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

Ping ZHENG; Kunhong LIN; Mengyuan LIU; Xuyan ZHAO; Yangxin XIAO; Yan XING

doi:10.19723/j.issn.1671-167X.2025.06.016

Journal of Peking University(Health Sciences) >

2025 , Vol. 57 >Issue 6: 1124 - 1131

DOI: https://doi.org/10.19723/j.issn.1671-167X.2025.06.016

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

Ping ZHENG ¹^,² ,
Kunhong LIN ¹ ,
Mengyuan LIU ¹ ,
Xuyan ZHAO ¹ ,
Yangxin XIAO ¹ ,
Yan XING ^,¹^,*

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1. Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China
2. Qingdao Chengyang People's Hospital, Qingdao 266109, Shandong, China

XING Yan, e-mail, xingyan@bjmu.edu.cn

Received date: 2025-08-11

Online published: 2025-11-07

Supported by

Clinical Cohort Construction Project of Peking University Third Hospital(BYSYDL2022008)

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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

Cite this article

Ping ZHENG , Kunhong LIN , Mengyuan LIU , Xuyan ZHAO , Yangxin XIAO , Yan XING . A follow-up study on the physical and motor development of premature infants with small for gestational age within 2 years after birth[J]. Journal of Peking University(Health Sciences), 2025 , 57(6) : 1124 -1131 . DOI: 10.19723/j.issn.1671-167X.2025.06.016

小于胎龄儿(small for gestational age infant，SGA) 是指出生体重和(或)出生身长≤同胎龄同性别的-2.0标准差(standard deviation，SD)^[1]或小于第10百分位的新生儿^[2]。SGA的发生有多种原因，包括母体因素、胎儿和胎盘因素以及遗传因素。近年来，随着围生期救治水平的提高，我国SGA发生率呈下降趋势^[3]，但SGA死亡风险仍然高于适于胎龄儿(appropriate for gestational age infant，AGA)，其中早产SGA的新生儿死亡风险最高^[4]，且远期儿童青少年期胰岛素抵抗在早产儿以及SGA群体的高患病率也逐渐被证实^[5]。生命早期阶段，即孕期和2岁内，是早产儿生长发育的关键窗口期，该时期的生长发育状况对于早产儿近期及远期的生存质量均具有重要影响^[6]。因此，本研究通过对比早产和足月SGA在生后2岁内的体格指标、运动发育、追赶生长及喂养方式等情况，以期为早产SGA在关键窗口期的生长发育管理进行指导。

1 资料与方法

1.1 研究对象

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建档的早产SGA(出生胎龄＜37周)和足月SGA(37周≤出生胎龄 < 42周)作为研究对象，入组标准：(1)出生体重位于同胎龄同性别出生体重第10百分位数以下(参照2013年Fenton生长曲线进行评定^[7])；(2)在儿童健康发展中心规律随访2次及以上。排除标准：出生或随访过程中被诊断为严重先天畸形、遗传性疾病，接受过外科手术或死亡。本研究获得北京大学第三医院医学科学研究伦理委员会批准(伦理编号：IRB00006761-M2024256)。

1.2 随访情况

早产儿按照矫正月龄进行随访分析^[8]，即按预产期(胎龄40周)为起点计算纠正后的生理年龄，计算方法为：矫正月龄=实际月龄-早产周数，其中早产周数=40周-出生胎龄。我院儿童健康发展中心规定的随访时间点为生后42天、4月、6月、8月、10月、12月、18月、24月；早产儿在4月龄前需增加随访，每月1次。本研究为回顾研究，由于不同患儿在儿童健康发展中心随访时间不固定，根据入组早产儿矫正月龄和足月儿实际月龄，本研究在统计分析时将随访时间划分为如下几个时间段：0~3、3~6、6~10、10~16、16~21、21~27月龄，其中3、6、10、16、21月龄分别计入后一个随访时间段内。入组患儿不一定在每个时间点均进行随访，且同一次随访也可能存在个别项目数据缺失。

