Document Detail

Low birth weight and morbidity from diarrhea and respiratory infection in northeast Brazil.
MedLine Citation:
PMID:  8618183     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To compare morbidity and mortality rates of low birth weight (LBW) and appropriate birth weight infants born at term, focusing on diarrheal and respiratory infections. STUDY DESIGN: A cohort of 133 LBW infants (1500 to 2499 gm) and 260 appropriate birth weight infants (3000 to 3499 gm), individually matched by sex and season of birth, were followed for the first 6 months of life. None had congenital anomalies and all were from poor families living in the interior of Pernambuco, northeast Brazil. Data on infant deaths, hospitalizations, and morbidity were collected prospectively through daily home visits (except Sundays) from birth through week 8, then twice weekly for weeks 9 to 26. The effects of birth weight were assessed with a variety of multivariable techniques, controlling for confounders. RESULTS: Of the LBW infants, 56% were wasted (thin), 23% were stunted, and 17% were both wasted and stunted. The LBW infants (median 2380 gm) experienced a sevenfold higher mortality rate and fourfold higher rate of hospitalization than appropriate birth weight infants. Almost all deaths and hospitalizations were in the postneonatal period. The LBW infants also experienced 33% more days with diarrhea and 32% more days with vomiting (p = 0.003 in each case). The prevalences of cough and fever were not significantly different. CONCLUSIONS: Infant deaths, hospitalizations, and diarrheal morbidity are increased in term LBW infants who have only a modest weight deficit.
During January-December 1993, in the interior of Pernambuco State, northeast Brazil, researchers recruited 133 low birth weight (LBW) (1500-2499 g) infants and 260 sex- and birth season-matched controls of appropriate birth weight (ABW) (3000-3499 g) from the maternity wards of hospitals in five communities. All infants were randomly assigned to receive either 1 mg zinc/day for 8 weeks or a placebo. All infants came from low income families. The researchers compared their morbidity, especially diarrhea and respiratory tract infections, and mortality rates during the first 6 months of life. Zinc supplement had no effect on any of the outcome measures. LBW infants were more likely than ABW infants to die (7.5% vs. 0.8%; adjusted hazard rate ratio [AHRR] = 6.58; p = .006) and to be hospitalized (24.8% vs. 6.5%; AHRR = 4.09; p .001) during the first 6 months of life. Yet the rate of consultations with medical personnel was essentially the same for both groups. 90% of the LBW deaths occurred in the postneonatal period, the underlying causes being diarrhea and respiratory infections. For both LBW and ABW infants, diarrhea was the main cause of hospitalization. Both groups experienced little diarrhea during the first 6 weeks of life. Thereafter, LBW infants suffered a higher prevalence of diarrhea than ABW infants up until 5 months. Beginning with day 1, LBW infants experienced more vomiting than ABW infants. Both groups experienced increasing rates of cough and fever throughout the 6-month period. Differences between the two groups were less pronounced than they were for diarrhea or vomiting. LBW infants were more likely to be sick longer with diarrhea and vomiting than ABW infants (p .001), but the difference in prevalence was less significant (p = .043). The onset of diarrhea was strongly associated with feeding mode (hazard rate ratio = 1.56 for partially breast-fed infants and 2.34 for infants no longer breast fed; p .001) as was the onset of vomiting (0.95 and 1.86, respectively; p .001 for the latter). LBW infants suffered more deaths, hospitalizations, and diarrhea morbidity than ABW infants.
P I Lira; A Ashworth; S S Morris
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of pediatrics     Volume:  128     ISSN:  0022-3476     ISO Abbreviation:  J. Pediatr.     Publication Date:  1996 Apr 
Date Detail:
Created Date:  1996-06-07     Completed Date:  1996-06-07     Revised Date:  2009-09-29    
Medline Journal Info:
Nlm Unique ID:  0375410     Medline TA:  J Pediatr     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  497-504     Citation Subset:  AIM; IM; J    
Centre for Human Nutrition, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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MeSH Terms
Brazil / epidemiology
Developing Countries*
Diarrhea, Infantile / epidemiology*,  mortality
Infant, Low Birth Weight*
Infant, Newborn
Likelihood Functions
Poisson Distribution
Proportional Hazards Models
Respiratory Tract Infections / epidemiology*,  mortality
Grant Support
//Wellcome Trust

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