Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada;
Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.
Pediatrics. 2017 Apr;139(Suppl 1):S12-S22. doi: 10.1542/peds.2016-2828D.
The last decade has witnessed major reductions in child mortality and a focus on saving lives with key interventions targeting major causes of child deaths, such as neonatal deaths and those due to childhood diarrhea and pneumonia. With the transition to Sustainable Development Goals, the global health community is expanding child health initiatives to address not only the ongoing need for reduced mortality, but also to decrease morbidity and adverse exposures toward improving health and developmental outcomes. The relationship between adverse environmental exposures frequently associated with factors operating in the prepregnancy period and during fetal development is well established. Also well appreciated are the developmental impacts (both short- and long-term) associated with postnatal factors, such as immunostimulation and environmental enteropathy, and the additional risks posed by the confluence of factors related to malnutrition, poor living conditions, and the high burden of infections. This article provides our current thinking on the pathogenesis and risk factors for adverse developmental outcomes among young children, setting the scene for potential interventions that can ameliorate these adversities among families and children at risk.
过去十年见证了儿童死亡率的大幅下降，并将重点放在通过针对新生儿死亡和儿童腹泻与肺炎等主要死因的关键干预措施来拯救生命。随着向可持续发展目标的过渡，全球卫生界正在扩大儿童健康倡议，不仅要解决持续减少死亡率的需求，还要减少发病率和不良暴露，以改善健康和发展结果。经常与妊娠前和胎儿发育期间起作用的因素相关的不良环境暴露之间的关系已经得到充分确立。人们也充分认识到与产后因素（如免疫刺激和肠病性肢端皮炎）相关的发育影响（短期和长期），以及与营养不良、恶劣生活条件和高感染负担相关的因素汇合所带来的额外风险。本文提供了我们对幼儿不良发育结果的发病机制和危险因素的最新思考，为可能的干预措施奠定了基础，这些干预措施可以改善高危家庭和儿童的这些逆境。