1.3 研究指标

1.3.1 体格指标测定及追赶生长评定

采用专用卷尺、婴儿体重测量仪及专用头围皮尺测定身长、体重和头围。对于发生体格生长减缓的婴儿，若其体格生长指标Z值变化(ΔZ)>+0.67即定义为追赶生长(catch-up growth)^[9]，本研究将体重ΔZ(即某月龄体重Z值-出生时体重Z值)＞+0.67定义为发生追赶生长^[10]，其中，某月龄体重Z值=(该月龄的实际体重-对应月龄的体重均值)/标准差。

1.3.2 维生素及骨密度测定

在3~6月龄时取末梢血采用液相色谱串联质谱法分别测定维生素A、维生素D水平。采用超声骨密度仪(Omnisense 7000P)测量小腿胫骨部位骨密度，用Z值进行评定(Z值为与同年龄同性别人群的平均骨密度值比较)，Z>0为骨密度正常，0>Z>-1为骨密度偏低，-1>Z>-2为轻度骨密度不足，Z<-2为严重骨密度不足。

1.3.3 运动发育评估

采用Peabody运动发育量表(Peabody developmental motor scales, second edition，PDMS-2)进行测评，得出粗大运动商(gross motor quotient，GMQ)、精细运动商(fine motor quotient，FMQ)及总发育商(total development quotient，TDQ)， < 80分为差，80~120分中等，>120分为优秀。

1.3.4 喂养方式评定

纯母乳喂养定义为母乳喂养大于全天喂养量70%；配方奶喂养定义为奶粉喂养量大于全天喂养量70%；混合喂养定义为母乳和配方奶混合，且均小于全天喂养量70%。

1.4 统计学方法

采用SPSS 25.0软件进行统计分析。计量资料用$\bar x \pm s$描述，同一随访时间段的组间比较采用t检验；分类变量用例数(百分数)描述，组间比较采用χ²检验或Fisher精确检验。为避免Ⅰ类错误风险，对显著性水平α进行Bonferroni校正，P<α/m(m为检验次数)为差异有统计学意义。采用多因素Logistic回归，校正母亲孕期合并症(如高血压、糖尿病、感染等)以及胎盘、脐带异常等混杂因素，分析喂养方式与追赶生长的关系, P < 0.05为差异具有统计学意义。

2 结果

2.1 一般资料

符合本研究纳入和排除标准的SGA共158例，其中早产SGA 87例(17.5%)，包括男51例、女36例，平均出生胎龄33.5周(27⁺²周~36⁺⁶周)，平均出生体重1 469 g(600~2 350 g)；对照组足月SGA 71例，包括男30例、女41例；两组在性别分布上差异无统计学意义(χ²=4.192，P=0.055)。

2.2 早产SGA与足月SGA主要体格指标比较

早产SGA组出生体重、身长、头围均小于足月SGA组，差异具有统计学意义(P＜0.05)。随访发现，体重仅在0~3月龄时两组间差异存在统计学意义，早产SGA组大于足月SGA组(P＜0.05)；头围在0~3和6~10月龄时早产SGA组明显大于足月SGA组，其余随访时间段两组间差异无统计学意义；而身长在所有随访时间段两组间差异均无统计学意义(表 1)。

表1 早产SGA和足月SGA体重、身长和头围比较

Table 1 Comparison of weight, body length and head circumference between preterm SGA and full-term SGA

Months of age	Group	Weight/kg		Body length/cm		Head circumference/cm
Months of age	Group	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

The age of 3, 6, 10, 16 and 21 months are included in the subsequent follow-up period, respectively. Bonferroni corrected P values, and there were 7 follow-up time points for independent hypothesis testing of different physical indicators, and the significance level of a single test was adjusted to 0.05/7. *P < 0.05/7, vs. full-term group. The sample size differed because of missing data at follow-up.

2.3 早产SGA与足月SGA追赶生长情况比较

早产SGA组和足月SGA组整体发生追赶生长的比例分别为72.03%和74.52%，差异无统计学意义(P＞0.05)。分别统计不同随访时间段早产SGA组和足月SGA组发生追赶生长的比例发现，两组间差异均无统计学意义(P＞0.05)，但在0~3月龄时早产SGA组发生追赶生长的比例略高于足月SGA组(69.1% vs. 51.3%，P=0.057，表 2)。

