| Research backgroundIn recent years, with the rapid development of NICU technology of newborn and neonatal perinatal medicine, the survival rate of premature infants was significantly increased. The incidence rate of premature infants is one of the indicators to measure the economic level and medical standard of a country.The rate of preterm labor showed a rising trend with decrease of the economy. The reasons may concerned to the following:lack of pregnant women health care and and increase childbirthrisk in low income areas. Women in low income areas are in poor overall health condition, which leads to increase the risk of infection during pregnancy and to premature birth. Low income areas havelimited medical care and resources, and are lacking of prevention and diagnosis measures of premature birth. In addition, in certain developed countries such as the United States, because of their advanced medical technology level and assistant reproductive technology, the survival rate of very low birth weight infant has been improved, resulting in increasedincidence of preterm infants.The life quality and the complications of preterm infants etc. have become a growing concern of international medicine. The health of preterm infants has become a global public health issue. In May 2nd of 2012, WHO and other organizations proposed "The Global Action Report On Preterm Birth" about the preterm infants for the first time. And November 17th was set up for "world premature infant day" in the report. The report is mainly about present situation, causes of premature labor, and caring for the needs of premature birth. A detailed action plan has been proposed to reduce the mortality rate and the rate of premature delivery. According to the report, 15 million of preterm infants were born each year in the world, which accounts for 11.1% of infant birth rate all over the world. The report shows that, in 2010,12 countries with the highest incidence of premature birth which were mainly developing countries. And 13 countries with the lowest incidence of premature birth are mostly developed countries. The total number of premature infants in China takes second place just after India. The proportion of premature birth was 7.1%, ranked 154 in the world-wide. The report pointed that the premature birth is the first cause of death in newborn, which accounted for nearly 35% of the neonatal deaths in the world. And the quality of life of premature infants has become the second cause of death of children under 5 years old, only after pneumonia. The report finally requests all countries to give more consideration to the study of the mechanism and risk factors of preterm labor, and to increase the prevention of premature birth.The preterm infants as a special group have more short-term and long-term complications after birth because of their immature function of organ system and the poor life ability. Most of current studies focus on promoting the development of children’s physical and mental health. IDA (iron deficiency anemia) is due to lack of trace elements in the body, resulting in a reduction in hemoglobin synthesis. IDA is characterized by decreasing hemoglobin content, microcytic hypochromic anemia, decreasing serum ferritin and efficiency iron therapy. It is the most common anemia in children, in particular occurs in infants and young children. As doing great harms to children’s health, IDA is one of the infantile diseases subject to prevention and to cure in China. Although our quality of life has been greatly improved, but the situation of children IDA is still very prominent. According to WHO data, the incidence of children in developing countries of IDA is about 20%. Our survey in 2004 showed that the prevalence of IDA in children aged 7 months to 7 years was 7.8%, of which the 1 year old baby up to 20.8%.An increasing research work indicated that IDA had a close relationship with preterm and low birth weight. And preterm birth and low birth weight represented high risk factors for IDA. In many literatures, the study of preterm infants and IDA is mainly about the current situation of IDA in preterm infants after one week or the newborn period. Wang Aiping and the co-workers have conducted a backward visit to preterm infants born 12 weeks after birth, reporting that the incidence of IDA in premature infants was 39.47%. Peng Hua and the co-workers have analyzed related factors of anemia in preterm infants, reporting that the incidence rate of anemia in hospitalized premature infants was 38.1%. Many researches show that the smaller the gestational age, the lower the birth weight is which is associated with higher the incidence of IDA in the neonatal period. But there is few study on the occurrence of IDA of preterm infants having 0-2 years old in a region, and there is few study on the relationship between the occurrence of IDA and birth weight and gestational age.Research objectiveAccording to the provisions of maternity and child health care package In Guangzhou, we will set up a high-risk project management about preterm infants after they were born. And we will set up a Frail-child project management after one moth age. So premature infant is the focus group of children’s health care. At present, the focus of the work of community child health care is to reduce the incidence of premature infants, to strengthen the project management and tracking of preterm infants, which can help the growth preterm infants to catch up and reach the normal level of children.IDA is a major global health problem. Prevention of early nutritional iron deficiency anemia has important significance in eugenics and improvement of population quality and in promoting the development of children’s physical and mental health. Many