression was used to estimate the association between maternal education and the risk of delivering a small-for-gestational-age (SGA) newborn below the 10th percentile of birthweight. RESULTS: Women with the lowest education had a significantly elevated risk of SGA newborns compared to women with the highest education in West (odds ratio [OR] = 2.58, 95% CI : 1.17-5.67) and East Germany (OR = 2.77, 95% CI : 1.54- 5.00). The distribution of factors known to influence intrauterine growth varied with education in both states. After adjusting for these factors, women with the lowest educational level still had a higher risk of SGA birth: OR (West) = 2.02, 95% CI : 0.87-4.72; OR (East) = 1.95, 95% CI : 1.02-3.74. CONCLUSIONS: Our findings support the assumption that in former socialist countries health inequalities as a result of social inequalities existed.     

血清视黄醇结合蛋白-4水平与胎儿宫内生长发育的关系

目的:检测新生儿血清视黄醇结合蛋白-4(RBP-4)的水平,探讨其与胰岛素水平及胎儿宫内生长发育的关系,并对相关因素进行分析。方法:用酶联免疫法检测89例新生儿血清中RBP-4和胰岛素水平,其中小于胎龄组(SGA)30例、适于胎龄组(AGA)30例、大于胎龄组(LGA)29例,并按出生体重评估新生儿宫内的营养状态。结果:①3组间RBP-4及胰岛素水平的差异有统计学意义(P均<0.05)。②血清RBP-4水平与新生儿出生体重呈明显正相关(r=0.943,P<0.01);③胰岛素水平与新生儿出生体重呈明显正相关(r=0.975,P<0.01);④RBP-4水平与胰岛素水平呈明显正相关(r=0.979,P<0.01)。结论:新生儿体内RBP-4水平在一定程度上反映宫内生长发育状态,可能和胰岛素共同参与调节新生儿的生长发育。     

早产小于胎龄儿临床及危险因素分析

目的 分析早产小于胎龄儿(SGA)与适于胎龄儿(AGA)高危因素、发病情况的差异,为早产SGA进行临床干预提供依据。方法 选取2011年l月-2017年12月昆明医科大学第一附属医院新生儿科收治的1 370例早产儿为研究对象,根据胎龄与出生体重的关系分为SGA组(675例)与AGA组(695例),比较两组早产儿的一般情况、围生期高危因素及并发症情况。结果 1)SGA组出生体重、出生身长、出生头围、出院体重、出院身长均小于AGA组,住院天数较AGA组长,差异均有统计学意义(χ² =-11.62、-7.12、-5.25、-5.72、-2.1、4.46,P＜0.05);2)SGA组其母系高龄产妇、妊娠高血压综合征、胎盘异常、剖宫产与AGA组相比较差异均有统计学意义(t=65.841、170.937、19.558、92.719,P＜0.05);3)早产SGA组并发窒息、新生儿呼吸窘迫综合征、心肌损伤、喂养不耐受、肺炎、败血症、低血糖、低甲状腺素血症的比例高于AGA组,差异均有统计学意义(t=4.465、4.162、6.035、3.97、5.180、5.21、4.71、5.031,P＜0.05);4)Logistic 回归分析显示:母亲患妊娠期高血压(OR=5.64,95%CI:1.28~16.16)、胎盘异常(OR=3.65,95%CI:1.16~7.69)、多胎妊娠(OR=2.89,95%CI:1.05~8.84)是早产SGA发生的独立危险因素。结论 加强孕期保健、胎儿宫内监测,及时发现胎儿宫内生长发育迟缓,对孕母进行积极治疗,有助于减少早产SGA的发生;加强早产SGA的监护治疗,可降低其并发症的发生。     

Adverse perinatal and neonatal outcomes and their determinants in rural Vietnam 1999-2005

Population-based estimations of perinatal and neonatal outcomes are sparse in Vietnam. There are no previously published data on small for gestational age (SGA) infants. A rural population in northern Vietnam was investigated from 1999 to 2005 (n=5521). Based on the birthweight distributions within the population under study, reference curves for intrauterine growth for Vietnamese infants were constructed and the prevalence and distribution of SGA was calculated for each sex. Neonatal mortality was estimated as 11.6 per 1000 live births and the perinatal mortality as 25.0 per 1000 births during the study period. The mean birthweight was 3112 g and the prevalence of low birthweight was 5.0%. The overall prevalence of SGA was 6.4%. SGA increased with gestational age and was 2.2%, 4.5% and 27.1% for preterm, term and post-term infants, respectively. Risk factors for SGA were post-term birth: adjusted odds ratio (AOR) 7.75 [95% CI 6.02, 9.98], mothers in farming occupations AOR 1.72 [95% CI 1.21, 2.45] and female infant AOR 1.61 [95% CI 1.27, 2.03]. There was a pronounced decrease in neonatal mortality after 33 weeks of gestation. Suggested interventions are improved prenatal identification of SGA infants by ultrasound investigation for fetal growth among infants who do not follow their expected clinical growth curve at the antenatal clinic. Other suggestions include allocating a higher proportion of preterm deliveries to health facilities with surgical capacity and neonatal care.     

