美国约翰斯·霍普金斯大学Eric D. McCollum团队比较了液化石油气或生物质烹饪对婴儿重症肺炎的影响。该研究于2024年1月3日发表于《新英格兰医学杂志》。

暴露于家庭空气污染是重症肺炎的一个危险因素。用液化石油气炉灶取代生物质炉灶对婴儿重症肺炎发病率的影响尚不确定。

2018年5月至2021年9月，研究组在印度、危地马拉、秘鲁和卢旺达进行了一项随机对照试验，招募18至34岁、妊娠9至20周以下的孕妇。将其分配使用未通风的液化石油气炉灶和燃料烹饪（干预组）或继续使用生物质燃料烹饪（对照组）。在每个试验组中，研究组监测了女性及其后代对指定炉灶使用的依从性，并测量了24小时个人暴露于细颗粒物（空气动力学直径≤2.5 μm[PM_2.5]的颗粒）的情况。该试验有四个主要结局；报告中提供数据的主要结局是通过设施监测或口头尸检确定的一岁内重症肺炎。

在3200名接受随机分组的孕妇中，3195名符合条件，生下3061名婴儿（干预组1536名，对照组1525名）。高水平的干预使儿童个人PM_2.5暴露量减少，干预组的中位暴露量为24.2微克/立方米（四分位间距，17.8至36.4），对照组为66.0微克/立方米。在出生的第一年，共发现175例重症肺炎发作，干预组的发病率为5.67例/100儿童-年，对照组为6.06例/100儿童-年（发病率比为0.96；P=0.81）。试验研究人员确定，未发生与干预相关的严重不良事件。

研究结果表明，母亲被分配使用液化石油气炉灶和燃料做饭的婴儿与母亲被分配继续使用生物质炉灶做饭的婴儿之间，重症肺炎的发生率没有显著差异。

附：英文原文

Title: Liquefied Petroleum Gas or Biomass Cooking and Severe Infant Pneumonia

Author: Eric D. McCollum, John P. McCracken, Miles A. Kirby, Laura M. Grajeda, Shakir Hossen, Lawrence H. Moulton, Suzanne M. Simkovich, Dina Goodman-Palmer, Ghislaine Rosa, Alexie Mukeshimana, Kalpana Balakrishnan, Gurusamy Thangavel, Sarada S. Garg, Adly Castaaza, Lisa M. Thompson, Anaite Diaz-Artiga, Aris T. Papageorghiou, Victor G. Davila-Roman, Lindsay J. Underhill, Stella M. Hartinger, Kendra N. Williams, Laura Nicolaou, Howard H. Chang, Amy E. Lovvorn, Joshua P. Rosenthal, Ajay Pillarisetti, Wenlu Ye, Luke P. Naeher, Michael A. Johnson, Lance A. Waller, Shirin Jabbarzadeh, Jiantong Wang, Yunyun Chen, Kyle Steenland, Thomas F. Clasen, Jennifer L. Peel, William Checkley

Issue&Volume: 2024-01-03

Abstract:

BACKGROUND

Exposure to household air pollution is a risk factor for severe pneumonia. The effect of replacing biomass cookstoves with liquefied petroleum gas (LPG) cookstoves on the incidence of severe infant pneumonia is uncertain.

METHODS

We conducted a randomized, controlled trial involving pregnant women 18 to 34 years of age and between 9 to less than 20 weeks’ gestation in India, Guatemala, Peru, and Rwanda from May 2018 through September 2021. The women were assigned to cook with unvented LPG stoves and fuel (intervention group) or to continue cooking with biomass fuel (control group). In each trial group, we monitored adherence to the use of the assigned cookstove and measured 24-hour personal exposure to fine particulate matter (particles with an aerodynamic diameter of ≤2.5 μm [PM2.5]) in the women and their offspring. The trial had four primary outcomes; the primary outcome for which data are presented in the current report was severe pneumonia in the first year of life, as identified through facility surveillance or on verbal autopsy.

RESULTS

Among 3200 pregnant women who had undergone randomization, 3195 remained eligible and gave birth to 3061 infants (1536 in the intervention group and 1525 in the control group). High uptake of the intervention led to a reduction in personal exposure to PM2.5 among the children, with a median exposure of 24.2 μg per cubic meter (interquartile range, 17.8 to 36.4) in the intervention group and 66.0 μg per cubic meter (interquartile range, 35.2 to 132.0) in the control group. A total of 175 episodes of severe pneumonia were identified during the first year of life, with an incidence of 5.67 cases per 100 child-years (95% confidence interval [CI], 4.55 to 7.07) in the intervention group and 6.06 cases per 100 child-years (95% CI, 4.81 to 7.62) in the control group (incidence rate ratio, 0.96; 98.75% CI, 0.64 to 1.44; P=0.81). No severe adverse events were reported to be associated with the intervention, as determined by the trial investigators.

CONCLUSIONS

The incidence of severe pneumonia among infants did not differ significantly between those whose mothers were assigned to cook with LPG stoves and fuel and those whose mothers were assigned to continue cooking with biomass stoves.

DOI: 10.1056/NEJMoa2305681

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2305681