studies have showed that infants, especially premature infants and low birth weight infants have high risk of IDA. Effective measures for iron supplementation in preterm birth and low birth weight infants, as early as possible, can effectively reduce the incidence of IDA.In This study, we selected 0-2 year’s old infants born in Dashi area of Panyu of Guangzhou as the research objects. We identify the incidence of premature infants in Dashi area of Panyu of Guangzhou, and master the base situation of preterm infants. through the study, we aim to identify the occurrence and severity of IDA in preterm infants at the age of 0-2 years in the area, to investigate the occurrence of IDA in preterm infants with different birth weight and different gestational age, and to find out the relationship between the occurrence of IDA and birth weight and gestational age, which can provide us a strong basis for the development of the area of premature infant health care strategy, as well as better control of IDA.Research methods and contentsResearch objectives:Through reviewing data we choose 243 cases of premature infants who are under regular health care and management at Community Health Services Center, Dashi area and Luopu Street as the research objects. Among them 138 baby boy cases,105 baby girl cases; 0-1 years old group:149 cases, among them 120 cases of late preterm infants,29 cases of early preterm infants; 66 cases with normal birth weight,83 cases with low birth weight.1-2 years group:94 cases, among them 70 cases of late preterm infants,24 cases of early preterm infants; 34 cases with normal birth weight,60 cases with low birth weight.250 full-term infant cases are selected into the control group. Among them 150 baby boy cases,100 baby girl cases; 0-1 years old group:150 cases,1-2 years group:100 cases.Research methods:(1)Identify the premature birth rate:Based on the birth list with birth date from January 2013 to December 2014 at Panyu District, Guangzhou we screen out a birth list born at Big Rock area (including all resident and local registered residences), and screen out the premature birth list from the Big Rock area birth list. We perform statistical analysis of the incidence rate of premature birth in Big Stock area.(2)Height and weight were measured in 0-1 years old group in their correction gestational age of 6 months. Similarly, height and weight were measured for 0-1 years old control group at their 6 months. We compared respectively the general situation for these two groups.(3)Height and weight were measured in 1-2 years old group in their correction gestational age of 18 months. Similarly, height and weight were measured for 1～2 years old control group at their 18 months. We respectively compared the general situation for these two groups.(4)Routine blood examination and trace elements detection for 0～1 years old group in their correction gestational age of 6 months to know hemoglobin (HGB) in vivo, mean erythrocyte volume (MCV), mean erythrocyte hemoglobin content (MCH), the average erythrocyte hemoglobin concentration (MCHC) and the content of trace element iron (FE). Similarly, routine blood examination and trace elements detection for 0～1 years old control group at their 6 months. We compared respectively the IDA status for these two groups.(5)Routine blood examination and trace elements detection for 1～2 years old group in their correction gestational age of 18 months to know HGB in vivo, MCV, MCH, MCHC and the content of FE. Similarly, routine blood examination and trace elements detection for 1～2 years old control group at their 18 months. We respectively compared the IDA status for these two groups.(6)According to the birth weight we divided the 0～1 years old preterm infants group into low birth weight infants group and normal birth weight infants group, comparing HGB, MCV, MCH, MCHC and the content of Fe between the two object groups, including IDA status.(7)According to the birth weight we divided the 1～2 years old preterm infants group into low birth weight infants group and normal birth weight infants group, comparing HGB, MCV, MCH, MCHC and the content of Fe between the two object groups, including IDA status.(8)According to the gestational age we divided the 0～1 years old preterm infants group into late preterm infants group and early preterm infants group, comparing HGB, MCV, MCH, MCHC and the content of Fe between the two object groups, including IDA status.(9)According to the gestational age we divide the 1～2 years old preterm infants group into late preterm infants group and early preterm infants group, comparing HGB, MCV, MCH, MCHC and the content of Fe between the two object groups, including IDA status.Research results(1)Incidence rate of premature infants in in Dashi area of Panyu of Guangzhou:In 2013 the incidence rate of premature infants in Dashi area is 7%, and 8% in 2014. The incidence rate of premature infants in the Dashi area is the same as the incidence rate of premature infants in the country.(2)IDA incidence rate of in Dashi area of Panyu of Guangzhou:The investigation shows that IDA incidence rate in 0～1 years old preterm infants is 18.8%,and 22.3% in 1～2 years old preterm infants. Both are lower than the incidence of anemia in preterm infants after birth.(3)The relationship between infants IDA and age:This research also suggests that IDA mainly occurs in 6 month old infants. The IDA incidence rate of premature infants in their correction gestational age of 6 months is 18.8%.The IDA incidence rate of 6 month old full term infants is 14.0%. Which are still at a high level. The IDA incidence rate and Irion deficiency rate of 18 month years old full term infants is 9.0%、7.0%. Which is significantly lower than that of the 6 month old infants.