早产儿宫外生长迟缓定义的一致性研究

Consistency of different definitions of extrauterine growth retardation in preterm infants

摘要

目的 通过系统评估不同早产儿宫外生长迟缓(EUGR)定义在早产儿中的诊断一致性,量化生长曲线、评估维度和胎龄的交互效应,为EUGR诊断标准的优化和标准化提供实证依据。方法 采用回顾性队列研究,选取2015年1月—2024年12月在海军军医大学第一附属医院及两家分中心新生儿病房住院的1 471例早产儿[按胎龄分为极早产儿组(<32周)、中期早产儿(32~<34周)、晚期早产儿组(34~<37周)3组],基于Fenton、INTERGROWTH-21^st和Olsen 3种生长曲线,结合横断面、纵向、真实横断面和真实纵向4种评估维度,构建12种EUGR定义。采用Cohen's Kappa系数评估定义间的一致性,并运用广义线性混合模型分析各因素效应。结果 EUGR检出率随胎龄增长而显著降低(χ²=11.633~404.237,P<0.001)。定义间一致性分析显示相同维度不同曲线间一致性最高(κ=0.55),相同曲线不同维度间一致性中等(κ=0.50),跨曲线维度组合一致性最弱(κ=0.29)。曲线选择对检出率影响大于维度选择(Wald χ²=604.43/ χ²=107.44)。胎龄与维度存在显著交互作用,纵向维度在晚期早产儿组检出率急剧降低并接近于0(95%CI: 0.0%~0.0%)。结论 基于研究结果建立分层诊断路径:极早产儿可优先考虑Fenton/Olsen真实纵向定义,中期早产儿建议联合评估,晚期早产儿可选用Olsen横断面定义。

Abstract

Objective To systematically evaluate the diagnostic consistency of different definitions of extrauterine growth retardation (EUGR) in preterm infants, and to quantify the interaction effects of growth charts, assessment dimensions, and gestational age, so as to provide evidence for prioritizing and standardizing the diagnosis criteria of EUGR. Methods In this retrospective cohort study, 1 471 preterm infants admitted to the neonatal ward of the First Affiliated Hospital of Naval Medical University and two participating centers between January 2015 and December 2024 were included. Infants were categorized into three groups according to gestational age: extremely preterm infants (<32 weeks), moderately preterm infants (32 to <34 weeks), and late preterm infants (34 to <37 weeks). Twelve EUGR definitions were constructed based on three growth charts (Fenton, INTERGROWTH-21^st, and Olsen) and four assessment dimensions (cross-sectional, longitudinal, true cross-sectional, and true longitudinal). Cohen's Kappa coefficient was used to assess agreement among definitions, and generalized linear mixed models were used to analyze the effects of each factor. Results The EUGR detection rate significantly decreased with increasing gestational age (χ²=11.633 - 404.237,P<0.001). Consistency analysis showed the highest agreement among different charts within the same assessment dimension (κ=0.55), moderate agreement among different dimensions within the same chart (κ=0.50). The agreement was the weakest across different chart-dimension combinations (κ=0.29). The choice of growth chart had a greater impact on the detection rate than the choice of assessment dimension (Wald χ²=604.43/ χ²=107.44). There was a significant interaction between gestational age and assessment dimensions, with the longitudinal dimension showing a sharp decline in detection rate in the late preterm group, approaching nearly zero (95%CI: 0.0% - 0.0%). Conclusion Based on the study findings, a stratified diagnostic approach may be proposed: for extremely preterm infants, the true longitudinal definitions based on the Fenton or Olsen growth charts may be prioritized; for moderately preterm infants, a combined assessment may be considered; and for late preterm infants, the Olsen cross-sectional definition may be an option.

关键词

宫外生长迟缓 / 生长曲线 / 胎龄效应 / 评估维度 / 早产儿

Key words

extrauterine growth retardation / growth curve / gestational age effect / assessment dimensions / preterm infants

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