Mwangome Martha, Ngari Moses, Bahwere Paluku, Kabore Patrick, McGrath Marie, Berkley James A
The Childhood Acute Illness and Nutrition Network,, CHAIN, Nairobi, P.O Box 43640-00100,, Kenya.
Clinical, KEMRI/Wellcome Trust Research Program, Kilifi, Kilifi, 80108, Kenya.
Gates Open Res. 2021 Aug 20;5:82. doi: 10.12688/gatesopenres.13231.2. eCollection 2021.
Wasting and underweight in infancy is an increasingly recognised problem but consensus on optimum assessment is lacking. In particular, there is uncertainty on how to interpret anthropometry among low birth weight (LBW) infants who may be growing normally. This research aimed to determine growth of infants from birth to two months (around age of vaccination) and the mortality risk of underweight LBW infants compared to normal birth weight (NBW) infants at two and six months age. A secondary analysis of a birth cohort of 1103 infants in Burkina Faso was conducted. Anthropometry was performed monthly from 0 to 12 months. We assessed associations with mortality using Cox proportional hazards models and assessed discriminatory values using area under receiver operating characteristics curves. Eighty-six (7.8%) children died by age one year, 26/86 (30%) and 51/86 (59%) within two and six months, respectively. At age two months, weight gain since birth did not better discriminate mortality risk than current weight-for-age (P=0.72) or mid-upper arm circumference (P=0.21). In total, 227 (21%) LBW infants had increased risk of mortality: adjusted hazards ratio (aHR) 3.30 (95%CI 2.09 to 4.90). Among infants who were underweight at two and six months, LBW infants (64% and 49%, respectively) were not at reduced risk of death compared to NBW infants (aHR 2.63 (95%CI 0.76 to 9.15) and 2.43 (95%CI 0.74 to 7.98), respectively). Assessing weight gain since birth does not offer advantages over immediate anthropometry for discriminating mortality risk. LBW infants who are later identified as underweight require care to help prevent mortality.
婴儿期消瘦和体重不足是一个日益受到关注的问题，但在最佳评估方法上尚未达成共识。特别是，对于如何解读低出生体重（LBW）婴儿的人体测量数据存在不确定性，这些婴儿可能生长正常。本研究旨在确定婴儿从出生到两个月（大约疫苗接种年龄）的生长情况，以及与正常出生体重（NBW）婴儿相比，低出生体重消瘦婴儿在两个月和六个月时的死亡风险。对布基纳法索1103名婴儿的出生队列进行了二次分析。从0到12个月每月进行人体测量。我们使用Cox比例风险模型评估与死亡率的关联，并使用受试者工作特征曲线下面积评估判别值。86名（7.8%）儿童在一岁前死亡，其中26/86（30%）和51/86（59%）分别在两个月和六个月内死亡。在两个月时，自出生以来的体重增加在区分死亡风险方面并不比当前年龄别体重（P=0.72）或上臂中部周长（P=0.21）更具优势。总共有227名（21%）低出生体重婴儿死亡风险增加：调整后风险比（aHR）为3.30（95%CI 2.09至4.90）。在两个月和六个月时体重不足的婴儿中，与正常出生体重婴儿相比，低出生体重婴儿（分别为64%和49%）死亡风险并未降低（aHR分别为2.63（95%CI 0.76至9.15）和2.43（95%CI 0.74至7.98））。评估自出生以来的体重增加在区分死亡风险方面并不比即时人体测量更具优势。后来被确定为体重不足的低出生体重婴儿需要护理以帮助预防死亡。
