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Moderate low birth weight and infectious disease mortality during infancy and childhood
J S Read1, J D Clemens, M A Klebanoff
1Division of Epidemiology, Statistics, and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892.
Insights
Moderately low birth weight infants face a higher risk of death from infectious diseases. This vulnerability, primarily linked to preterm birth, extends through childhood, underscoring the need for targeted interventions.
Area of Science:
- Pediatrics
- Epidemiology
- Public Health
Background:
- Infant and child mortality remain significant global health concerns.
- Identifying risk factors for postperinatal mortality is crucial for developing effective public health strategies.
- Previous research has indicated associations between birth weight and infant mortality, but the specific risks for infectious diseases in moderately low birth weight infants require further elucidation.
Purpose of the Study:
- To investigate the association between moderately low birth weight (MLBW) and postperinatal infectious disease mortality in singleton infants without congenital anomalies.
- To determine if this increased risk persists beyond infancy and into childhood.
- To explore the differential contributions of preterm birth and small-for-gestational age status to infectious disease mortality in MLBW infants.
Main Methods:
- A prospective cohort study involving 54,795 live births from 12 US medical centers (1959-1966).
- Exclusion criteria included multiple gestation, very low birth weight (<1500g), major congenital anomalies, and early neonatal deaths.
- Postperinatal mortality due to infectious diseases was assessed up to age 7 years, with causes independently classified by blinded pediatricians.
Main Results:
- Moderately low birth weight infants exhibited a significantly increased risk of infectious disease mortality (Relative Risk [RR] = 2.49, 95% Confidence Interval [CI] 1.74-3.55).
- This elevated risk was confirmed even with stringent criteria for infectious etiology and persisted throughout the follow-up period (up to age 7).
- The increased mortality risk was primarily associated with preterm birth (RR = 2.77, 95% CI 1.19-6.46) rather than being small-for-gestational age (RR = 1.19, 95% CI 0.37-3.83).
Conclusions:
- Moderate low birth weight is a significant risk factor for postperinatal infectious disease mortality in children.
- Preterm birth, rather than intrauterine growth restriction, appears to be the primary driver of this vulnerability.
- These findings highlight the long-term health implications of moderate low birth weight and the critical role of prematurity in susceptibility to infections.
Abstract:
The purpose of this study was to determine whether moderately low birth weight, singleton babies without congenital anomalies are at increased risk for postperinatal infectious disease mortality. The study cohort consisted of 54,795 live births assembled at 12 medical school-affiliated hospitals in different regions of the United States between 1959 and 1966 and followed prospectively. After exclusions of multiple gestation births, very low birth weight (less than 1,500 g) births, births with major congenital anomalies, and first-week deaths, 51,931 children remained for analysis. Postperinatal infectious disease mortality was assessed through age 7 years. Causes of death were classified independently by two pediatricians, blinded to birth weight status, according to an algorithm developed for the study. Moderately low birth weight infants and children were at increased risk of infectious disease mortality (relative risk (RR) = 2.49, 95% confidence interval (CI) 1.74-3.55). The risk persisted among those whose deaths met our strictest criteria for infectious etiology and was sustained beyond infancy throughout the age interval under analysis. Among those with moderate low birth weight, there was an increased risk among those with preterm birth (RR = 2.77, 95% CI 1.19-6.46) but not among those who were born small-for-gestational age (RR = 1.19, 95% CI 0.37-3.83). The data suggest that moderate low birth weight renders individuals vulnerable to infectious disease mortality during both infancy and childhood. Among moderately low birth weight infants and children, this vulnerability appeared to be attributable primarily to preterm birth rather than to intrauterine growth retardation.