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Olson D, Lamb MM, Connery AK, Colbert AM, Calvimontes M, Bauer D, Paniagua-Avila MA, Martínez MA, Arroyave P, Hernandez S, Colborn KL, Roell Y, Waggoner JJ, Natrajan MS, Anderson EJ, Bolaños GA, El Sahly HM, Munoz FM, Asturias EJ. Cumulative Febrile, Respiratory, and Gastrointestinal Illness Among Infants in Rural Guatemala and Association With Neurodevelopmental and Growth Outcomes. Pediatr Infect Dis J 2023; 42:739-744. [PMID: 37343218 PMCID: PMC10527407 DOI: 10.1097/inf.0000000000004006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND Infectious disease exposures in early life are increasingly recognized as a risk factor for poor subsequent growth and neurodevelopment. We aimed to evaluate the association between cumulative illness with neurodevelopment and growth outcomes in a birth cohort of Guatemalan infants. METHODS From June 2017 to July 2018, infants 0-3 months of age living in a resource-limited region of rural southwest Guatemala were enrolled and underwent weekly at-home surveillance for caregiver-reported cough, fever, and vomiting/diarrhea. They also underwent anthropometric assessments and neurodevelopmental testing with the Mullen Scales of Early Learning (MSEL) at enrollment, 6 months, and 1 year. RESULTS Of 499 enrolled infants, 430 (86.2%) completed all study procedures and were included in the analysis. At 12-15 months of age, 140 (32.6%) infants had stunting (length-for-age Z [LAZ] score < -2 SD) and 72 (16.7%) had microcephaly (occipital-frontal circumference [OFC] < -2 SD). In multivariable analysis, greater cumulative instances of reported cough illness (beta = -0.08/illness-week, P = 0.06) and febrile illness (beta = -0.36/illness-week, P < 0.001) were marginally or significantly associated with lower MSEL Early Learning Composite (ELC) Score at 12-15 months, respectively; there was no association with any illness (cough, fever, and/or vomiting/diarrhea; P = 0.27) or with cumulative instances of diarrheal/vomiting illness alone ( P = 0.66). No association was shown between cumulative instances of illness and stunting or microcephaly at 12-15 months. CONCLUSIONS These findings highlight the negative cumulative consequences of frequent febrile and respiratory illness on neurodevelopment during infancy. Future studies should explore pathogen-specific illnesses, host response associated with these syndromic illnesses, and their association with neurodevelopment.
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Affiliation(s)
- Daniel Olson
- Department of Pediatrics, University of Colorado School of Medicine, 13123 E. 16th Ave., Aurora, CO 80045, USA
- Center for Global Health, Colorado School of Public Health, 13199 East Montview Blvd, Aurora, CO 80045, USA
- Children’s Hospital Colorado, 13123 E. 16th Ave., Aurora, CO 80045, USA
- Department of Epidemiology, Colorado School of Public Health, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Molly M. Lamb
- Center for Global Health, Colorado School of Public Health, 13199 East Montview Blvd, Aurora, CO 80045, USA
- Department of Epidemiology, Colorado School of Public Health, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Amy K. Connery
- Children’s Hospital Colorado, 13123 E. 16th Ave., Aurora, CO 80045, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, 12631 E 17th Ave, Aurora, CO 80045, USA
| | - Alison M. Colbert
- Children’s Hospital Colorado, 13123 E. 16th Ave., Aurora, CO 80045, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, 12631 E 17th Ave, Aurora, CO 80045, USA
| | - Mirella Calvimontes
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Desiree Bauer
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - M. Alejandra Paniagua-Avila
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St. New York, NY 10032, USA
| | - María Alejandra Martínez
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Paola Arroyave
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Sara Hernandez
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Kathryn L. Colborn
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave #6117, Aurora, CO 80045, USA
| | - Yannik Roell
- Center for Global Health, Colorado School of Public Health, 13199 East Montview Blvd, Aurora, CO 80045, USA
| | - Jesse J. Waggoner
- Department of Medicine, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322, USA
| | - Muktha S. Natrajan
- Department of Medicine, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322, USA
| | - Evan J. Anderson
- Department of Medicine, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322, USA
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322, USA
| | - Guillermo A. Bolaños
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | | | - Flor M. Munoz
- Department of Pediatrics, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Edwin J. Asturias
- Department of Pediatrics, University of Colorado School of Medicine, 13123 E. 16th Ave., Aurora, CO 80045, USA
- Center for Global Health, Colorado School of Public Health, 13199 East Montview Blvd, Aurora, CO 80045, USA
- Children’s Hospital Colorado, 13123 E. 16th Ave., Aurora, CO 80045, USA
- Department of Epidemiology, Colorado School of Public Health, 13001 E 17th Pl, Aurora, CO 80045, USA
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Anthropometric proxies for child neurodevelopment in low-resource settings: length- or height-for-age, head circumference or both? J Dev Orig Health Dis 2023; 14:61-69. [PMID: 35844103 PMCID: PMC9845425 DOI: 10.1017/s2040174422000423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Stunting (<-2 SD of length- or height-for-age on WHO growth curves) is the most used predictor of child neurodevelopmental (ND) risk. Occipitofrontal head circumference (OFC) may be an equally feasible, but more direct and robust predictor. We explored association of the two measurements with ND outcome, separately and combined, and examined if cutoffs are more efficacious than continuous measures in predicting ND risk. Infants and young children in rural Guatemala (n = 642; age range = 0.1-35.9 months) were enrolled in a prospective natural history study, and their ND was tested using the Mullen Scales of Early Learning (MSEL) longitudinally. Length- or height-for-age and OFC-for-age were calculated. We performed age-adjusted multivariable regression analyses to explore the association between 1) length or height and ND, 2) OFC and ND, and 3) both length or height and OFC combined, with ND; concurrently, predictively, and longitudinally, as continuous variables and using WHO z-score cutoffs. Continuous length- or height-for-age and OFC z-scores were more strongly associated with MSEL than the traditional -2 SD WHO cutoff. The combination of height-for-age z-score and OFC z-score was consistently, strongly associated with the MSEL Early Learning Composite concurrently (p-values 0.0004-0.11), predictively (p-value 0.001-0.07), with the exception of the 18-24 months age group which had very few records, and in the longitudinal model (p-value <0.0001-0.004). The combination of continuous length- or height-for-age and OFC shows additional utility in estimating ND risk in infants and young children. Measurement of OFC may improve precision of prediction of ND risk in infants and young children.
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