表2 早产SGA与足月SGA追赶生长情况比较

Table 2 Comparison of catch-up growth of preterm SGA and full-term SGA

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
0-3	Preterm	56 (69.1)	25 (30.9)
3-6	Full-term	46 (71.9)	18 (28.1)	χ²=0.067	0.796
3-6	Preterm	51 (69.9)	22 (30.1)
6-10	Full-term	45 (77.6)	13 (22.4)	χ²=1.032	0.310
6-10	Preterm	53 (69.7)	23 (30.3)
10-16	Full-term	45 (84.9)	8 (15.1)	χ²=3.031	0.082
10-16	Preterm	42 (71.2)	17 (28.8)
16-21	Full-term	19 (73.1)	7 (26.9)	χ²=0.388	0.533
16-21	Preterm	35 (79.5)	9 (20.5)
21-27	Full-term	11 (84.6)	2 (15.4)		0.696^a
21-27	Preterm	23 (71.9)	9 (28.1)

The age of 3, 6, 10, 16 and 21 months are included in the subsequent follow-up period, respectively. a, Fisher’s exact test.

2.4 早产SGA与足月SGA维生素A、D水平及骨密度比较

3~6月龄时早产SGA组与足月SGA组维生素A水平[(0.26±0.05) mg/L vs. (0.24±0.05) mg/L，t=-1.104，P=0.275]和维生素D3水平[(43.49±18.92) mg/L vs. (39.11±9.05) mg/L，t=-1.011，P=0.316]差异均无统计学意义，且在各随访时间段两组间骨密度Z值差异均无统计学意义(P＞0.05, 表 3)。

表3 早产SGA和足月SGA骨密度变化情况

Table 3 Bone mineral density changes of preterm SGA and full-term SGA

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
0-3	Preterm	68	-1.980±1.050
3-6	Full-term	59	-1.306±1.220	0.760	0.699
3-6	Preterm	65	-1.465±1.098
6-10	Full-term	51	-0.792±0.918	0.495	0.532
6-10	Preterm	57	-0.875±0.830
10-16	Full-term	47	0.034±0.936	-0.927	0.832
10-16	Preterm	50	0.210±0.932
16-21	Full-term	21	0.367±1.075	-0.236	0.843
16-21	Preterm	29	0.438±1.037
21-27	Full-term	11	0.552±1.088	0.269	0.961
21-27	Preterm	26	0.438±1.214

The age of 3, 6, 10, 16 and 21 months are included in the subsequent follow-up period, respectively. The sample size changed due to the absence of bone mineral density measurement in different follow-up periods. Bonferroni corrected P values, and there were six follow-up time points for indepen-dent hypothesis testing of bone mineral density indicators, with the significance level adjusted to 0.05/6 for individual tests.

2.5 早产SGA和足月SGA运动发育指标的比较

早产SGA在3~6和6~10月龄粗大运动、精细运动与总运动发育商得分均高于足月SGA，差异具有统计学意义(P＜0.05)，其余随访时间段两组间差异均无统计学意义(P＞0.05，表 4)。

表4 早产SGA与足月SGA运动发育情况比较

Table 4 Comparison of motor development of preterm SGA and full-term SGA

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

The age of 3, 6, 10, 16 and 21 months are included in the subsequent follow-up period, respectively. The sample size changed due to the absence of motor development assessment in different follow-up periods. Bonferroni corrected P values, there were six follow-up time points for independent hypothesis testing of different motor indicators, and the significance level of the individual tests was adjusted to 0.05/6, *P < 0.05/6, vs. full-term group. GMQ, gross motor quotient; FMQ, fine motor quotient; TDQ, total development quotient.

2.6 早产SGA喂养方式与追赶生长的关系

为研究早产SGA组喂养方式与追赶生长的关系，本研究矫正了母亲孕期合并症(如高血压、糖尿病、感染等)以及胎盘、脐带异常等影响因素，多因素Logistic回归分析表明，早产SGA组在0~3月龄(aOR=6.29，95%CI：1.04~37.8，P=0.045)及3~6月龄(aOR=27.67，95%CI：1.54~499.04，P=0.024)时母乳喂养与发生追赶生长相关联，而配方奶喂养和混合喂养与发生追赶生长的关联无统计学意义(P＞0.05，表 5)。

表5 早产SGA追赶生长与喂养方式关系

Table 5 Relationship between catch-up growth and feeding patterns in preterm SGA infants

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

aOR, adjusted odds ratio; CI, confident intervals.

