Feeding practices and growth patterns of moderately low birthweight infants in resource-limited settings: results
Linda Vesel1, Roopa M Bellad2, Karim Manji3
1Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA lvesel@ariadnelabs.org.
Insights
Low birthweight infants, especially those small for gestational age, face higher risks of poor growth. Early identification of risk factors like delayed birthweight regain is crucial for timely interventions.
Area of Science:
- Neonatal Nutrition
- Pediatric Growth Monitoring
- Global Child Health
Background:
- Low birthweight (LBW) is a significant global health concern, impacting infant development and survival.
- Understanding feeding patterns and growth trajectories in LBW infants is essential for targeted interventions.
- Early identification of risk factors for poor growth in LBW infants can improve long-term outcomes.
Purpose of the Study:
- To describe the feeding profiles of low birthweight (LBW) infants in the first six months of life.
- To examine growth patterns in LBW infants.
- To identify early risk factors associated with poor growth outcomes at six months of age.
Main Methods:
- A prospective observational cohort study was conducted with 1114 stable, moderately LBW infants across India, Malawi, and Tanzania.
- Infants were followed for six months with nine study visits.
- Key variables included birth weight, LBW type (preterm/term and size-for-gestational age), lactation practices, feeding patterns, and birthweight regain by two weeks.
Main Results:
- Only 43.8% of infants were exclusively breastfed to six months; 22.3% did not regain birthweight by two weeks.
- At six months, significant rates of stunting (32.6%), underweight (25.8%), and wasting (10.2%) were observed.
- Infants who were small-for-gestational age (SGA), regardless of preterm or term status, and those not regaining birthweight by two weeks showed significantly higher risks of stunting and underweight at six months.
Conclusions:
- Infant size-for-gestational age (SGA) and failure to regain birthweight by two weeks are critical indicators for identifying LBW infants at risk of poor growth.
- Early interventions focusing on optimal feeding support, growth monitoring, and understanding SGA infant needs are vital.
- Proactive management strategies are necessary for vulnerable LBW infants to ensure appropriate weight gain and prevent long-term growth deficits.
Objectives:
To describe the feeding profile of low birthweight (LBW) infants in the first half of infancy; and to examine growth patterns and early risk factors of poor 6-month growth outcomes.
Design:
Prospective observational cohort study.
Setting And Participants:
Stable, moderately LBW (1.50 to <2.50 kg) infants were enrolled at birth from 12 secondary/tertiary facilities in India, Malawi and Tanzania and visited nine times over 6 months.
Variables Of Interest:
Key variables of interest included birth weight, LBW type (combination of preterm/term status and size-for-gestational age at birth), lactation practices and support, feeding profile, birthweight regain by 2 weeks of age and poor 6-month growth outcomes.
Results:
Between 13 September 2019 and 27 January 2021, 1114 infants were enrolled, comprising 4 LBW types. 363 (37.3%) infants initiated early breast feeding and 425 (43.8%) were exclusively breastfed to 6 months. 231 (22.3%) did not regain birthweight by 2 weeks; at 6 months, 280 (32.6%) were stunted, 222 (25.8%) underweight and 88 (10.2%) wasted. Preterm-small-for-gestational age (SGA) infants had 1.89 (95% CI 1.37 to 2.62) and 2.32 (95% CI 1.48 to 3.62) times greater risks of being stunted and underweight at 6 months compared with preterm-appropriate-for-gestational age (AGA) infants. Term-SGA infants had 2.33 (95% CI 1.77 to 3.08), 2.89 (95% CI 1.97 to 4.24) and 1.99 (95% CI 1.13 to 3.51) times higher risks of being stunted, underweight and wasted compared with preterm-AGA infants. Those not regaining their birthweight by 2 weeks had 1.51 (95% CI 1.23 to 1.85) and 1.55 (95% CI 1.21 to 1.99) times greater risks of being stunted and underweight compared with infants regaining.
Conclusion:
LBW type, particularly SGA regardless of preterm or term status, and lack of birthweight regain by 2 weeks are important risk identification parameters. Early interventions are needed that include optimal feeding support, action-oriented growth monitoring and understanding of the needs and growth patterns of SGA infants to enable appropriate weight gain and proactive management of vulnerable infants.
Trial Registration Number:
NCT04002908.
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