Objective

To examine associations of systemic inflammation with growth outcomes at neonatal intensive care unit discharge or transfer among infants with extremely low gestational ages.

Study design

We studied 850 infants at born at 23-27 weeks of gestation. We defined inflammatory protein elevation as the highest quartile of C-reactive protein (CRP), Interleukin (IL)-6, tumor necrosis factor-∝, or IL-8 on postnatal days 1, 7, and 14. We compared z-scores of weight, length, and head circumference at neonatal intensive care unit discharge or transfer between infants with vs without inflammatory protein elevation, adjusting in linear regression for birth size z-score, sex, gestational age, diet, comorbidities, medications, and length of hospitalization.

Results

The mean gestational age was 25 weeks (range, 23-27 weeks) and birth weight z-score 0.14 (range, −2.73 to 3.28). Infants with a high CRP on day 7 had lower weights at discharge or transfer (−0.17 z-score; 95% CI, −0.27 to −0.06) than infants without CRP elevation, with similar results on day 14. Infants with CRP elevation on day 14 were also shorter (−0.21 length z-scores; 95% CI, −0.38 to −0.04), and had smaller head circumferences (−0.18 z-scores; 95% CI, −0.33 to −0.04) at discharge or transfer. IL-6 elevation on day 14 was associated with lower weight (−0.12; 95% CI, −0.22 to −0.02); IL-6 elevation on day 7 was associated with shorter length (−0.27; 95% CI, −0.43 to −0.12). Tumor necrosis factor-∝ and IL-8 elevation on day 14 were associated with a lower weight at discharge or transfer.

Conclusions

Postnatal systemic inflammation may contribute to impaired nutrient accretion during a critical period in development in infants with extremely low gestational ages.

中文翻译：

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出生后前 2 周的全身炎症是极低胎龄住院婴儿身体发育结果的决定因素

客观的

旨在检查全身性炎症与新生儿重症监护病房出院或极低胎龄婴儿转移时的生长结果之间的关联。

学习规划

我们研究了 850 名出生时妊娠 23-27 周的婴儿。我们将炎症蛋白升高定义为产后第 1、7 和 14 天 C 反应蛋白 (CRP)、白细胞介素 (IL)-6、肿瘤坏死因子-∝ 或 IL-8 的最高四分位数。我们比较了 z 分数新生儿重症监护病房出院时体重、身长和头围的变化，或在炎性蛋白升高与无炎性蛋白升高的婴儿之间转移，调整出生大小 z 评分、性别、胎龄、饮食、合并症、药物和产程长短的线性回归住院。

结果

平均胎龄为 25 周（范围，23-27 周），出生体重 z 评分为 0.14（范围，-2.73 至 3.28）。第 7 天 CRP 高的婴儿在出院或转院时的体重低于 CRP 未升高的婴儿（-0.17 z 分数；95% CI，-0.27 至 -0.06），第 14 天的结果相似。第 14 天也较短（-0.21 长度 z 分数；95% CI，-0.38 至 -0.04），出院或转移时头围较小（-0.18 z 分数；95% CI，-0.33 至 -0.04） . 第 14 天 IL-6 升高与体重减轻相关（-0.12；95% CI，-0.22 至 -0.02）；第 7 天的 IL-6 升高与较短的长度相关（-0.27；95% CI，-0.43 至 -0.12）。第 14 天肿瘤坏死因子-∝ 和 IL-8 升高与出院或转院时体重减轻有关。

结论

在胎龄极低的婴儿发育的关键时期，产后全身性炎症可能会导致营养物质积累受损。