小于胎龄儿早期血脂及脂蛋白代谢特点

目的 了解小于胎龄儿(small for gestational age neonates,SGA)早期血脂及脂蛋白代谢特点。方法 选择无严重并发症新生SGA 47例为研究对象,以45例足月适于胎龄儿(adequate for gestational age,AGA)作为对照组。于出生后12 h内静脉采血,测定血浆总胆固醇(total cholesterol,TC)、甘油三脂(triglyceride,TG),低密度脂蛋白胆固醇(low-density lipoprotein cholesterols,LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterols,HDL-C)、载脂蛋白(apolipoproteins,apo)A1及apo-B水平,计算LDL-C/HDL-C及apo-B/apo-A1比值;并进一步将SGA根据是否足月、宫内发育迟缓程度(出生体重位于同胎龄平均体重P₃以下为SGA1组,P₃~P₁₀之间为SGA2组)及性别进行分组,比较上述指标的水平。结果 与对照组比较, SGA患儿具有高的TC(2.41±0.61 vs 2.11±0.78,P<0.05)、LDL-C(0.90±0.44 vs 0.71±0.42,P<0.05)和apo-B(0.40±0.22 vs 0.29±0.15,P<0.01)浓度,及高的LDL-C/HDL-C(1.31±1.29 vs 0.82±0.46,P<0.05)、apo-B/apo-A1(0.60±0.35 vs 0.40±0.19,P<0.01)比值;SGA1组比SGA2组具有低的TC、HDL-C及apoA1水平,而具有高的apo-B/apo-A1比值(P<0.01或<0.05);早产SGA患儿比足月SGA患儿具有低的TG水平(P<0.05);性别对SGA血脂及脂蛋白水平没有影响。结论 不良的宫内环境使SGA早期可出现脂质代谢异常,宫内发育迟缓越严重脂质代谢异常越明显,SGA远期可能更易出现心血管疾病;早产SGA血浆TG水平低于足月SGA,可能与新生儿成熟度相关。     

足月产小于胎龄儿的孕早期影响因素

  目的  探究影响足月产小于胎龄儿(small for gestational age, SGA)发生的因素,为预防其发生提供科学依据。  方法  采用问卷调查及医院信息系统收集数据,使用logistic回归分析模型分析足月产SGA的影响因素。  结果  足月产SGA的发生率为6.6%,非初次怀孕、孕期补充二十二碳六烯酸(docosahexaenoic acid, DHA)是足月产SGA发生的保护因素,孕前低BMI、妊娠期合并脐带缠绕是足月产SGA发生的危险因素(均有P＜0.05)。  结论  孕妇在备孕和妊娠期应保持合理体重、孕期补充DHA、预防脐带缠绕等妊娠期并发症,以降低SGA发生风险。     

BCG vaccination of full-term infants with chronic intrauterine malnutrition: influence of immunization age on development of post-vaccination, delayed tuberculin hypersensitivity.

To determine the effect of intrauterine growth retardation (IUGR) on the response to BCG vaccination, we evaluated the specific delayed tuberculin hypersensitivity of 57 full-term infants with symmetric IUGR (SGA or small for gestational age) and 52 full-term infants with normal intrauterine growth (AGA or appropriate for gestational age). The infants were evaluated using post-vaccination skin tests to tuberculin purified protein derivative (PPD) and tuberculin lymphocyte transformation tests. Using a positive response to the skin test as an indicator of delayed hypersensitivity, we found that the rate of response to BCG in the SGA and AGA groups was similar. A total of 65% of infants with IUGR responded to BCG vaccination. The response rate among SGA infants who were vaccinated at 5 days of age, about 26 days of age (weight > or = 2500 g), 3 months of age, and 6 months of age was 68%, 47%, 69%, and 88%, respectively. The overall response rate for infants with no IUGR was 71%; the rate response to BCG vaccination among this group was 52% (those vaccinated at 5 days of age), 90% (3 months of age), and 80% (6 months of age). Our data suggest that the immunogenicity of BCG vaccine is similar in term infants who have normal or abnormal intrauterine growth and the presence of IUGR should not be a reason for delaying BCG vaccination.