Kerac Marko, Mwangome Martha, McGrath Marie, Haider Rukhsana, Berkley James A
Food Nutr Bull. 2015 Mar;36(1 Suppl):S30-4. doi: 10.1177/15648265150361S105.
Globally, some 4.7 million infants aged under 6 months are moderately wasted and 3.8 million are severely wasted. Traditionally, they have been over-looked by clinicians, nutritionists, and policy makers.
To present evidence and arguments for why treating acute malnutrition in infants under 6 months of age is important and outline some of the key debates and research questions needed to advance their care.
Narrative review.
Treating malnourished infants under 6 months of age is important to avoid malnutrition-associated mortality in the short-term and adverse health and development outcomes in the long-term. Physiological and pathological differences demand a different approach from that in older children; key among these is a focus on exclusive breastfeeding wherever possible. New World Health Organization guidelines for the management of severe acute malnutrition (SAM) include this age group for the first time and are also applicable to management of moderate acute malnutrition (MAM). Community-based breastfeeding support is the core, but not the sole, treatment. The mother-infant dyad is at the heart of approaches, but wider family and community relationships are also important. An urgent priority is to develop better case definitions; criteria based on mid-upper-arm circumference (MUAC) are promising but need further research. To effectively move forward, clinical trials of assessment and treatment are needed to bolster the currently sparse evidence base. In the meantime, nutrition surveys and screening at health facilities should routinely include infants under 6 months of age in order to better define the burden and outcomes of acute malnutrition in this age group.
在全球范围内，约有470万6个月以下的婴儿中度消瘦，380万婴儿严重消瘦。传统上，临床医生、营养学家和政策制定者一直忽视这些婴儿。
提供证据并论证为何治疗6个月以下婴儿的急性营养不良很重要，并概述在改善其护理方面的一些关键争议点和研究问题。
叙述性综述。
治疗6个月以下的营养不良婴儿对于避免短期的营养不良相关死亡以及长期的不良健康和发育结局很重要。生理和病理差异要求采用与大龄儿童不同的方法；其中关键的一点是尽可能注重纯母乳喂养。世界卫生组织新的严重急性营养不良管理指南首次纳入了这一年龄组，也适用于中度急性营养不良的管理。以社区为基础的母乳喂养支持是核心，但不是唯一的治疗方法。母婴二元组是治疗方法的核心，但更广泛的家庭和社区关系也很重要。当务之急是制定更好的病例定义；基于上臂中部周长（MUAC）的标准很有前景，但需要进一步研究。为了有效推进，需要进行评估和治疗的临床试验来加强目前尚不充分的证据基础。与此同时，医疗机构的营养调查和筛查应常规纳入6个月以下的婴儿，以便更好地确定这一年龄组急性营养不良的负担和结局。
