Ashworth A
Centre for Human Nutrition, London School of Hygiene and Tropical Medicine, UK.
Eur J Clin Nutr. 1998 Jan;52 Suppl 1:S34-41; discussion S41-2.
This review aims to quantify the risks of mortality and morbidity associated with intrauterine growth retardation (IUGR). Twenty-nine data sets with birth-weight-specific mortalities are examined to determine whether consistent patterns of risk emerge when data from different populations are compared. Measures of mortality risk are also made with birth weight as a dichotomous variable. Twelve data sets are presented. From the data available, it is estimated that for term infants weighing 2000-2499 g at birth, the risk of neonatal death is 4 times higher than for infants weighing 2500-2999 g, and 10 times higher than for infants weighing 3000-3499 g. The risk of postneonatal death in term infants weighing 2000-2499 g is estimated to be 2 times higher than for infants 2500-2999 g, and 4 times that of infants weighing 3000-3499 g. Estimates of risk for IUGR infants are less consistent than for preterm infants. This could be due to methodological differences, particularly smaller sample sizes in the studies in developing countries, or may reflect real variation in risk. The latter may be associated with the heterogeneity of IUGR across populations, or to varying risks depending, for example, on which infections predominate or infant age at peak prevalence. IUGR is most prevalent in developing countries and the review therefore focuses on morbidity from diarrhoeal and respiratory infections. Data from nine studies are presented. There is an increased risk of diarrhoea in term infants < 2500 g and an increased risk of pneumonia. The risks of morbidity and mortality appear to differ depending on whether infants are wasted or stunted at birth. Stunted infants of low birth weight have higher neonatal mortality than wasted newborns, but this could be due to inclusion of infants with congenital anomalies who are often stunted. Wasted infants are more prone than stunted infants to neonatal morbidity. No comparative postneonatal data were located.
本综述旨在量化与宫内生长迟缓（IUGR）相关的死亡和发病风险。对29个具有特定出生体重死亡率的数据集进行了检查，以确定比较不同人群的数据时是否会出现一致的风险模式。还将出生体重作为二分变量来衡量死亡风险。给出了12个数据集。根据现有数据估计，对于出生时体重为2000 - 2499克的足月儿，新生儿死亡风险比体重为2500 - 2999克的婴儿高4倍，比体重为3000 - 3499克的婴儿高10倍。出生时体重为2000 - 2499克的足月儿的新生儿后期死亡风险估计比体重为2500 - 2999克的婴儿高2倍，是体重为3000 - 3499克婴儿的4倍。IUGR婴儿的风险估计比早产儿的风险估计更不一致。这可能是由于方法学差异，特别是发展中国家研究中的样本量较小，或者可能反映了风险的实际差异。后者可能与不同人群中IUGR的异质性有关，或者与例如取决于哪种感染占主导或发病高峰时婴儿年龄的不同风险有关。IUGR在发展中国家最为普遍，因此本综述重点关注腹泻和呼吸道感染的发病率。给出了9项研究的数据。出生体重<2500克的足月儿患腹泻的风险增加，患肺炎的风险也增加。发病和死亡风险似乎因婴儿出生时是否消瘦或发育迟缓而有所不同。低出生体重且发育迟缓的婴儿比消瘦的新生儿有更高的新生儿死亡率，但这可能是由于纳入了常有发育迟缓的先天性异常婴儿。消瘦的婴儿比发育迟缓的婴儿更容易出现新生儿发病。未找到比较新生儿后期的数据。
