Hvelplund Carolina, Hansen Bo Mølholm, Koch Susanne Vinkel, Andersson Mikael, Skovgaard Anne Mette
Department of Pediatrics and Adolescence, University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Pediatrics, University Hospital Herlev, Copenhagen, Denmark;
Department of Pediatrics, University Hospital Herlev, Copenhagen, Denmark;
Pediatrics. 2016 Feb;137(2):e20152575. doi: 10.1542/peds.2015-2575. Epub 2016 Jan 13.
To describe the incidence, age at diagnosis, and associations between perinatal risk factors of feeding and eating disorders (FED) diagnosed at hospital in children aged 0 to 3 years.
A nationwide cohort of 901 227 children was followed until 48 months of age in the national registers from 1997 to 2010. Multivariable Cox proportional hazards regression was used to estimate hazard ratios (HRs) for FED diagnosis according to the International Classification of Diseases and associations with perinatal risk factors.
A total of 1365 children (53% girls) were diagnosed with FED at hospital, corresponding to a cumulative incidence of 1.6 per 1000 live births. High risk of FED was seen in children born before gestational week 28 (HR, 3.52; 95% confidence interval [CI], 2.15-5.78). HRs were 3.74 for children small for gestational age ≤3 SD (95% CI, 2.71-5.17) and 4.71 in those with congenital malformations (95% CI, 3.86-5.74). Increased risk of FED was associated with female gender (HR, 1.2; 95% CI, 1.08-1.34), maternal smoking in pregnancy (HR, 1.24; 95% CI, 1.08-1.42), immigrant status (HR, 2.24; 95% CI, 1.92-2.61), and being the firstborn (HR, 1.33; 95% CI, 1.19-1.50).
FED in referred children aged 0 to 3 years are associated with perinatal adversities, female gender, maternal smoking in pregnancy, being firstborn, and having immigrant parents. The results suggest complex causal mechanisms of FED and underscore the need for a multidisciplinary approach in the clinical management of young children with persistent problems of feeding, eating, and weight faltering.
描述0至3岁儿童在医院诊断出的喂养和进食障碍（FED）的发病率、诊断年龄以及围产期危险因素之间的关联。
1997年至2010年期间，在国家登记册中对全国范围内的901227名儿童进行随访，直至48个月龄。采用多变量Cox比例风险回归分析，根据国际疾病分类估计FED诊断的风险比（HR）以及与围产期危险因素的关联。
共有1365名儿童（53%为女孩）在医院被诊断为FED，相当于每1000例活产儿的累积发病率为1.6。孕28周前出生的儿童患FED的风险较高（HR，3.52；95%置信区间[CI]，2.15 - 5.78）。小于胎龄儿≤3标准差的儿童HR为3.74（95%CI，2.71 - 5.17），患有先天性畸形的儿童HR为4.71（95%CI，3.86 - 5.74）。FED风险增加与女性性别（HR，1.2；95%CI，1.08 - 1.34）、母亲孕期吸烟（HR，1.24；95%CI，1.08 - 1.42）、移民身份（HR，2.24；95%CI，1.92 - 2.61）以及头胎出生（HR，1.33；95%CI，1.19 - 1.50）有关。
0至3岁转诊儿童的FED与围产期逆境、女性性别、母亲孕期吸烟、头胎出生以及父母为移民有关。结果表明FED存在复杂的因果机制，并强调在临床管理持续存在喂养、进食和体重增长问题的幼儿时需要采取多学科方法。
