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北京大学学报（医学版） ›› 2025, Vol. 57 ›› Issue (6): 1124-1131. doi: 10.19723/j.issn.1671-167X.2025.06.016

• 论著 • 上一篇    下一篇

早产小于胎龄儿生后2岁内体格及运动发育状况的随访研究

郑萍1,2,*, 林坤鸿1,*, 刘梦圆1, 赵旭琰1, 肖扬欣1, 邢燕1,*()   

  1. 1. 北京大学第三医院儿科, 北京 100191
    2. 青岛市城阳人民医院儿科, 山东青岛 266109
  • 收稿日期:2025-08-11 出版日期:2025-12-18 发布日期:2025-11-07
  • 通讯作者: 邢燕
  • 作者简介:

    * These authors contributed equally to this work

  • 基金资助:
    北京大学第三医院临床队列建设项目(BYSYDL2022008)

A follow-up study on the physical and motor development of premature infants with small for gestational age within 2 years after birth

Ping ZHENG1,2, Kunhong LIN1, Mengyuan LIU1, Xuyan ZHAO1, Yangxin XIAO1, Yan XING1,*()   

  1. 1. Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China
    2. Qingdao Chengyang People's Hospital, Qingdao 266109, Shandong, China
  • Received:2025-08-11 Online:2025-12-18 Published:2025-11-07
  • Contact: Yan XING
  • Supported by:
    Clinical Cohort Construction Project of Peking University Third Hospital(BYSYDL2022008)

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摘要：

目的: 探究早产小于胎龄儿(small for gestational age infant, SGA)生后2岁内的体格发育和运动发育规律。方法: 选取2018年1月1日至2022年12月31日于北京大学第三医院出生并在该院儿童健康发展中心规律随访的SGA作为研究对象, 将其分为早产SGA组和足月SGA组, 根据随访时间划分为如下时间段: 0~3、3~6、6~10、10~16、16~21、21~27月龄, 收集身长、体重、头围、Peabody运动发育量表评分、维生素A和D水平、骨密度及喂养方式, 其中早产儿按照矫正月龄计算。采用SPSS 25.0统计软件进行分析。结果: 完成规律随访的SGA共158例, 其中早产SGA组87例, 足月SGA组71例。两组出生身长、体重、头围差异均有统计学意义(P < 0.05)。生后0~3月龄早产SGA体重追赶较快, 生后0~3月龄和6~10月龄早产SGA组头围均大于足月SGA组, 差异有统计学意义[(38.18±2.14) cm vs. (37.12±1.66) cm, (43.04±1.54) cm vs.(42.35±1.70) cm, P < 0.05];生后3~6月龄和6~10月龄早产SGA组粗大运动、精细运动与总运动发育商均高于足月SGA组, 差异有统计学意义(P均 < 0.05)。早产SGA组在0~3月龄、3~6月龄时母乳喂养与发生追赶生长的关联有统计学意义(P < 0.05);两组血液维生素A、D水平及骨密度差异无统计学意义。结论: 早产SGA在12月龄前体重和头围较足月SGA增长快, 运动发育状况优于足月SGA, 12月龄后两组体格指标和运动发育状况趋于一致; 母乳喂养是早产SGA优选的喂养方式, 可促使早期发生追赶生长, 此外, 母亲孕期未合并糖尿病也是SGA早期发生追赶生长的有利因素之一。

关键词: 小于胎龄儿, 体格发育, 运动发育, 体重增长, 母乳喂养

Abstract:

