Read J S, Clemens J D, Klebanoff M A
Division of Epidemiology, Statistics, and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892.
Am J Epidemiol. 1994 Oct 15;140(8):721-33. doi: 10.1093/oxfordjournals.aje.a117320.
The purpose of this study was to determine whether moderately low birth weight, singleton babies without congenital anomalies are at increased risk for postperinatal infectious disease mortality. The study cohort consisted of 54,795 live births assembled at 12 medical school-affiliated hospitals in different regions of the United States between 1959 and 1966 and followed prospectively. After exclusions of multiple gestation births, very low birth weight (less than 1,500 g) births, births with major congenital anomalies, and first-week deaths, 51,931 children remained for analysis. Postperinatal infectious disease mortality was assessed through age 7 years. Causes of death were classified independently by two pediatricians, blinded to birth weight status, according to an algorithm developed for the study. Moderately low birth weight infants and children were at increased risk of infectious disease mortality (relative risk (RR) = 2.49, 95% confidence interval (CI) 1.74-3.55). The risk persisted among those whose deaths met our strictest criteria for infectious etiology and was sustained beyond infancy throughout the age interval under analysis. Among those with moderate low birth weight, there was an increased risk among those with preterm birth (RR = 2.77, 95% CI 1.19-6.46) but not among those who were born small-for-gestational age (RR = 1.19, 95% CI 0.37-3.83). The data suggest that moderate low birth weight renders individuals vulnerable to infectious disease mortality during both infancy and childhood. Among moderately low birth weight infants and children, this vulnerability appeared to be attributable primarily to preterm birth rather than to intrauterine growth retardation.
本研究的目的是确定出生体重适度偏低、无先天性异常的单胎婴儿在围产期后感染性疾病死亡方面是否存在更高风险。研究队列包括1959年至1966年间在美国不同地区的12家医学院附属医院收集的54,795例活产婴儿，并对其进行前瞻性随访。排除多胎妊娠分娩、极低出生体重（低于1500克）分娩、有重大先天性异常的分娩以及第一周死亡病例后，剩余51,931名儿童进行分析。评估了直至7岁的围产期后感染性疾病死亡率。两位儿科医生在不知道出生体重状况的情况下，根据为该研究制定的算法独立对死亡原因进行分类。出生体重适度偏低的婴幼儿感染性疾病死亡风险增加（相对风险（RR）=2.49，95%置信区间（CI）1.74 - 3.55）。在那些死亡符合我们最严格的感染病因标准的人群中，这种风险持续存在，并且在整个分析的年龄区间内，超出婴儿期后仍持续存在。在出生体重适度偏低的人群中，早产者风险增加（RR = 2.77，95% CI 1.19 - 6.46），但小于胎龄儿风险未增加（RR = 1.19，95% CI 0.37 - 3.83）。数据表明，出生体重适度偏低使个体在婴儿期和儿童期都易患感染性疾病死亡。在出生体重适度偏低的婴幼儿中，这种易感性似乎主要归因于早产，而非宫内生长迟缓。
