资源有限环境中中低出生体重儿的喂养方式和生长模式：一项多中心、纵向观察性研究的结果。
Feeding practices and growth patterns of moderately low birthweight infants in resource-limited settings: results from a multisite, longitudinal observational study.
机构信息
Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India.
出版信息
BMJ Open. 2023 Feb 15;13(2):e067316. doi: 10.1136/bmjopen-2022-067316.
OBJECTIVES
To describe the feeding profile of low birthweight (LBW) infants in the first half of infancy; and to examine growth patterns and early risk factors of poor 6-month growth outcomes.
DESIGN
Prospective observational cohort study.
SETTING AND PARTICIPANTS
Stable, moderately LBW (1.50 to <2.50 kg) infants were enrolled at birth from 12 secondary/tertiary facilities in India, Malawi and Tanzania and visited nine times over 6 months.
VARIABLES OF INTEREST
Key variables of interest included birth weight, LBW type (combination of preterm/term status and size-for-gestational age at birth), lactation practices and support, feeding profile, birthweight regain by 2 weeks of age and poor 6-month growth outcomes.
RESULTS
Between 13 September 2019 and 27 January 2021, 1114 infants were enrolled, comprising 4 LBW types. 363 (37.3%) infants initiated early breast feeding and 425 (43.8%) were exclusively breastfed to 6 months. 231 (22.3%) did not regain birthweight by 2 weeks; at 6 months, 280 (32.6%) were stunted, 222 (25.8%) underweight and 88 (10.2%) wasted. Preterm-small-for-gestational age (SGA) infants had 1.89 (95% CI 1.37 to 2.62) and 2.32 (95% CI 1.48 to 3.62) times greater risks of being stunted and underweight at 6 months compared with preterm-appropriate-for-gestational age (AGA) infants. Term-SGA infants had 2.33 (95% CI 1.77 to 3.08), 2.89 (95% CI 1.97 to 4.24) and 1.99 (95% CI 1.13 to 3.51) times higher risks of being stunted, underweight and wasted compared with preterm-AGA infants. Those not regaining their birthweight by 2 weeks had 1.51 (95% CI 1.23 to 1.85) and 1.55 (95% CI 1.21 to 1.99) times greater risks of being stunted and underweight compared with infants regaining.
CONCLUSION
LBW type, particularly SGA regardless of preterm or term status, and lack of birthweight regain by 2 weeks are important risk identification parameters. Early interventions are needed that include optimal feeding support, action-oriented growth monitoring and understanding of the needs and growth patterns of SGA infants to enable appropriate weight gain and proactive management of vulnerable infants.
TRIAL REGISTRATION NUMBER
NCT04002908.
目的
描述低出生体重（LBW）婴儿在婴儿期前半段的喂养情况；并探讨生长模式和 6 个月早期不良生长结局的风险因素。
设计
前瞻性观察队列研究。
地点和参与者
稳定、中度 LBW（1.50 至 <2.50kg）婴儿于 2019 年 9 月 13 日至 2021 年 1 月 27 日期间在印度、马拉维和坦桑尼亚的 12 个二级/三级医疗机构中出生时入组，并在 6 个月内进行 9 次访视。
感兴趣的变量
主要观察变量包括出生体重、LBW 类型（早产/足月和出生时胎龄与体重比的组合）、哺乳方式和支持、喂养情况、出生后 2 周内体重恢复情况以及 6 个月时不良生长结局。
结果
共纳入 1114 名婴儿，包括 4 种 LBW 类型。363（37.3%）名婴儿开始早期母乳喂养，425（43.8%）名婴儿在 6 个月时纯母乳喂养。231（22.3%）名婴儿未能在 2 周内恢复出生体重；6 个月时，280（32.6%）名婴儿生长迟缓，222（25.8%）名婴儿体重不足，88（10.2%）名婴儿消瘦。与早产适宜胎龄（AGA）婴儿相比，早产小胎龄（SGA）婴儿在 6 个月时发生生长迟缓的风险分别高出 1.89（95%CI 1.37 至 2.62）倍和 2.32（95%CI 1.48 至 3.62）倍，体重不足的风险分别高出 1.89（95%CI 1.37 至 2.62）倍和 2.32（95%CI 1.48 至 3.62）倍。足月 SGA 婴儿与早产 AGA 婴儿相比，生长迟缓、体重不足和消瘦的风险分别高出 2.33（95%CI 1.77 至 3.08）倍、2.89（95%CI 1.97 至 4.24）倍和 1.99（95%CI 1.13 至 3.51）倍。出生后 2 周内体重未恢复的婴儿与体重恢复的婴儿相比，发生生长迟缓的风险分别高出 1.51（95%CI 1.23 至 1.85）倍和 1.55（95%CI 1.21 至 1.99）倍，体重不足的风险分别高出 1.51（95%CI 1.23 至 1.85）倍和 1.55（95%CI 1.21 至 1.99）倍。
结论
LBW 类型，特别是 SGA 无论早产或足月状态，以及出生后 2 周内体重未恢复，是重要的风险识别参数。需要采取早期干预措施，包括提供最佳喂养支持、以行动为导向的生长监测，以及了解 SGA 婴儿的需求和生长模式，以实现适当的体重增长，并对脆弱婴儿进行积极管理。
试验注册
NCT04002908。
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