Objective: To investigate the physical and motor development of preterm small for gestational age infant (SGA) within 2 years after birth. Methods: SGA born in Peking University Third Hospital from January 1, 2018 to December 31, 2022 and followed up regularly in the Center for Child Health and Deve-lopment were selected as study subjects. They were divided into preterm SGA group and full-term SGA group. Length, weight, head circumference, Peabody motor development score, vitamin A and D, bone mineral density and feeding status of SGA 0-3, 3-6, 6-10, 10-16, 16-21, 21-27 months after birth were collected through the electronic child health care follow-up system. The preterm infants were calculated according to the corrected gestational age. SPSS 25.0 statistical software was used to analyze the data. Results: A total of 158 SGA completed the regular follow-up, including 87 preterm SGA and 71 full-term SGA. The birth length, weight and head circumference of the two groups were statistically significant (all P < 0.05). The body weight of preterm SGA caught up faster 0-3 months after birth, and the head circumference of preterm SGA was higher than that of full-term SGA 0-3 months [(38.18±2.14) cm vs. (37.12±1.66) cm] and 6-10 months [(43.04±1.54) cm vs. (42.35±1.70) cm] after birth. The differences were statistically significant (all P < 0.05). The scores of gross motor, fine motor and total motor development 3-6 and 6-10 months after birth were significantly higher in preterm SGA than in full-term SGA (all P < 0.05). Breastfeeding 0-3 months of age and 3-6 months of age was significantly associated with catch-up growth in preterm SGA (P < 0.05). There were no significant differences in vitamins A and D and bone mineral density between the two groups. Conclusion: In the first year after birth, the weight and head circumference of preterm SGA increase faster than those of full-term SGA, and the motor development of preterm SGA is better than that of full-term SGA. After the first year of life, the physical indicators and motor development of the two groups tend to be consistent. Breastfeeding is the preferred feeding mode for preterm SGA, which promotes rapid catch-up growth in the early stage. The absence of maternal diabetes during pregnancy is also one of the positive factors for the occurrence of catch-up growth in SGA.

Key words: Small for gestational age infant, Physical development, Motor development, Weight gain, Breastfeeding

中图分类号: 

  • R722

表1

早产SGA和足月SGA体重、身长和头围比较"

Months of age Group Weight/kg Body length/cm Head circumference/cm
n $\bar x \pm s$ n $\bar x \pm s$ n $\bar x \pm s$
At the moment of birth Full-term 71 2.28±0.30 71 45.70±2.31 41 32.26±1.56
Preterm 87 1.47±0.41* 87 39.37±4.39* 55 28.72±2.77*
0-3 Full-term 39 4.30±0.86 39 54.49±3.18 38 37.12±1.66
Preterm 81 4.81±1.15* 81 55.54±4.27 81 38.18±2.14*
3-6 Full-term 64 6.39±0.98 64 62.54±3.01 63 40.58±1.60
Preterm 73 6.48±0.97 73 62.34±3.12 73 41.00±1.61
6-10 Full-term 58 7.45±1.06 58 66.65±2.86 57 42.35±1.70
Preterm 76 7.53±1.07 76 67.37±2.68 74 43.04±1.54*
10-16 Full-term 53 8.79±1.15 52 72.82±3.23 52 44.76±1.42
Preterm 59 8.82±1.18 59 73.84±2.87 58 44.83±1.59
16-21 Full-term 26 9.78±1.27 26 78.76±3.64 24 45.78±1.36
Preterm 44 9.64±1.10 44 78.93±3.44 44 45.65±2.58
21-27 Full-term 13 11.23±1.86 13 85.63±6.23 12 47.39±0.99
Preterm 32 10.89±1.26 31 85.87±4.31 31 46.68±1.67

表2

早产SGA与足月SGA追赶生长情况比较"

Months of age Groups Catch-up group，n(%) No catch-up group, n(%) Statistics P
0-3 Full-term 20 (51.3) 19 (48.7) χ2=3.610 0.057
Preterm 56 (69.1) 25 (30.9)
3-6 Full-term 46 (71.9) 18 (28.1) χ2=0.067 0.796
Preterm 51 (69.9) 22 (30.1)
6-10 Full-term 45 (77.6) 13 (22.4) χ2=1.032 0.310
Preterm 53 (69.7) 23 (30.3)
10-16 Full-term 45 (84.9) 8 (15.1) χ2=3.031 0.082
Preterm 42 (71.2) 17 (28.8)
16-21 Full-term 19 (73.1) 7 (26.9) χ2=0.388 0.533
Preterm 35 (79.5) 9 (20.5)
21-27 Full-term 11 (84.6) 2 (15.4) 0.696a
Preterm 23 (71.9) 9 (28.1)

表3

早产SGA和足月SGA骨密度变化情况"

