Predictive Value of a Multidimensional Neonatal Nutritional Risk Screening Scale for Extrauterine Growth Restriction in Premature Infants
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摘要:
目的 应用多维度新生儿营养风险筛查量表对住院早产儿入开展营养风险筛查，探讨其对早产儿出院时发生EUGR的预测价值。 方法 选取 2023年1月至2023年9月在昆明医科大学第二附属医院新生儿科住院的104名早产儿为研究对象，入院24 h内、每隔1周采用多维度新生儿营养风险筛查量表对住院患儿进行营养风险筛查，从4个维度（出生情况、体重变化、营养摄入方式、疾病诊断）进行评分，总分≥8分为高风险；≥4分且<8分为中风险；<4分为低风险。以早产儿出院时宫外生长迟缓（EUGR）为主要临床结局指标，绘制受试者工作曲线（ROC），探索新生儿营养风险筛查对早产儿宫外发育迟缓的预测价值。 结果 出院时共有40例（38.5%）早产儿发生EUGR。EUGR组早产儿入院第7天营养风险筛查评分高于非EUGR组（P < 0.05）。入院第7天营养风险高风险率最高（非EUGR组为7.9%，EUGR组为22%，所有早产儿为13.5%），在入院24 h，入院第7 d时EUGR早产儿的营养风险高风险率高于非EUGR组（P < 0.05）。EUGR组和非EURG组的入院第7天营养风险筛查得分、出生体重Z评分、出院时矫正胎龄别体重Z评分、血清白蛋白存在显著差异（P < 0.05），分别绘制ROC曲线，AUC分别为0.625（95%CI 0.514，0.736）、0.652（95%CI 0.544，0.760）、0.674（95%CI 0.561，0.786）、0.641（95%CI 0.531，0.750），具有一定的预测价值。建立联合预测ROC模型，联合预测EUGR的AUC为0.786（95%CI 0.692，0.880），高于单一指标预测的AUC（P < 0.001）。 结论 EUGR在住院早产儿中的发生较为普遍。早产儿住院第1周的营养风险最高，多维度新生儿营养风险筛查量表可动态评估早产儿住院期间的营养风险，可作为早产儿发生EUGR的预警指标之一，联合出生体重Z评分、出院体重Z评分、血清白蛋白对EUGR的预测效能更高，可作为早产儿个体化营养管理的依据。 Abstract:Objective To apply a multidimensional neonatal nutritional risk screening scale for hospitalized premature infants to explore its predictive value for extrauterine growth restriction （EUGR） at the time of discharge. Methods A total of 104 premature infants hospitalized in the Neonatal Department of the Second Affiliated Hospital of Kunming Medical University from January 2023 to September 2023 were selected as research subjects. Nutritional risk screening was conducted within 24 hours of admission and weekly thereafter using the multidimensional neonatal nutritional risk screening scale. Scoring was based on four dimensions （birth status, weight changes, nutritional intake methods, and disease diagnosis）, with a total score of ≥8 indicating high risk; ≥4 and <8 indicating moderate risk; and <4 indicating low risk. EUGR at the time of discharge was the primary clinical outcome indicator. Receiver operating characteristic （ROC） curves were constructed to explore the predictive value of neonatal nutritional risk screening for EUGR in premature infants. Results At discharge, 40 premature infants （38.5%） experienced EUGR. The nutritional risk screening scores of the EUGR group on day 7 of hospitalization were higher than those of the non-EUGR group （P < 0.05）. The rate of high nutritional risk on day 7 of hospitalization was highest （7.9% in the non-EUGR group, 22% in the EUGR group, and 13.5% overall）. On both day 1 and day 7 of hospitalization, the rate of high nutritional risk in the EUGR group was higher than that in the non-EUGR group （P < 0.05）. There were significant differences in the nutritional risk screening scores on day 7, birth weight Z-scores, discharge corrected gestational age weight Z-scores, and serum albumin levels between the EUGR and non-EUGR groups （P < 0.05）. ROC curves were plotted, yielding AUCs of 0.625 （95%CI 0.514, 0.736）, 0.652 （95%CI 0.544, 0.760）, 0.674 （95%CI 0.561, 0.786）, and 0.641 （95%CI 0.531, 0.750）, indicating certain predictive value. A