日本新生児成育医学会雑誌　第28巻　第1号　31 ～ 38頁（2016年）

日本新生児成育医学会雑誌 28(1)：31-38；2016　

受付日：平成26．11．05

受理日：平成27．06．16

極低出生体重児における修正40 週の体格と脳容量に関する検討

Relationship between Anthropometric Measurements and Brain Volume in Very Low Birth Weight Infants at Around Term-equivalent Age

＊1昭和大学　医学部　小児科学講座，＊2公益財団法人東京都医療公社荏原病院　小児科

＊1Department of Pediatrics, Showa University School of Medicine, ＊2Department of Pediatrics, Tokyo Metropolitan Health and Medical Treatment Corporation Ebara Hospital

渡邊佳孝＊1・板橋家頭夫＊1・滝　元宏＊2・宮沢篤生＊1・中野有也＊1・村瀬正彦＊1・山川琢司＊1

Yoshitaka WATANABE＊1，Kazuo ITABASHI＊1，Motohiro TAKI＊2，Tokuo MIYAZAWA＊1，Yuya NAKANO＊1，Masahiko MURASE＊1，Takuji YAMAKAWA＊1

Key Words：very low birth weight infant，extrauterine growth restriction，nutrition，brain volume

　極低出生体重児を対象に修正40 週周辺の身体計測値と入院中の栄養摂取量やMRI による脳容量，臨床背景との関連性について検討した。対象はおもにearly aggressive nutrition と強化母乳栄養による栄養管理が行われた極低出生体重児27 例で，修正40 週周辺で頭部MRI を撮影した。栄養摂取量は母乳分析をもとに計算した。この検討により以下の結果を得た。①対象27 名の在胎週数，出生体重は29.7 週，1,117g で，修正40 週までの蛋白質摂取量，エネルギー摂取量は2.7g/kg/day，97.9kcal/kg/day，修正40 週周辺の体重，身長，頭囲SD スコア（SDS）は－0.8，－1.4，0.7 であった（中央値）。②重回帰分析では，修正40 週周辺の体重SDS と関連していたのは出生体重SDS とエネルギー摂取量で，身長SDS は出生体重SDS と白質容量が，頭囲SDS は白質容量のみが関連していた。以上より，母乳分析を行うと実際の栄養摂取量は胎児発育に必要なレベルに比べて明らかに低値で，現状の栄養管理法下では身長SDS や頭囲SDS が中枢神経系の発育を反映していると推測された。

　We evaluated the relationship of nutritional status during NICU hospitalization, brain volume measured by MRI, and clinical background with body measurements of very low birth weight infants（ VLBWIs） at around term-equivalent age. Twenty-seven VLBWIs were mainly nutritionally managed through the provision of early aggressive nutrition and human milk fortification, and underwent brain MRIs at around term-equivalent age. A nutritional analysis was also performed. The following results were obtained in this study. 1） The 27 VLBWIs showed the following median values： gestational age, 29.7 weeks；birth weight, 1,117 g；and protein and energy intake, 2.7 g/kg/day and 97.9 kcal/kg/day, respectively. At a corrected age of 40 weeks, the SD scores （SDSs） for body weight, body length, and occipitofrontal circumference （OFC） were －0.8, －1.4, and 0.7, respectively. 2） Multiple regression analyses were also performed and showed the following：the SDS of body weight at around term-equivalent age was a significant determinant of the SDSs of body weight at birth and energy intake；the SDS of body length at around term-equivalent age was a significant determinant of the SDS of body weight at birth and white matter volume；and the SDS of OFC at around termequivalent age was a significant determinant of white matter volume alone. From the aforementioned results, the amount of nutrients that were actually ingested was obviously less than the amount necessary for fetal growth. It was speculated that the SDSs of body length and OFC reflect the development of the central nervous system in VLBWIs receiving nutritional management.