日本未熟児新生児学会雑誌　第27巻第1号　77 ～ 83頁（2015年）

日本未熟児新生児学会雑誌　27(1)：77-83；2015　

受付日：平成26．01．23

受理日：平成26．07．09

早産低出生体重児におけるNICU 入院中の身体測定値SD スコアの推移に関する検討

Standard Deviation Score of Physical Growth during Neonatal Intensive Care Unit Hospitalization in Preterm and Low Birth Weight Infants

昭和大学　医学部　小児科学講座

Department of Pediatrics, Showa Univerisity School of Medicine

小林　梢・櫻井基一郎・板橋家頭夫・滝　元宏・中野有也・宮沢篤生・村瀬正彦・三浦文宏・相澤まどか・水野克巳

Kozue KOBAYASHI，Motoichiro SAKURAI，Kazuo ITABASHI，Motohiro TAKI，Yuya NAKANO，Tokuo MIYAZAWA，Masahiko MURASE，Fumihiro MIURA，Madoka AIZAWA，Katsumi MIZUNO

Key Words：preterm infant, SD score，extrauterine growth restriction， nutrition，postnatal growth monitoring

　早産児の成長は，身体測定値で評価することが一般的であるが，標準値との較差や推移が評価し難いという問題点がある。そこで，今回我々は，在胎期間別出生時体格標準値から算出したSD スコア（SDS）を用いて評価を行った。対象は2006 年からの6 年間に入院した在胎28 週以下のappropriate for gestational age 児64 名である。対象を在胎25 週以下，および26，27，28 週の4 群に分けSDS の推移を評価した。その結果，全ての群で体重，身長，頭囲のSDS は一旦減少した後に増加に転じていた。在胎が未熟であるほどSDS 最低値と修正40 週のSDS は低値であった。各在胎週数群間で，SDS 増加量に有意差は認めなかった。以上より，入院中の成長改善には，生後早期のSDS 減少を最小限とし，増加に転じるまでの期間を短縮することが必要であると考えられた。また，SDS は日常診療における成長評価の指標として有用であると考えられる。

　A correlation between growth during NICU hospitalization and later physical growth and neurological development has been reported. Moreover, it is common to evaluate the growth of preterm infants by tracking the changes in physical measurements in the NICU. Extrauterine Growth Restriction（EUGR）has recently been in use as a growth index. It is reported that prevention of EUGR could improve long-term outcomes for infants admitted in the NICU. However, EUGR is a growth index that is applied at 40 weeks of corrected gestational age. Therefore, it can only be used at the time of discharge and does not allow measurement of the changes during hospitalization. In addition, it is difficult to evaluate the range from the standard values by using only the physical measurements. In this study, we evaluated the chronological growth of preterm infants by using the standard deviation score（SDS）that is based on the new standard values for each gestational age as stated in Japan in 2010. The subjects were preterm infants with a gestational age ≦28 weeks, born and admitted to the NICU between January 2007 and December 2012. Sixty-four appropriate for gestational age （AGA）infants were divided into 4 groups according to their gestational age in weeks（≦25, 26, 27, and 28）, and we calculated the mean SDS of every corrected week for each group.
　The SDS of weight, height, and head circumference all decreased once and subsequently increased at 30–31 weeks of corrected age. However, there was no significant difference in the rate of decreasing or increasing in the SDS among the groups. If SDS starts to increase earlier, SDS would be higher at the term equivalent age, thereby enabling the prevention of EUGR and improving growth at the term equivalent age. Thus, inducing the early increase of SDS is necessary. SDS would be also be a useful method to evaluate growth and nutrition in daily medical treatment.