Analysis Of The Factors Of Extrauterine Growth Retardation In Preterm Infants And The Effect Of Enhanced Nutrition On Their Growth And Development

Research background and objectives:The growth and development measures(body weight,body length,head circumference)of premature infants when discharged from hospital were lower than 10%of the average growth parameters of gestational age children as extrauterine growth restriction which was first proposed by American scholar Clark in 2003.In the Worldwide,with the deepening of research on strategies,the incidence of extrauterine growth restriction has decreased,although it is not obvious.In recent years,about half of premature babies have developed into extrauterine growth restriction.Low birth weight and low gestational age due to premature birth are the most imextrauterine growth restriction and the implementation of nutritional enhancement portant causes of extrauterine growth restriction.In addition,many factors such as intrauterine growth restriction,insufficiently early nutrient intake,recovery of fetal weight loss after birth and disease are also closely related to extrauterine growth restriction.Extrauterine growth restriction is associated with advanced neurodevelopment and intelligence.Recent studies have also shown that excessive weight gain in the late stage of extrauterine growth restriction increases the risk of certain diseases in adulthood,especially cardiovascular diseases,diabetes and hypertension.The study found that active nutrition interventions minimize the risk of birth-induced nutrition loss and reduce the likelihood of extrauterine growth restriction at discharge during the first few weeks of life in preterm infants.In order to enhance the nutrition of premature infants,prevent post-natal growth retardation,and meet the needs of catching up with growth,implement a positive nutrition strategy,early intravenous input of major nutrients such as amino acids,fat milk and sugar,as well as water and electrolytes,and start the intestinal tract as soon as possible.Nutrition and breastfeeding have a positive impact on growth.In addition,understanding long-term risk factors associated with cognitive development in preterm infants requires long-term follow-up studies.Therefore,follow-up assessment is very important to promote the health and cognitive ability of premature infants.Based on the above research background,this topic is divided into two parts.Part I is to evaluate the incidence and incidence of extrauterine growth restriction in premature infants in Ji nan Maternity and Child Care hospital,and to provide positive nutritional support and assessment for low birth weight infants by prospective study.The effectiveness,feasibility,and safety of intensive nutrition programs in low birth weight infants.Part II is to analyze the physical development and neuromotor development of very low and extremely low birth weight infants after discharge and to explore the effects of early intervention on the growth and development of very low and extremely low birth weight infants.This study will provide an experimental basis for reducing the incidence of extrauterine growth restriction in preterm infants and exploring appropriate nutritional support in clinical practice and establishing post-discharge follow-up and early intervention strategies to minimize the incidence of extrauterine growth restriction.Methods:Part ?The study was from the premature infants who were admitted to the neonatal ward in April 1,2015 to March 31,2016.The study group was divided into two groups according to the relationship between gestational age and body weight.Intestinal feeding in premature infants begins as early as possible.If breast milk is available,breast milk is preferred,there is no breast milk,and formula milk from premature infants is gradually added.If the child develops intolerance or even the clinical manifestations of necrotizing enterocolitis,oral feeding is stopped.Insufficient intestinal feeding was supplemented with intravenous nutrition and randomly divided into traditional nutrition group and intensive nutrition group according to different nutrition programs.In the traditional nutrition group,for amino acid supplementation,children were given 0.5g/kg·day of amino acids starting from 12-24 hours after birth,increasing by 0.5g/kg.day until 3.5g/kg·day.Fatty milk was given 24 hours after birth.0.5g/kg·day,increase by 0.5g/kg day,the total amount does not exceed 3g/kg day;intensive nutrition group,12-24 hours after birth,begin to give children amino acids 1.5-2g/kg day,according to 0.5-1 g/kg day is increased until 3.5g/kg·day,and fat milk is given 1g/kg.day 24 hours after birth,in accordance with 0.5g/kg day,the total amount does not exceed 3g/kg·day;both groups of glucose start at 5-6g/kg·day,gradually increase to 16-18g/kg·day.Discharge criteria were normal body temperature for at least 24 hours,oral sucking was good,and blood oxygen saturation and heart rate did not decrease during feeding.SaO2 remained above 90%without oxygen,and there was no apnea for more than a week.Those who weigh less than 2000 grams when admitted to the hospital need to be>2000 grams when discharged.Collect and record the gestational age of the child,the main complications and complications during the mother's pregnancy,whether there are multiple births,and the main complications of the child during hospitalization.Record the child's milking time,the number of days of stomach tube,the time of intravenous nutrition,and the nutrient supply such as the time required for total gastrointestinal feeding.Record body weight,head circumference,birth length indicators and discharge indicators.Part ?Very low birth weight infant(VLBWI)and extremely low birth weight infants(ELBWI)were born in Ji nan Maternity and Child Care hospital hospital in April 1,2015 to March 31,2016,after discharge from hospital to high risk children Outpatient follow-up,divided into two groups.There were 82 cases in the study group.The first follow-up time was 7-10 days after discharge.Corrected gestational age 40 weeks and corrected monthly age 1-6 months were followed up every month.Corrected monthly age7 to 12months were followed up every 2 months,and physical measurements(length,body mass,head circumference)and 20 neurobehavioral tests were performed at the time of follow-up.The infants' intelligent development scale was adjusted at 6 months and 12 months.We evaluated infants'CDCC and evaluated its nutritional status and develops feeding regimens;conducted early interventions(touch,passive exercises,acupressure,active exercise training,etc.)for neurobehavioral abnormalities,and adjusted interventions based on each neurobehavioral test.Twenty-five patients in the control group were not followed up on time.The data was collected and evaluated during the 6-month and 12-month rectification of the telephone.All data were processed by SPSS 17.0 statistical software.The chi-square test was used for the count data.The t test was used for the