Donowitz Jeffrey R, Drew Jeannie, Taniuchi Mami, Platts-Mills James A, Alam Masud, Ferdous Tahsin, Shama Talat, Islam Md Ohedul, Kabir Mamun, Nayak Uma, Haque Rashidul, Petri William A
Division of Pediatric Infectious Diseases, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia, USA.
Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA.
Clin Infect Dis. 2021 Aug 2;73(3):e683-e691. doi: 10.1093/cid/ciaa1938.
Diarrheal pathogens have been associated with linear growth deficits. The effect of diarrheal pathogens on growth is likely due to inflammation, which also adversely affects neurodevelopment. We hypothesized that diarrheagenic pathogens would be negatively associated with both growth and neurodevelopment.
We conducted a longitudinal birth cohort study of 250 children with diarrheal surveillance and measured pathogen burden in diarrheal samples using quantitative polymerase chain reaction. Pathogen attributable fraction estimates of diarrhea over the first 2 years of life, corrected for socioeconomic variables, were used to predict both growth and scores on the Bayley-III Scales of Infant and Toddler Development.
One hundred eighty children were analyzed for growth and 162 for neurodevelopmental outcomes. Rotavirus, Campylobacter, and Shigella were the leading causes of diarrhea in year 1 while Shigella, Campylobacter, and heat-stable toxin-producing enterotoxigenic Escherichia coli were the leading causes in year 2. Norovirus was the only pathogen associated with length-for-age z score at 24 months and was positively associated (regression coefficient [RC], 0.42 [95% confidence interval {CI}, .04 to .80]). Norovirus (RC, 2.46 [95% CI, .05 to 4.87]) was also positively associated with cognitive scores while sapovirus (RC, -2.64 [95% CI, -4.80 to -.48]) and typical enteropathogenic E. coli (RC, -4.14 [95% CI, -8.02 to -.27]) were inversely associated. No pathogens were associated with language or motor scores. Significant maternal, socioeconomic, and perinatal predictors were identified for both growth and neurodevelopment.
Maternal, prenatal, and socioeconomic factors were common predictors of growth and neurodevelopment. Only a limited number of diarrheal pathogens were associated with these outcomes.
腹泻病原体与线性生长发育迟缓有关。腹泻病原体对生长的影响可能是由于炎症，而炎症也会对神经发育产生不利影响。我们假设致腹泻病原体与生长和神经发育均呈负相关。
我们对250名接受腹泻监测的儿童进行了一项纵向出生队列研究，并使用定量聚合酶链反应测量腹泻样本中的病原体负荷。校正社会经济变量后，计算出生后头两年腹泻的病原体归因分数估计值，用于预测生长情况以及贝利婴幼儿发展量表第三版的得分。
对180名儿童进行了生长情况分析，对162名儿童进行了神经发育结局分析。轮状病毒、弯曲杆菌和志贺菌是第1年腹泻的主要病因，而志贺菌、弯曲杆菌和产热稳定毒素的肠产毒性大肠杆菌是第2年的主要病因。诺如病毒是唯一与24个月龄时年龄别身长Z评分相关的病原体，且呈正相关（回归系数[RC]，0.42[95%置信区间{CI}，0.04至0.80]）。诺如病毒（RC，2.46[95%CI，0.05至4.87]）也与认知得分呈正相关，而札幌病毒（RC，-2.64[95%CI，-4.80至-0.48]）和典型肠致病性大肠杆菌（RC，-4.14[95%CI, -8.02至-0.27]）呈负相关。没有病原体与语言或运动评分相关。确定了生长和神经发育的重要母亲、社会经济和围产期预测因素。
母亲、产前和社会经济因素是生长和神经发育的常见预测因素。只有少数腹泻病原体与这些结局相关。