Months of age Groups n Bone mineral density (Z value)，$\bar x \pm s$ t P
0-3 Full-term 31 -1.510±0.995 2.123 0.928
Preterm 68 -1.980±1.050
3-6 Full-term 59 -1.306±1.220 0.760 0.699
Preterm 65 -1.465±1.098
6-10 Full-term 51 -0.792±0.918 0.495 0.532
Preterm 57 -0.875±0.830
10-16 Full-term 47 0.034±0.936 -0.927 0.832
Preterm 50 0.210±0.932
16-21 Full-term 21 0.367±1.075 -0.236 0.843
Preterm 29 0.438±1.037
21-27 Full-term 11 0.552±1.088 0.269 0.961
Preterm 26 0.438±1.214

表4

早产SGA与足月SGA运动发育情况比较"

Months of age Groups n GMQ, $\bar x \pm s$ FMQ, $\bar x \pm s$ TDQ, $\bar x \pm s$
0-3 Full-term 10 99.50±5.68 102.00±8.08 101.60±6.62
Preterm 57 101.26±5.64 100.60±6.04 100.89±5.57
3-6 Full-term 26 96.00±5.00 97.58±4.57 96.65±3.57
Preterm 62 99.79±4.83* 101.35±4.63* 100.31±4.69*
6-10 Full-term 24 96.88±4.91 97.38±4.83 96.60±3.53
Preterm 45 100.16±5.90* 100.60±5.30* 100.16±5.13*
10-16 Full-term 18 97.06±7.47 100.22±8.18 97.84±7.94
Preterm 33 96.09±6.62 102.00±8.51 98.24±7.11
16-21 Full-term 9 100.22±9.44 99.67±9.90 100.47±7.92
Preterm 21 97.71±7.89 104.00±4.87 100.33±5.96
21-27 Full-term 5 99.60±4.78 97.80±12.78 100.00±4.79
Preterm 7 97.86±5.05 100.43±2.70 98.71±2.29

表5

早产SGA追赶生长与喂养方式关系"

Months of age Feeding patterns Catch-up, n(%) No catch-up, n(%) P aOR 95%CI
0-3 Breast milk 19 (86.4) 3 (13.6) 0.045 6.29 1.04-37.8
Formula milk 7 (53.8) 6 (46.2) 0.965 1.04 0.18-6.03
Mixed 20 (80.0) 5 (20.0) 0.149 3.19 0.66-15.43
3-6 Breast milk 15 (83.3) 3 (16.7) 0.024 27.67 1.54-499.04
Formula milk 13 (61.9) 8 (38.1) 0.372 3.62 0.22-61.11
Mixed 22 (78.6) 6 (21.4) 0.074 12.89 0.78-212.40

表6

SGA发生相关因素和生后追赶生长的关系"

Factors CUG1 CUG2 CUG3 CUG4 CUG5 CUG6
Yes No Yes No Yes No Yes No Yes No Yes No
Gestational hypertension
  No 32 21 50 20 48 19 42 9 20 7 12 4
  Yes 44 23 47 20 50 17 45 16 33 10 20 6
  P 0.550 0.869 0.697 0.277 0.800 >0.999
Gestational diabetes mellitus
  No 51 27 72 22 68 21 61 12 36 9 24 5
  Yes 25 17 25 18 30 15 26 13 17 8 8 5
  P 0.525 0.027 0.230 0.041 0.262 0.238
Liver and kidney diseases
  No 73 39 91 35 92 33 82 22 49 16 32 9
  Yes 3 5 6 5 6 3 5 3 4 1 0 1
  P 0.141 0.298 0.701 0.374 >0.999 0.238
Placental abnormalities
  No 67 36 83 32 85 32 76 22 51 14 32 10
  Yes 9 8 14 8 13 4 11 3 2 3 0 0
  P 0.337 0.420 0.783 >0.999 0.088
Umbilical cord abnormalities
  No 67 37 85 34 86 34 76 24 48 17 29 10
  Yes 9 7 12 6 12 2 11 1 5 0 3 0
  P 0.528 0.679 0.351 0.294 0.325 0.568
Twin pregnancy
  No 53 36 74 34 80 29 70 21 42 14 28 9
  Yes 23 8 23 6 18 7 17 4 11 3 4 1
  P 0.145 0.256 0.887 0.780 >0.999 >0.999
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