difference between the groups.The logistic regression analysis was used for the analysis of the disease risk factors.P<0.05 was considered statistically significant.Results:Part?Among the 144 premature infants,according to the birth weight,birth length,birth head circumference and birth three,the intrauterine growth restriction reached 27.08%,13.19%,20.14%and 8.33%,respectively.According to the three criteria of discharge quality,discharge length,discharge head circumference and discharge three,the extrauterine growth restriction reached 61.11%,20.83%,25.69%and 11.81%,respectively.There were significant differences in the gestational age and birth weight between the intrauterine growth restriction group and the gestational age group.There was no significant difference between birth length and head circumference.There was a significant difference between the intrauterine growth restriction group and the gestational age group in terms of discharge quality,discharge length,discharge head circumference and recovery to birth weight.Time,hospital stay,body weight growth rate in intravenous nutrition application There was no significant difference between the growth rate of body length and the growth rate of head circumference.The premature infants were divided into three groups according to the body weight of the birth,according to the birth weight evaluation:the incidence of intrauterine growth restriction between the three groups was significantly different,and the incidence of intrauterine growth restriction in the birth weight less than 1500 g group,the birth weight of 2000-2500g group followed,the 1500-2000g group had the lowest incidence of intrauterine growth restriction.According to the evaluation of birth length,the incidence of intrauterine growth restriction was the highest in the birth weight less than 1500g group,the birth weight was 2000-2500g group,and the 1500-2000g group had the lowest intrauterine growth restriction rate.According to the evaluation of the birth head circumference,the incidence of intrauterine growth restriction was not significantly different among the three groups.According to the three evaluations of birth,the incidence of intrauterine growth restriction was the highest in the birth weight less than 1500g group,the birth weight was 1500-2000g group,and the 2000-2500g group had the lowest incidence of intrauterine growth restriction.According to the quality of discharge,body length and head circumference,it was found that the growth rate of extrauterine growth was less than 1500g.The incidence of extrauterine growth restriction was the highest when the body weight was less than 1500-2000g.The incidence of growth restriction was second,and the incidence of extrauterine growth restriction was the lowest in the birth weight 2000-2500g group.In addition,the incidence of uterine growth restriction in the intrauterine growth restriction group was 97.44%,46.15%,and 43.59%,respectively,based on the quality of the discharged body,body length,and head circumference.The corresponding proportions for the gestational age group were 47.62%,11.43%and 19.05%,respectively.Statistical analysis showed that the incidence of extrauterine growth retardation in preterm infants in the intrauterine growth restriction group was higher than that in the group suitable for gestational age.Preeclampsia in mothers has significant effects on intrauterine growth restriction and extrauterine growth restriction.In terms of physical development,there was a significant difference between the traditional nutrition group and the intensive nutrition group in terms of body weight growth rate,head circumference growth rate,intravenous nutrition application time,discharge length,and discharge head circumference,but at birth gestational age,body weight,There were no significant differences in body length,head circumference,length of growth,time to return to birth weight,length of hospital stay,and quality of discharge.In the biochemical indicators,the traditional nutrition group and the intensive nutrition group had significant differences in the two indexes of aspartate aminotransferase(AST)and alanine aminotransferase(ALT).The remaining serum calcium,phosphorus,creatinine,urea nitrogen,bile acid,triglyceride There were no significant differences in total cholesterol,low-density lipoprotein(LDL),high-density lipoprotein(HDL),total protein,albumin,globulin,and alkaline phosphatase(NBAP).Part ?The incidence rate of the extrauterine growth restriction(EUGR)in the study group was 71.59%of the first follow-up and the nutritional guidance was strengthened.When the corrected age was 6 months,the rate was reduced to 17.07%.When the corrected age was 12 months,the incidence rate of the two groups was 12.19%and 32%,respectively.During the follow-up,20neuromotor examinations were performed,and early interventions were performed on children with suspected and abnormalities.The incidence of abnormalities decreased with the increase of age;corrected infants' intelligent development scale(CDCC)was detected at 6 months of age.The number of Neurodevelopmental impairment(NDI)was 31(incidence rate 37.08%).The 12-month age group was corrected,the number of NDI was 12(incidence rate 24.39%),CP was 3(incidence rate 3.65%),control group NDI was 8(incidence rate 32.00%),CP was 4 person(incidence rate was 16%).The incidence of cerebral palsy was significantly different.There were no blindness or hearing loss in both groups.Conclusions:1.The results of this study show that the lower the birth weight,the higher the incidence of extrauterine growth retardation.Therefore,intrauterine growth restriction is a high-risk group of extrauterine growth restriction.2.Through prenatal mothers with pre-eclampsia,multiple pregnancies,gestational diabetes,placental abruption,intrauterine distress,and neonatal complications including:pneumonia,neonatal hyaline membrane disease,digestive disorders(feeding Intolerance,necrotizing enterocolitis,intestinal infection,gastrointestinal bleeding)analysis of high-risk factors found that maternal preeclampsia is not only a high risk factor for intrauterine growth restriction,but also significant for the occurrence of extrauterine growth restriction influences.3.Strengthening nutrition can promote the growth of body weight,head circumference and length.Intensive nutrition had no significant effect on renal function,blood lipid levels,plasma protein content,bile acid,alkaline phosphatase,calcium,phosphorus and other results.4.Establish a follow-up mechanism for early-stage intensive nutrition for very low birth weight infants and extremely-low birth weight infants after discharge,which can achieve catch-up growth before 12 months of corrected age,while small for gestational age(SAG)is nutrition Programmatic influence is more difficult to achieve catch-up growth.5.Early intervention after discharge from very low birth weight infants and extremely low birth weight infants can improve neurodevelopment and reduce the incidence of cerebral palsy.