2.7 SGA及其追赶生长的相关因素

本研究发现，早产SGA母亲患有妊娠高血压比例(57/87，65.5%)高于足月SGA母亲(20/71，28.2%)，差异具有统计学意义(χ²=21.83，P＜0.05)。母亲孕期合并糖尿病，其SGA在3~6和10~16月龄时发生追赶生长的比例明显低于未合并糖尿病者，差异有统计学意义(P < 0.05)；母亲有胎盘异常(如帆状胎盘、前置胎盘、胎盘早剥等)的情况下，其SGA在16~21月龄时发生追赶生长的比例低于无胎盘异常者，差异接近有统计学意义(P=0.053)；其余情况下(孕期是否合并高血压、肝肾疾病、脐带异常以及双胎)未发现追赶生长的比例差异有统计学意义(P＞0.05，表 6)。

表6 SGA发生相关因素和生后追赶生长的关系

Table 6 The relationship between risk factors of SGA and catch-up growth

Factors	CUG1		CUG2		CUG3		CUG4		CUG5		CUG6
Factors	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

CUG 1-6 represented catch-up growth at 0-3, 3-6, 6-10, 10-16, 16-21, and 21-27 months, respectively. The age of 3, 6, 10, 16 and 21 months are included in the subsequent follow-up period, respectively. “Yes” represents the occurrence of catch-up growth and “No” represents the absence of catch-up growth.

3 讨论

本研究以SGA为研究对象，比较早产及足月SGA在生后2岁内的体格及运动发育情况的差异，并探究两组在追赶生长方面是否存在差异，以及追赶生长与喂养方式的关系。本研究发现，早产SGA出生时各项指标均低于足月SGA，但出生后早期其体重和头围均较足月SGA增长快，且运动发育评估也优于足月SGA，至12月龄左右两组体格指标和运动发育状况趋于一致。从追赶生长方面来看，3月龄内早产SGA发生追赶生长的比例明显高于足月SGA，而在其他月龄则普遍为足月SGA组略高, 此外，母乳喂养可以促进早产SGA实现追赶生长。

SGA的发生由多种因素引起，主要包括母亲因素(孕期营养状况，合并高血压、糖尿病、肝肾病等，细菌、病毒感染等)、胎盘和脐带因素(脐带过细、扭转、过长、过短，胎盘功能低下、胎盘感染、前置胎盘反复出血等)、胎儿因素(双胎、多胎、遗传基因病等)^[11]。孕期的预防干预可减少SGA的发生风险，SGA出生后的规范管理及合理的追赶生长对其儿童及成年时期的身体健康和神经发育也至关重要。早产SGA与足月SGA的追赶生长轨迹存在差异，本研究结果显示，尽管出生时早产SGA身长、体重、头围均落后于足月SGA，但在出生后早产SGA出现加速增长，至5月龄时，两组各体格指标差异已无统计学意义(P>0.05)。一项系统综述分析表明，早产婴儿的出生端粒长度明显长于足月婴儿^[12]；另一项研究也证实，当环境条件影响个体的生长轨迹时，端粒损失的增加可能会支持这种生长加速，比如在生后有限的时间内，生长速度会加快^[13]。这些证据均支持早产SGA的追赶生长潜能优于足月SGA，说明早产SGA在生后一段时间内出现生长加速，体格发育指标可以达到足月SGA水平。出生后早期(6个月内)对早产SGA的营养干预，如常量营养素强化配方奶粉、强化母乳喂养等，可以加速追赶生长^[14]。此外，母亲孕期不合并糖尿病也是早期快速追赶生长的有利因素之一。

