Olsen Else M, Skovgaard Anne M, Weile Birgitte, Jørgensen Torben
Research Centre for Prevention and Health, and Child and Adolescent Psychiatric Centre, Copenhagen University Hospital, Glostrup, Denmark.
Paediatr Perinat Epidemiol. 2007 Sep;21(5):418-31. doi: 10.1111/j.1365-3016.2007.00851.x.
Failure to thrive (FTT) is the term widely used to describe poor weight gain in infancy, a condition associated with cognitive deficiency in later childhood. FTT has been investigated in earlier population studies, but little is known about risk factors for FTT or the sequence of events as this requires data to be collected prospectively within the first year of life. Furthermore, several different anthropometric criteria have been used to define FTT, and it is not known whether children identified by the different criteria are comparable. In the present population study we compared risk factors for FTT in a general infant population using different definitions of FTT. Three different criteria of FTT mirroring those used in previous population studies were applied to a birth cohort of 6090 infants. Sociodemographic data and prospectively collected information concerning physical and mental development of the children were obtained from National registries and standardised public health nurse records. Risk factors preceding each of the three 'types' of FTT were compared. The three criteria for FTT identified children with very different profiles and a prevalence of FTT ranging from around 2% to 21% in this affluent population. The criterion of slow weight gain conditional on birthweight (conditional weight gain) was associated with lower birthweight, small-for-gestational-age and deviant overall development. Adding low body mass index did not change this profile. In contrast, the commonly used criterion of downward crossing of centiles on an ordinary weight-for-age chart was associated with factors normally linked with low risk of adverse physical and mental development. Slow conditional weight gain, irrespective of additional thinness, seemed to identify infants with prenatal growth retardation and early developmental delays. In contrast, simple downward crossing of centiles seemed mainly to identify healthy low-risk infants, and thus, seems a poor screening measure of FTT in this affluent infant population. Thus, conditional weight gain appears to be the most sensible measure of FTT at present. However, only longitudinal studies including different anthropometric measures and different outcomes can unravel the discriminating power of the different FTT definitions concerning long-term prognosis.
生长发育不良（FTT）是一个广泛用于描述婴儿期体重增加不佳的术语，这种情况与儿童后期的认知缺陷有关。早期的人群研究曾对生长发育不良进行过调查，但对于生长发育不良的风险因素或事件顺序了解甚少，因为这需要在生命的第一年进行前瞻性数据收集。此外，已经使用了几种不同的人体测量标准来定义生长发育不良，并且尚不清楚通过不同标准识别出的儿童是否具有可比性。在本人群研究中，我们使用生长发育不良的不同定义比较了普通婴儿群体中生长发育不良的风险因素。将反映先前人群研究中使用的标准的三种不同的生长发育不良标准应用于6090名婴儿的出生队列。社会人口统计学数据以及有关儿童身体和心理发育的前瞻性收集信息来自国家登记处和标准化的公共卫生护士记录。对三种“类型”的生长发育不良之前的风险因素进行了比较。这三种生长发育不良标准识别出的儿童情况差异很大，在这个富裕人群中，生长发育不良的患病率在2%至21%左右。以出生体重为条件的体重增长缓慢（条件性体重增加）标准与较低的出生体重、小于胎龄儿以及整体发育异常有关。加上低体重指数并没有改变这种情况。相比之下，在普通年龄别体重图表上百分位数下降的常用标准与通常与身心发育不良低风险相关的因素有关。无论是否额外消瘦，条件性体重增长缓慢似乎能识别出有产前生长迟缓及早期发育延迟的婴儿。相比之下，单纯的百分位数下降似乎主要识别出健康的低风险婴儿，因此，在这个富裕的婴儿群体中，这似乎是一种较差的生长发育不良筛查措施。因此，条件性体重增加目前似乎是生长发育不良最合理的衡量标准。然而，只有包括不同人体测量指标和不同结局的纵向研究才能揭示不同生长发育不良定义对长期预后的鉴别能力。