combined predictive ROC model yielded an AUC of 0.786 （95%CI 0.692, 0.880） for EUGR, which was higher than the AUCs for individual indicators （P < 0.001）. Conclusion The occurrence of EUGR is relatively common among hospitalized premature infants. The nutritional risk is highest during the first week of hospitalization. The multidimensional neonatal nutritional risk screening scale can dynamically assess nutritional risk during hospitalization and may serve as one of the early warning indicators for EUGR in premature infants. The predictive efficacy for EUGR is enhanced when combined with birth weight Z-scores, discharge weight Z-scores, and serum albumin, providing a basis for individualized nutritional management of premature infants. -
图 1 营养风险筛查高风险率变化趋势
注：*表示EUGR组和非EUGR组早产儿在入院24 h营养风险筛查高风险率的差异有统计学意义（χ2 = 8.321， P = 0.016）；** 表示EUGR组和非EUGR组早产儿在入院第7天营养风险筛查高风险率的差异有统计学意义（χ2 = 6.589，P = 0.037）
Figure 1. Trends in high-risk screening for nutritional risk
图 2 营养风险筛查及联合其他危险因素预测EUGR的ROC曲线
Figure 2. ROC curve for nutritional risk screening and the prediction of EUGR in conjunction with other risk factors
表 1 两组早产儿基线资料比较 [n（%）]
Table 1. Comparison of baseline data between two groups of preterm infants [n（%）]
组别 n 男孩 剖宫产 VLBW 出生胎龄≥32周 SGA NRDS PDA Sepsis BPD 非EUGR组 64 31（48.4） 36（56.3） 10（15.6） 40（62.5） 4（6.3） 18（28.1） 9（14.1） 10（15.6） 3（4.7） EUGR组 40 27（67.5） 23（57.5） 6（15.0） 26（65.0） 4（10.0） 13（32.5） 4（10.0） 5（12.5） 4（10.0） χ2 3.626 0.016 0.07 0.311 0.488 0.225 0.371 0.195 1.107 P 0.057 0.900 0.932 0.856 0.485 0.635 0.542 0.659 0.293 注：EUGR为宫外发育迟缓，VLBW为极低出生体重儿，SGA为小于胎龄儿，PDA为动脉管未闭，Sepsis为脓毒症，BPD为支气管肺发育不良。 
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表 2 两组早产儿营养风险筛查评分（$ \bar x \pm s $）
Table 2. Nutritional risk screening scores for preterm infants in two groups （$ \bar x \pm s $）
筛查时点 n 营养风险筛查得分 z P 非EUGR组 EUGR组 入院24 h 104 4.98±1.52 5.02±1.88 −0.065 0.948 入院第7天 104 4.44±1.99 5.29±2.14 −2.077 0.038* 入院第14天 45 4.88±1.99 5.20±1.99 −0.639 0.523 入院第21天 29 5.00±1.78 4.38±2.06 −1.095 0.274 *P < 0.05。
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表 3 两组早产儿生长及营养相关指标比较[M（Q1，Q3）]
Table 3. Comparison of growth and nutrition related indexes between two groups [M（Q1，Q3）]
组别 出生体重Z评分 出院时矫正胎龄
别体重Z评分肠内营养
开始时龄（h）到达全肠内
营养的时间（d）白蛋白（g/L） 非EUGR组 −0.04（−0.83，0.94） 0.61（−0.16，1.65） 1（1，12） 4（0，7） 31.30（28.25，34.50） EUGR组 −0.75（−1.60，0.14）* −0.34（−1.16，0.94）* 1.25（1，24） 6（1，14） 30.10（25.35，32.20）* u −2.481 −2.957 −1.426 −1.796 −2.396 p 0.013 0.003 0.154 0.072 0.017 *P < 0.05。 注：出生体重Z评分=（出生体重-同胎龄同性别参考人群体重平均值）/同胎龄同性别参考人群体重标准差；出院时矫正胎龄别体重Z评分=（出生时体重-同矫正胎龄同性别参考人群体重平均值）/同矫正胎龄同性别参考人群体重标准差。
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表 4 营养风险筛查及联合预测EUGR的ROC曲线下面积
Table 4. Area under the ROC curve for nutritional risk screening and combined prediction of EUGR
检验结果变量 曲线下面积 标准误差 渐近显著性 渐近 95%CI 下限 上限 血清白蛋白 0.641 0.056 0.012 0.531 0.750 出院时矫正胎龄别体重Z评分 0.674 0.057 0.002 0.561 0.786 出生体重Z评分 0.652 0.055 0.006 0.544 0.760 入院第7天营养风险筛查得分 0.625 0.057 0.028 0.514 0.736 4项联合预测概率 0.786 0.048 0.000 0.692 0.880
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