Extrauterine growth retardation in premature infants in Shanghai: a multicenter retrospective review.

Intrauterine growth retardation (IUGR) represents the degree of body growth and development decided by genes and by placental function. Extrauterine growth retardation/restriction (EUGR) refers to severe nutritional deficits during the first weeks of life that result in growth that is less than expected based on intrauterine growth rates (growth values < or =10th percentile of intrauterine growth expected in accordance with the estimated gestational age). The deficits affect not only weight but also head circumference and height. As is well known, a nutrition support team (NST) is a multidisciplinary team comprised of physicians, nurses, dietitians, pharmacists, social workers, and medical technologists who provide nutritional management. In this study, we review 2,015 premature infants (1,209 boys and 806 girls) from four hospitals in the Shanghai area from January 1, 2003 to December 31, 2006, two of which had NSTs. The overall incidence of EUGR was 56.8% assessed by weight, while the incidence of IUGR was 26.1%. Higher incidence of EUGR was associated with lower birth weight, but higher gestational age. There was a significant relationship between EUGR incidence and NST availability (chi(2) = 60.630, p < 0.001), though there was no similar finding for IUGR incidence. The incidence of EUGR was 44% in NST hospitals and 62.6% in non-NST hospitals. According to logistic regression, the following five factors were related to EUGR: male gender, gestational age at birth, birth weight, length of hospital stay, and NST availability. NSTs reduced the risk of EUGR by a magnitude of 0.47. EUGR remains a serious problem in premature infants in Shanghai, but NSTs can reduce EUGR incidence.

[Studies of the norm and psychometric properties of Ages and Stages Questionnaires in Shanghai children].

OBJECTIVE: To introduce the Ages and Stages Questionnaire (ASQ) to China, we created ASQ-Chinese (ASQ-C) and carried out studies of its norm and the psychometrical properties in Shanghai children aged 3-66 months in collaboration with the author of the ASQ with the permissions from the publisher. METHOD: The 19 ASQ intervals were translated into Chinese, to make the ASQ-C culturally relevant, and back translated into English. The project used a stratified cluster sampling method and recruited children aged 3 - 66 months with respect to demographic characteristics that were representative of Shanghai census data, and excluded the children whose mother tongue was not Chinese and/or diagnosed with disabilities by the authoritative hospitals in Shanghai. Parents/caregivers of the 8472 children either independently completed the age-appropriate ASQ-Cs or completed with help from the researchers for the normative samples. Among them, professionals completed the age-appropriate ASQ-C again for 519 children within six days after the parents/caregivers completed the ASQ-C for inter-rater reliability. In terms of test-retest reliability, 651 parents completed another age-appropriate questionnaires within a 10- to 23-day interval. For concurrent validity, BSIDII were administered with 255 children from 6, 12, 18, 24, and 30-month ASQ-C age intervals. The cutoffs of the ASQ-C and the BSIDII were all set at the two standard deviations below the means. The statistical analysis was carried out using SPSS 13.0. RESULT: The ASQ-Cs were independently completed by 85.25% of the parents/caregivers; the percentage of gender, family income and region of residence were similar to the Shanghai population census conducted in the recent years. Two standard deviations below the means were used as the cutoff scores of the ASQ-Cs across the age intervals. In terms of internal consistency of the ASQ-C, Cronbach standardized alpha was 0.77. The Pearson correlation coefficient between the ASQ-C total scores of the two testers was 0.84 (P < 0.0001). The Pearson correlation coefficient between the ASQ-C total scores of the two tests was 0.82 (P < 0.0001). The percentage of the agreement between the ASQ-C and the BSID II was 84.31%, the sensitivity of ASQ-C was 85.00%, and the specificity of ASQ-C was 84.26%. CONCLUSION: It is practicable that the ASQ-C can be completed by the parents/caregivers of Shanghai children. ASQ-C has solid psychometric properties and is worthy of further research and introduction to China.

[Extrauterine growth retardation and correlated factors in premature neonates].

OBJECTIVE: Poor growth is a common problem in premature neonates. No sufficient attention has been paid to the nutrition deficit and extrauterine growth retardation in premature neonates in China. The present study aimed to assess the incidences of intrauterine growth retardation (IUGR) and extrauterine growth retardation (EUGR) in premature neonates in Shanghai area and their correlated factors. METHODS: Data of the neonates discharged between January 1, 2003 and December 31, 2004 from 5 hospitals (Xinhua Hospital, Shanghai Children's Medical Center, Shanghai Children's Hospital, Pediatric Hospital Affiliated to Fudan University, and Shanghai International Peace Maternity and Child Health Hospital) were reviewed. The criteria of exclusion were cases who died or had a malformed appearance, the mother had endocrine or metabolic diseases. The criteria for enrollment were (1) gestational age < 37 weeks, (2) admitted less than 24 hours after birth and discharged from the same hospital, (3) duration of hospitalization was > or = 7 days. The growth values on discharge of each patient were compared to the expected values based on the intrauterine growth data and postmenstrual day on discharge. Growth retardation was defined as measured growth values (weight, head circumference) < or = 10th percentile of the values (growth expectation based on estimated postmenstrual age). In each specific group, the number of neonates with < or = 10(th) percentile for each growth parameter was counted and the percentages of patients who had values < or = 10(th) percentile on birth and discharge were calculated. The growth curves used for assessing birth weight and head circumference for different gestational age neonates were those published in 1986. All the data were analyzed using the SPSS statistical software package. The risk factors for extrauterine growth retardation on weight and head circumference were estimated with logistic regression model. RESULTS: The subjects included 1196 premature neonates in the five hospitals (734 boys and 462 girls). The incidence of IUGR was 22.7% and 19.2% assessed by weight and head circumference, respectively. The incidence of EUGR was 49.7% and 23.1% assessed by weight and head circumference, respectively. Assessment of IUGR in accordance with the birth weight and head circumference in the five hospitals showed no significant correlation between IUGR and non-IUGR by birth weight (chi(2) = 4.944) and head circumference (chi(2) = 0.017) respectively. Whereas the assessment of EUGR in accordance with weight and head circumference showed a significant correlation between EUGR and non-EUGR by weight on discharge (chi(2) = 28.109), but no significant correlation was found between EUGR and non-EUGR by head circumference on discharge (chi(2) = 0.275). In specific birth weight groups, the lower the weight, the higher the incidence of IUGR and EUGR by the weight and head circumference. The incidence of EUGR in VLBWI was 78.9% and 50.0% assessed by weight and head circumference, respectively. Assessed by weight, significant correlation was observed between EUGR and non-EUGR in birth weight (t = 18.674), hospitalization duration (Z = -8.790) and the median number of day for total using EN (Z = -4.650); but by the head circumference, significant correlation was observed in head circumference at birth (t = 9.555), hospitalization duration (Z = -3.930) and the median number of day for total using EN (Z = -3.004). The relationship between EUGR and some risk factors was analyzed with Logistic regression model. Assessed by the weight, the following 4 factors were related to EUGR: sex (chi(2) = 10.351), gestation age at birth (chi(2) = 56.275), birth weight (chi(2) = 102.126) and different hospital (chi(2) = 4.773). Assessed by the head circumference, the following 2 factors were correlated: gestation age at birth (chi(2) = 10.322) and head circumference (chi(2) = 10.620). CONCLUSIONS: This study showed that the incidence of EUGR in premature neonates was significantly higher than the data reported in other countries. The incidence of EUGR increased with the decreased birth weight. Different nutritional support had influence on EUGR.