Growth patterns preceding mortality in the first 6 months of life among breastfed infants born to HIV infected women in Malawi

Poor infant nutritional status is a notable underlying cause of mortality. We examined growth patterns preceding death in 34 exclusively breastfed infants born to HIV infected women in the Breastfeeding, Antiretroviral and Nutrition study in Lilongwe, Malawi. Women were randomized to receive either a lipid‐based nutrient supplement during lactation or no supplement. These groups were further randomized to maternal antiretroviral (ARV) drugs, infant nevirapine or no postnatal ARVs. Infants were grouped by age at death (0< 1 mo, n =12; 1< 3 mo, n =11; and 3< 6 mo, n =11). These groups were compared to surviving infants using multinomial logistic regression. Low birth weight (LBW < 2.5 kg) strongly predicted early death (OR 10.27, 95% CI 3.27–32.27 in those 0–1 mo; OR 4.01, 95% CI 1.05–15.30) but not in the 3 < 6 mo group. Measures at regular follow‐up visits showed that lower mean weight, length, and BMI Z‐scores (based on WHO growth standards) more strongly predicted early death than they predicted death during 3< 6 mos. Declining anthropometric Z‐scores were evident in the weeks prior to death. Of the 34 infants who died, 8 were HIV infected and 5 of these 8 deaths occurred in 3< 6 mo. The analysis provides further evidence of the need to prevent LBW and optimize early growth in infants born in developing countries. Supported by the Centers for Disease Control (U48‐ DP000059 ‐01) and by the Bill and Melinda Gates Foundation (OPP53107). Grant Funding Source : Centers for Disease Control (U48 ‐ DP000059 ‐ 01) and by the Bill and Melinda Gates Foundation (OPP53107)