Skull S A, Ruben A R, Walker A C
Royal Darwin Hospital, Darwin, NT.
Med J Aust. 1997 Apr 21;166(8):412-4. doi: 10.5694/j.1326-5377.1997.tb123191.x.
To examine the association between malnutrition and microcephaly in the first two years of life.
Cross-sectional study.
Royal Darwin Hospital (a tertiary referral centre); 157 of 165 previously studied Aboriginal children aged under two years who were admitted with diarrhoea between May 1990 and April 1991. Birth weight, birth length, birth head circumference, admission head circumference and admission nutritional status were examined. Nutritional status was categorised according to World Health Organization (WHO) criteria for wasting (thinness) and stunting (shortness). Microcephaly on admission was defined as a head circumference less than the second percentile on Australian reference charts. Small-for-gestational-age (SGA) and birth microcephaly were defined as being less than the tenth percentile for an Australian hospitalised population, corrected for gestational age at confinement. Low birth weight (LBW) was defined as less than 2500 g.
Microcephaly on admission.
Of the 157 children, 76 (48%) were wasted, 36 (23%) stunted and 37 (24%) microcephalic on admission. A total of 26 (17%) children had been of LBW, 17 (11%) SGA and 21 (13%) microcephalic at birth. On univariate analysis, microcephaly on admission was associated with wasting (crude odds ratio [OR], 3.91; 95% confidence interval [CI], 1.6-9.7; P < 0.005), but not stunting. There were no significant associations between microcephaly on admission and LBW, being SGA, microcephaly at birth, age or sex. With multivariate analysis, birth head circumference was significantly associated with microcephaly on admission (adjusted OR, 3.62; 95% CI, 1.28-10.23; P < 0.05), as was wasting (adjusted OR, 4.38; 95% CI, 1.88-10.20; P < 0.001).
Wasting was significantly associated with microcephaly, independent of intrauterine growth retardation (as measured by being SGA) and LBW. As malnutrition in critical periods of both intra- and extrauterine development may have irreversible effects on intellectual potential and behaviour, the emphasis on improved nutrition must begin during pregnancy, and should continue in infancy and early childhood.
研究生命最初两年内营养不良与小头畸形之间的关联。
横断面研究。
皇家达尔文医院（一家三级转诊中心）；1990年5月至1991年4月期间因腹泻入院的165名先前接受研究的两岁以下原住民儿童中的157名。对出生体重、出生身长、出生时头围、入院时头围及入院时营养状况进行了检查。根据世界卫生组织（WHO）关于消瘦（体重过轻）和发育迟缓（身材矮小）的标准对营养状况进行分类。入院时小头畸形定义为头围低于澳大利亚参考图表的第二百分位数。小于胎龄儿（SGA）和出生时小头畸形定义为低于澳大利亚住院人群第十百分位数，并根据分娩时的孕周进行校正。低出生体重（LBW）定义为低于2500克。
入院时小头畸形。
157名儿童中，76名（48%）消瘦，36名（23%）发育迟缓，37名（24%）入院时小头畸形。共有26名（17%）儿童出生时低体重，17名（11%）小于胎龄儿，21名（13%）出生时小头畸形。单因素分析显示，入院时小头畸形与消瘦相关（粗比值比[OR]，3.91；95%置信区间[CI]，1.6 - 9.7；P < 0.005），但与发育迟缓无关。入院时小头畸形与低出生体重、小于胎龄儿、出生时小头畸形、年龄或性别之间无显著关联。多因素分析显示，出生时头围与入院时小头畸形显著相关（校正OR，3.62；95%CI，1.28 - 10.23；P < 0.05），消瘦也是如此（校正OR，4.38；95%CI，1.88 - 10.20；P < 0.001）。
消瘦与小头畸形显著相关，独立于宫内生长迟缓（以小于胎龄儿衡量）和低出生体重。由于宫内和宫外发育关键期的营养不良可能对智力潜能和行为产生不可逆影响，改善营养的重点必须始于孕期，并应在婴儿期和幼儿期持续下去。
