Birth size and early pneumonia predict linear growth among HIV‐exposed uninfected infants

Abstract Stunting remains a global health priority, particularly in sub‐Saharan Africa. Identifying determinants of linear growth in HIV‐exposed uninfected (HEU) infants can inform interventions to prevent stunting in this vulnerable population. HIV‐infected mothers and their uninfected infants were followed monthly from pregnancy to 12‐month post‐partum in Nairobi, Kenya. Mixed‐effects models estimated the change in length‐for‐age z‐score (LAZ) from birth to 12 months by environmental, maternal, and infant characteristics. Multivariable models included factors univariately associated with LAZ. Among 372 HEU infants, mean LAZ decreased from −0.54 (95% confidence interval [CI] [−0.67, −0.41]) to −1.09 (95% CI [−1.23, −0.96]) between 0 and 12 months. Declines in LAZ were associated with crowding (≥2 persons per room; adjusted difference [AD] in 0–12 month change: −0.46; 95% CI [−0.87, −0.05]), use of a pit latrine versus a flush toilet (AD: −0.29; 95% CI [−0.57, −0.02]), and early infant pneumonia (AD: −1.14; 95% CI [−1.99, −0.29]). Infants with low birthweight (<2,500 g; AD: 1.08; 95% CI [0.40, 1.76]) and birth stunting (AD: 1.11; 95% CI [0.45, 1.78]) experienced improved linear growth. By 12 months of age, 46 infants were stunted, of whom 11 (24%) were stunted at birth. Of the 34 infants stunted at birth with an available 12‐month LAZ, 68% were not stunted at 12 months. Some low birthweight and birth‐stunted HEU infants had significant linear growth recovery. Early infant pneumonia and household environment predicted poor linear growth and may identify a subgroup of HEU infants for whom to provide growth‐promoting interventions.