Abstract
Objectives
Malnutrition in infants less than six months is increasingly recognized. However, the WHO criteria for identifying malnutrition have not been fully evaluated against the risk of in-patient mortality. The observational study was conducted to evaluate the predictability of in-patient mortality of different anthropometric criteria and combination of criteria in order to understand which diagnostic criteria or combination of criteria most accurately predict in-patient mortality.
Methods
Data from a cohort of infants aged one to six months, admitted to Kalawati Saran Children’s Hospital, New Delhi between February and December 2018 was analyzed. The discriminatory ability of different anthropometric indexes [weight-for-age Z score (WAZ), weight-for-length Z score (WLZ) and mid-upper arm circumference (MUAC)] and their combinations to predict in-patient mortality was assessed using Receiver operating characteristic (ROC) curves.
Results
A total of 1813 infants aged one to six months were admitted during the 11 mo period, of which 107 (5.9%) died in the hospital. Of all admissions, 39.9%, 26% and 23.4% were severely underweight, severely wasted and severely stunted, respectively. WAZ < -3 was the most sensitive predictor of mortality [sensitivity: 74.8%; specificity: 62.3%; area under the curve (AUC): 0.69, 95% CI: 0.64–0.74].
Conclusions
WAZ < -3 was the most sensitive predictor out of all individual and combined parameters/indexes in identifying infants less than six months at high risk of mortality which suggests that, it should be used to identify at-risk infants between one to six months on admission to in-patient care. Children identified as falling into this category should be properly evaluated and treated during their in-patient stay.
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Prachi Rajput and Deepika Choudhary for help in data collection.
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PK, YM, SB conceptualized the study. YM led data collection. RS did the statistical analysis. ER, RS and PK wrote the first draft. AD, SB, VK, and ADW provided critical inputs in finalizing the manuscript. All authors read and approved the final draft. PK will be the guarantor of the study.
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Kumar, P., Meiyappan, Y., Rogers, E. et al. Outcomes of Hospitalized Infants Aged One to Six Months in Relation to Different Anthropometric Indices – An Observational Cohort Study. Indian J Pediatr 87, 699–705 (2020). https://doi.org/10.1007/s12098-020-03236-9
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DOI: https://doi.org/10.1007/s12098-020-03236-9