HIV 暴露和未暴露婴儿的母乳喂养持续时间与生长模式和临床结局的关系：南非夸祖鲁-纳塔尔省的一项队列研究。
Growth patterns and clinical outcomes in association with breastfeeding duration in HIV exposed and unexposed infants: a cohort study in KwaZulu Natal, South Africa.
机构信息
Department of Paediatrics and Child Health, School of Clinical Medicine, University of KwaZulu-Natal, 719 Umbilo Road, Congella, 4013, South Africa.
Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of KwaZulu-Natal, 719 Umbilo Road, Congella, 4013, South Africa.
出版信息
BMC Pediatr. 2021 Apr 19;21(1):183. doi: 10.1186/s12887-021-02662-8.
BACKGROUND
Exclusive breastfeeding for 6 months and breastfeeding with complementary feeds until 12 months for HIV exposed and uninfected (HEU) infants or 24 months for HIV unexposed (HU) infants is the current World Health Organisation (WHO) recommendation for low and middle income countries (LMICs) to improve clinical outcomes and growth trajectories in infants. In a post-hoc evaluation of HEU and HU cohorts, we examine growth patterns and clinical outcomes in the first 9 months of infancy in association with breastfeeding duration.
METHODS
Two cohorts of infants, HEU and HU from a low-socioeconomic township in South Africa, were evaluated from birth until 9 months of age. Clinical, anthropometric and infant feeding data were analysed. Standard descriptive statistics and regression analysis were performed to determine the effect of HIV exposure and breastfeeding duration on growth and clinical outcomes.
RESULTS
Included in this secondary analysis were 123 HEU and 157 HU infants breastfed for a median of 26 and 14 weeks respectively. Median WLZ score was significantly (p < 0.001) lower in HEU than HU infants at 3, 6 and 9 months (- 0.19 vs 2.09; - 0.81 vs 0.28; 0.05 vs 0.97 respectively). The median LAZ score was significantly lower among HU infants at 3 and 6 months (- 1.63 vs 0.91, p < 0.001; - 0.37 vs 0.51, p < 0.01) and a significantly higher proportion of HU was classified as stunted (LAZ < -2SD) at 3 and 6 months (3.9% vs 44.9%, p < 0.001; 4.8% vs 20.9%, p < 0.001 respectively) independent of breastfeeding duration. A higher proportion of HEU infants experienced one or more episodes of skin rash (44.5% vs 12.8%) and upper respiratory tract infection (URTI) (30.1% vs 10.9%) (p < 0.0001). In a multivariable analysis, the odds of occurrence of wasting, skin rash, URTI or any clinical adverse event in HEU infants were 2.86, 7.06, 3.01 and 8.89 times higher than HU infants after adjusting for breastfeeding duration.
CONCLUSION
Our study has generated additional evidence that HEU infants are at substantial risk of infectious morbidity and decreased growth trajectories however we have further demonstrated that these adverse outcomes were independent of breastfeeding duration.
背景
为改善婴儿的临床结局和生长轨迹，世界卫生组织（WHO）建议在中低收入国家（LMICs）实行纯母乳喂养 6 个月，并在 6 个月后添加补充食品至 12 个月，对于 HIV 暴露或未暴露的婴儿则建议母乳喂养至 24 个月。在对 HIV 暴露和未暴露婴儿队列的事后评估中，我们研究了与母乳喂养持续时间相关的婴儿出生后前 9 个月的生长模式和临床结局。
方法
在南非一个低社会经济乡镇，对两个婴儿队列（HIV 暴露婴儿和 HIV 未暴露婴儿）进行评估，从出生到 9 个月龄。分析临床、人体测量和婴儿喂养数据。采用标准描述性统计和回归分析，确定 HIV 暴露和母乳喂养持续时间对生长和临床结局的影响。
结果
本二次分析包括 123 名 HIV 暴露婴儿和 157 名 HIV 未暴露婴儿，中位数母乳喂养持续时间分别为 26 周和 14 周。在 3、6 和 9 个月时，HIV 暴露婴儿的 WLZ 评分明显（p<0.001）低于 HIV 未暴露婴儿（-0.19 比 2.09；-0.81 比 0.28；0.05 比 0.97）。在 3 和 6 个月时，HIV 未暴露婴儿的 LAZ 评分明显较低（-1.63 比 0.91，p<0.001；-0.37 比 0.51，p<0.01），3 和 6 个月时更多的 HIV 未暴露婴儿被归类为生长迟缓（LAZ<−2SD）（3 个月时分别为 3.9%比 44.9%，p<0.001；6 个月时分别为 4.8%比 20.9%，p<0.001），这与母乳喂养持续时间无关。HIV 暴露婴儿出现皮肤皮疹（44.5%比 12.8%）和上呼吸道感染（URTI）（30.1%比 10.9%）的比例明显更高（p<0.0001）。在多变量分析中，在调整母乳喂养持续时间后，HIV 暴露婴儿发生消瘦、皮疹、URTI 或任何临床不良事件的几率是 HIV 未暴露婴儿的 2.86、7.06、3.01 和 8.89 倍。
结论
我们的研究进一步证明，HIV 暴露婴儿存在较大的感染发病率和生长轨迹下降风险，但我们还发现这些不良结局与母乳喂养持续时间无关。
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