Bois C, Servolin J, Guillemot G
Service départemental de protection maternelle et infantile (PMI), conseil général des Hauts-de-Seine, 2-16 boulevard Soufflot, Nanterre, Hauts-de-Seine, France.
Arch Pediatr. 2010 Jul;17(7):1035-41. doi: 10.1016/j.arcped.2010.03.017. Epub 2010 May 21.
The WHO curves published in 2006 reflect the exact growth of infants who are exclusively breast-fed for at least 4 months. These curves are universal but not widely used in France. At 2-3 months, they have a much higher level than the curves of the Personal Child Health Record. The aim of our study was to evaluate whether the choice of the type of curve influenced the interpretation of infant growth and the advice given, and whether WHO curves could be used for all infants. Initially, 22 physicians retrospectively interpreted the WHO and Personal Child Health Record weight gain curves of 20 infants who were exclusively breast-fed. All of the curves were interpreted twice. In a second step, we drew the WHO curves from 0 to 3 months for the 151 infants monitored by the consultation. At 2 months, there is a very clear discordance in the interpretations of the French and WHO curves (weighted kappa = -0.26 CI 95% [-0.62; 0.18]), contrasting with the satisfactory concordance of the WHO interpretations (weighted kappa = 0.71 CI 95% [0.25; 0.89]) and Personal Child Health Record (weighted kappa = 0.58 CI 95% [0.09; 0.81]) curves. By overestimating the weight gain during the first weeks, in one-third of the infants use of the French curves leads to either inappropriate suggestions of restrictions or their insufficient weight not being taken into account. Moreover, the weight gain at 2-3 months for 151 infants of all categories is within the limits of the WHO curves, without going below the percentile lines for the non-breast-fed infants, except premature babies. Broader use of the WHO curves could be proposed in order to optimize the care of infants, regardless of how they are fed.
2006年发布的世界卫生组织（WHO）生长曲线反映了纯母乳喂养至少4个月婴儿的确切生长情况。这些曲线具有通用性，但在法国并未得到广泛应用。在2至3个月时，它们的水平比个人儿童健康记录中的曲线要高得多。我们研究的目的是评估生长曲线类型的选择是否会影响对婴儿生长的解读及所给出的建议，以及WHO生长曲线是否可用于所有婴儿。最初，22位医生回顾性地解读了20名纯母乳喂养婴儿的WHO生长曲线和个人儿童健康记录中的体重增加曲线。所有曲线都被解读了两次。第二步，我们为咨询门诊监测的151名婴儿绘制了0至3个月的WHO生长曲线。在2个月时，法国生长曲线和WHO生长曲线的解读存在非常明显的不一致（加权卡帕值=-0.26，95%置信区间[-0.62；0.18]），这与WHO生长曲线解读的良好一致性（加权卡帕值=0.71，95%置信区间[0.25；0.89]）以及个人儿童健康记录生长曲线解读的良好一致性（加权卡帕值=0.58，95%置信区间[0.09；0.81]）形成对比。由于高估了最初几周的体重增加，在三分之一的婴儿中，使用法国生长曲线会导致要么提出不恰当的限制建议，要么未考虑到他们体重不足的情况。此外，除早产儿外，所有类别151名婴儿在2至3个月时的体重增加都在世卫组织生长曲线范围内，未低于非母乳喂养婴儿的百分位数线。为了优化对婴儿的护理，无论其喂养方式如何，都可以建议更广泛地使用WHO生长曲线。
