Gibson J J, Alexander G R
South Med J. 1985 Jan;78(1):26-30. doi: 10.1097/00007611-198501000-00007.
Infectious diarrhea (ID) caused 242 infant deaths in South Carolina between 1970 and 1978, and is still a significant cause of death in the southeastern United States. Therefore, using South Carolina death certificates from 1970 to 1978 and the state's linked birth/death certificate file, we sought prenatal and postnatal characteristics that might predict death from gastroenteritis in the first year of life. Accuracy of diagnoses was verified from the original death certificates and in a sample of hospital charts. Most deaths caused by ID occurred after the first 28 days of life and were significantly concentrated in the winter. Low birth weight (odds ratio 7.09), nonwhite race (7.00), inadequate prenatal care (4.35), small size of hospital (0.31), and illegitimate birth (2.35) were all significantly associated with postneonatal death. Infants with all of the three strongest predictor characteristics were 14 times as likely to die of ID, but the "predictive value" of this combination for ID death was only 0.54%. Although mothers of these high-risk infants should be given special education about prevention of dehydration, and the families would be logical candidates for a rotavirus vaccine trial, more expensive interventions should not be instituted without a cost-benefit analysis.
1970年至1978年间，感染性腹泻（ID）导致南卡罗来纳州242名婴儿死亡，并且在美国东南部它仍然是一个重要的死亡原因。因此，我们利用1970年至1978年南卡罗来纳州的死亡证明以及该州的出生/死亡证明关联文件，寻找可能预测生命第一年因肠胃炎死亡的产前和产后特征。从原始死亡证明以及医院病历样本中核实诊断的准确性。大多数由ID导致的死亡发生在出生后28天之后，并且显著集中在冬季。低出生体重（优势比7.09）、非白人种族（7.00）、产前护理不足（4.35）、医院规模小（0.31）以及非婚生育（2.35）均与新生儿期后死亡显著相关。具有所有三种最强预测特征的婴儿死于ID的可能性是其他婴儿的14倍，但这种组合对ID死亡的“预测价值”仅为0.54%。虽然应该对这些高危婴儿的母亲进行预防脱水的特殊教育，并且这些家庭是轮状病毒疫苗试验的合理人选，但在没有进行成本效益分析的情况下，不应采取更昂贵的干预措施。
