Elizabeth K E, Krishnan Viji, Vijayakumar T
SAT Hospital, Government Medical College, Thiruvananthapuram, India.
Indian J Med Res. 2008 Aug;128(2):128-33.
BACKGROUND & OBJECTIVE: Low birth weight (LBW) babies are a vulnerable group and represent two outcomes--preterm birth (preterm LBW) and term with intrauterine growth retardation (term LBW). LBW babies are considered to have low nutrient reserve, but the extent of deficiency as compared to the normal babies and the differences between preterm LBW and term LBW are unclear. This study was carried out to look at key anthropometric, biochemical and clinical (ABC) parameters of LBW babies, both preterm and term, in comparison to a control group of term normal weight babies.
A group of 500 babies was selected at birth from a tertiary care teaching hospital and categorized into LBW (n = 251) with preterm LBW (n = 59), term LBW (n = 192) and term controls (n = 249). Two controls were dropped as tests could not be performed in the available cord blood sample. Key anthropometric and biochemical parameters were measured. Socio-economic status, age, parity, height and pre-delivery haemoglobin of the mothers were also recorded.
The maternal characteristics were comparable in the three groups. Socio-economically, majority of them belonged to lower middle or upper lower class (Class III and IV) representing the non affluent. All the anthropometric measurements and nutrients measured namely total protein, albumin, cholesterol, triglycerides, calcium, magnesium, zinc and iron were significantly lower in LBW babies compared to term control babies. These values were lowest in preterm LBW followed by term LBW. Total iron binding capacity (TIBC) showed inverse association with iron. Some of the babies including control babies had protein, albumin, calcium and iron below the normal range and mean albumin, calcium and iron levels were below the normal range in all the three subsets.
INTERPRETATION & CONCLUSION: Preterm and term LBW babies are born with significantly lower nutrient reserves at birth compared to term control babies. Normal weight babies from the non affluent sections also have low nutrients especially albumin, calcium and iron. As these levels are liable to be further lowered by recurrent infections and inappropriate feeding habits, nutritional surveillance, extra feeding and supplements like calcium and iron are recommended for such vulnerable babies to promote optimum growth and to prevent deficiencies. This is important as currently, there are no clear or uniform recommendations for extra feeding and nutrient supplements to LBW babies and no supplements other than exclusive breast feeding are recommended for term normal birth weight babies. Extra nutritional inputs for LBW and selected non affluent babies along with care of the prospective and prenatal mothers for ensuring adequate transfer of nutrients to the offspring seem necessary. Such interventions can be integrated with the existing health care programmes to reach all the beneficiaries.
低体重出生儿是一个弱势群体，包括两种情况——早产低体重儿（早产低体重）和足月但宫内生长受限的低体重儿（足月低体重）。低体重出生儿被认为营养储备较低，但与正常出生儿相比，其缺乏程度以及早产低体重儿和足月低体重儿之间的差异尚不清楚。本研究旨在观察早产和足月低体重出生儿的关键人体测量、生化和临床（ABC）参数，并与足月正常体重出生儿的对照组进行比较。
从一家三级护理教学医院选取500名出生时的婴儿，分为低体重组（n = 251），其中早产低体重儿（n = 59）、足月低体重儿（n = 192）和足月对照组（n = 249）。由于在可用的脐带血样本中无法进行检测，剔除了两名对照组婴儿。测量了关键的人体测量和生化参数。还记录了母亲的社会经济地位、年龄、产次、身高和产前血红蛋白水平。
三组母亲的特征具有可比性。在社会经济方面，她们中的大多数属于中下层或中上层下层阶级（III类和IV类），代表非富裕阶层。与足月对照组婴儿相比，低体重出生儿的所有人体测量指标和所测量的营养素，即总蛋白、白蛋白、胆固醇、甘油三酯、钙、镁、锌和铁，均显著较低。这些值在早产低体重儿中最低，其次是足月低体重儿。总铁结合力（TIBC）与铁呈负相关。包括对照组婴儿在内的一些婴儿的蛋白质、白蛋白、钙和铁低于正常范围，并且在所有三个亚组中，平均白蛋白、钙和铁水平均低于正常范围。
与足月对照组婴儿相比，早产和足月低体重出生儿出生时的营养储备明显较低。来自非富裕阶层的正常体重婴儿也有低营养素情况，尤其是白蛋白、钙和铁。由于反复感染和不适当的喂养习惯可能会使这些水平进一步降低，因此建议对这类脆弱的婴儿进行营养监测、额外喂养以及补充钙和铁等营养素，以促进最佳生长并预防营养缺乏。这一点很重要，因为目前对于低体重出生儿的额外喂养和营养补充没有明确或统一的建议，并且对于足月正常出生体重的婴儿，除了纯母乳喂养外不建议使用其他补充剂。对低体重出生儿和部分非富裕婴儿进行额外的营养投入，以及照顾准母亲和产前母亲以确保向后代充分输送营养似乎是必要的。此类干预措施可与现有的医疗保健计划相结合，以惠及所有受益者。
