Abstract
Background: 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. Methods: 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. Results: 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). Conclusion: 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.
Highlights
Infancy is the period of fastest relative growth; on average, a normally growing infant more than doubles their birth weight in the first six months of life :The WHO Child Growth Standards 2006: [Available from: http://www.who.int/childgrowth/standards/en/]
We examined data from a birth cohort to compare the discriminatory value for mortality for anthropometry at birth and changes from birth to the following timepoints in infancy: i) at two months of age which is around the time of infant immunisations; and ii) at six months of age
We examined differences in weightfor-age z-score (WAZ), and proportion of infants underweight at month two stratified by birth weight and used an independent t-test to test for differences in WAZ between infants born normal birth weight (NBW) and low birth weight (LBW)
Summary
Infancy is the period of fastest relative growth; on average, a normally growing infant more than doubles their birth weight in the first six months of life :The WHO Child Growth Standards 2006: [Available from: http://www.who.int/childgrowth/standards/en/]. Apparent wasting or underweight may occur due to growth faltering and/or as a result of having been born preterm, low birth weight (LBW) or small for gestational age[1]. 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. 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)
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