(4)The relationship between infants IDA and premature delivery:This research also suggests that the IDA incidence rate of preterm infants within 2 years of age was significantly higher than that of full-term infants.The IDA incidence rate and Irion deficiency rate of premature infants at the corrected gestational age of 6 months is 18.8%、16.8%.Both are higher than that of full term infants(The IDA incidence rate and Irion deficiency rate is 14.0%、2.0%).And the IDA incidence rate and Irion deficiency rate of premature infants at the corrected gestational age of 18 months is 22.3%、23.4%. The IDA incidence rate and Irion deficiency rate of 18 months old full term infants is 9.0%、7.0%. And the difference was significant (P<0.05).(5)The relationship between premature infants IDA with birth weight:In this investigation premature infants are divided into low birth weight infants group and normal birth weight infants group. This research shows that the IDA incidence rate of low birth weight infants in the 0～1 years old group is 26.5% which is significantly higher than that of the normal birth weight infants(9.1%), and the difference was significant (P<0.05). Iiron deficiency rate differences don’t show significance (P>0.05). The lower the birth weight is, the IDA incidence rate is higher. The IDA incidence rate of low birth weight infants in the 1～2 years old group is 21.7%.There was no significant difference in the IDA incidence rates of low birth weight infants and normal birth weight infants in the 1～2 years old group (p>0.05).We concluded that the effect of birth weight on the occurrence of IDA was smaller and smaller when the premature infants are up to 1～2 years old. The incidence IDA rates of early and late preterm infants is comparable. The incidence IDA rates of low birth weight and normal birth weight preterm infants is comparable. Visibly, the level of iron in low birth weight preterm infants aged 1～2 years has a catch up growth.(6)The relationship between premature infants IDA with gestational age:In this investigation premature infants are divided into early preterm infants and late preterm infants groups according to the gestational age. This research shows that the IDA incidence rate of early preterm infants in the 0-1 years old group is 41.4% which is significantly higher than that of the late preterm infants (13.3%), and the difference was significant (P<0.05). Irion deficiency rate differences don’t show significance (P>0.05). The smaller the gestational age is, the IDA incidence rate is higher. There was no significant difference in the IDA incidence rates of late preterm infants and early preterm infants in the 1～2 years old group (p>0.05).We concluded that the effect of gestational age on the occurrence of IDA was smaller and smaller when the premature infants are up to 1～2 years old. The incidence IDA rates of early and late preterm infants is comparable. And the IDA incidence rate of early preterm infants aged 1～2 years (20.8%) is significantly lower than that of early preterm infants aged 0～1 years. Visibly, the level of iron in early preterm infants aged 1～2 years has a catch up growth. All these results suggest that prevention and reduction measures against premature infants IDA should be taken from early age stage, especially in the first year after birth.(7)The severity level of infants IDA:The results of this research show that anemia of infants is mostly mild, only one 18 months old premature infant with moderate anemia (HGB:87g/L). And infants with anemia are mostly with microcytic hypochromic anemia and the content of trace elements iron also significantly declined. The investigation shows that iron deficiency rate is 11.5% which is below the IDA incidence rate (16.0%), and displays that in IDA cases Microcytic haemogram firstly appear and the development the content of iron in the body will be further influenced. This suggests the HGB level and cellular morphology are sensitive indicators of anemia. So for basic level hospital unit iron deficiency could be preliminarily diagnosed according to the initial hemoglobin levels and to the red cell morphology.(8)Prevention and treatment of infant IDA:The incidence of IDA in preterm infants at 18 months was significantly higher than that in the full term infants (P< 0.05). The difference was statistically significant. The incidence rate of IDA is higher in premature infants with small gestational age. Those studies have showed that premature infants, especially infants with small gestational age and low birth weight having high risk of IDA.Research conclusionAnd through the study, we have identified the occurrence of IDA in preterm infants at the age of 0-2 years in the area. The preliminary conclusions of this study are as follows:1. Incidence rate of premature infants in in Dashi area of Panyu of Guangzhou is relatively low. In 2013 the incidence rate of premature infants in Dashi area is 7%, and 8% in 2014.2. IDA incidence rate of in Dashi area of Panyu of Guangzhou in 0-1 years old preterm infants is 18.8%, and 22.3% in 1-2 years old preterm infants.3.Premature infants are more vulnerable to IDA than in full-term infants; the smaller the gestational age, lower birth weightis, IDA occur rate is higher in preterm infants aged 1 years old.4. the level of iron in early preterm infants and low birth weight preterm infants aged 1-2 years approach the level of normal birth weight of preterm infants and late preterm infants.5. Premature infants, low birth weight infants, less than the gestational age are the po pulation which has high incidence of IDA. We should take comprehensive measures to protect them from IDA and provide them with proper treatments. |
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