Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh.
Department of Health and Nutrition, Save the Children Bangladesh, Dhaka, Bangladesh.
Matern Child Nutr. 2019 Jan;15(1):e12642. doi: 10.1111/mcn.12642. Epub 2018 Jul 4.
Severe acute malnutrition (SAM) affects ~4 million infants under 6 months (u6m) worldwide, but evidence underpinning their care is "very low" quality. To inform future research and policy, the objectives of our study were to identify risk factors for infant u6m SAM and describe the clinical and anthropometric outcomes of treatment with current management strategies. We conducted a prospective cohort study in infants u6m in Barisal district, Bangladesh. One group of 77 infants had SAM (weight-for-length Z-score [WLZ] <-3 and/or bipedal oedema); 77 others were "non-SAM" (WLZ ≥-2 to <+2, no oedema, mid-upper-arm circumference ≥125 mm). All were enrolled at 4-8 weeks of age and followed up at 6 months. Maternal education and satisfaction with breastfeeding were among factors associated with SAM. Duration of exclusive breastfeeding was shorter at enrolment (3·9 ± 2.1 vs. 5.7 ± 2.2 weeks, P < 0.0001) and at age 6 months (13.2 ± 8.9 vs. 17.4 ± 7.9 weeks; P = 0.003) among SAM infants. Despite referral, only 13 (17%) reported for inpatient care, and at 6 months, 18 (23%) infants with SAM still had SAM, and 3 (3.9%) died. In the non-SAM group, one child developed SAM, and none died. We conclude that current treatment strategies have limited practical effectiveness: poor uptake of inpatient referral being the main reason. World Health Organization recommendations and other intervention strategies of outpatient-focused care for malnourished but clinically stable infants u6m need to be tested. Breastfeeding support is likely central to future treatment strategies but may be insufficient alone. Better case definitions of nutritionally at-risk infants are also needed.
严重急性营养不良（SAM）影响全球约 400 万 6 个月以下婴儿，但支持其护理的证据质量“非常低”。为了为未来的研究和政策提供信息，我们研究的目的是确定 6 个月以下婴儿 SAM 的风险因素，并描述当前管理策略治疗的临床和人体测量结果。我们在孟加拉国巴里萨尔区进行了一项 6 个月以下婴儿的前瞻性队列研究。一组 77 名婴儿患有 SAM（体重与身长 Z 评分[WLZ] <-3 和/或双足水肿）；另一组 77 名为“非 SAM”（WLZ ≥-2 至 <+2，无水肿，上臂中部周长≥125mm）。所有婴儿均在 4-8 周龄时入组，并在 6 个月时进行随访。母亲的教育程度和对母乳喂养的满意度是与 SAM 相关的因素之一。SAM 婴儿的纯母乳喂养时间在入组时（3.9±2.1 周比 5.7±2.2 周，P<0.0001）和 6 个月时（13.2±8.9 周比 17.4±7.9 周；P=0.003）更短。尽管进行了转诊，但只有 13 名（17%）接受了住院治疗，在 6 个月时，仍有 18 名（23%）SAM 婴儿患有 SAM，3 名（3.9%）死亡。在非 SAM 组中，有 1 名儿童出现 SAM，无死亡病例。我们得出结论，目前的治疗策略效果有限：主要原因是对住院转诊的接受程度较差。需要对世界卫生组织推荐的和其他以门诊为重点的针对营养不良但临床稳定的 6 个月以下婴儿的干预策略进行测试。母乳喂养支持可能是未来治疗策略的核心，但仅凭母乳喂养可能还不够。还需要更好的营养风险婴儿的病例定义。