一项全球性的meta分析涵盖了60篇相关研究的52 882名儿童(1~12岁)，得出早产和足月SGA认知水平明显低于适于胎龄儿的结论^[15]。Zhao等^[16]研究发现早产SGA较同胎龄非SGA儿童脑瘫发生风险明显升高，张懿敏等^[17]认为胎龄较小早产SGA儿童远期智力发育落后于非SGA儿童，而胎龄较大的早产SGA及足月SGA则与非SGA无明显差异。王晓庆等^[18]研究表明，在18~24月龄时早产SGA和足月SGA大运动水平均落后于足月AGA。同样地，早产SGA在运动和互动过程上的表现明显较差，尽管早产AGA在互动和运动过程中也表现不佳，但比早产SGA要好；有研究发现出现自发追赶生长的SGA神经发育结局更好^[19]。本研究中，早产SGA组在矫正月龄3~6和6~10月龄时的粗大运动、精细运动、总发育商均高于足月SGA组，且头围也大于足月SGA组，证实了头围生长迅速在一定程度上可以反映大脑生长发育良好，运动发育会相对优秀，因此这部分患儿运动发育指标评分也相对较高，但在其余月龄阶段两组间则无明显差异。有研究发现，新生儿重症监护病房(neonatal intensive care unit，NICU)期间的头围生长轨迹与早产SGA神经发育结局相关。如果早产SGA在矫正4月龄时实现头围生长追赶，矫正9月龄时实现身长和体重追赶，则可以预测其在矫正18月龄时神经发育即可达到最佳水平^[20]。一项关于早产或足月SGA早期神经和运动功能的前瞻性队列研究提示，2岁时早产儿组年龄与发育进程问卷(age and stages questionnaires 2, ASQ 2)大运动评分低于分界值的概率比足月儿组高17倍(95%CI：1.9~160.0)^[21]，表明早产SGA幼儿期运动发育指标仍会落后于足月SGA。

本研究发现，维生素A和D水平及骨密度在早产及足月SGA组间差异均无统计学意义。有研究表明孕期低维生素D水平可导致早产及SGA的发生^[22-23]，而早产SGA因宫内营养较差，加之生后喂养不耐受及长期静脉营养均会进一步加重骨代谢异常^[24]，若早期应用更大剂型的维生素AD补剂及强化喂养会使这种情况有所改善，可以与足月SGA维生素A、D水平及骨骼生长发育情况趋于一致^[25]。

母乳是婴幼儿最优的营养来源，有合理的蛋白、脂肪比例及天然的免疫球蛋白。本研究发现，对于早产SGA，0~3和3~6月龄时母乳喂养与追赶生长发生显著相关。有研究分析了早期喂养方式对后期生长轨迹的影响，发现生长速度或追赶生长现象在6~12月龄和12~18月龄之间无明显差异。前6个月的生长速度可能受到喂养方式的影响，似乎是随后生长轨迹的主要预测指标^[26]。母乳喂养可能由于其营养物质的能量效率而对生长发育产生积极影响，因此，目前捐赠人乳已被欧洲儿科胃肠病学、肝病学和营养学会(European Society for Paediatric Gastroenterology, Hepatology and Nutrition，ESPGHAN)提议作为一种策略^[27]，以降低新生儿疾病的风险和相关的死亡率，特别在极早产儿或极低出生体重婴儿^[28]。

本研究尚存在如下局限性：(1)随访时间不固定，实际随访时间点受个体情况影响，导致研究月龄区间相对较大，无法完全代表相应时间点的生长发育及追赶情况。(2)由于研究需要在多个时间点进行随访，随着随访时间延长样本量逐渐减少，导致人群基线特征差异增大，多数SGA在12月龄后随访次数大大下降，考虑可能与其在出生后早期规律随访，追赶生长成功后退出随访有关，导致后续分析观察值和真实值产生偏离。(3)本研究仅分析主要喂养方式与追赶生长的关系，实际可能存在更换喂养方式的情况，比如前期强化奶喂养、后期添加辅食等。(4)本研究将早产SGA与足月SGA进行对比，探讨早产SGA婴幼儿期体格及运动发育情况，缺少与早产AGA之间的比较，后续还需进一步研究。

综上，早产SGA在生后12月龄内体重和头围较足月SGA增长快，运动发育状况优于足月SGA，在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SGA在生后早期追赶生长，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。

利益冲突 所有作者均声明不存在利益冲突。

作者贡献声明 郑萍、林坤鸿：提出研究思路，设计研究方案，分析数据，撰写论文；刘梦圆、赵旭琰、肖扬欣：收集、整理数据；邢燕：总体把关和审定论文。所有作者均参与论文修改，并对最终文稿进行审读和确认。

References

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