Nutritional Management of Low Birth Weight and Preterm Infants in Low- and Low Middle-Income Countries
Maha Azhar1, Rahima Yasin1, Sawera Hanif1
1Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan.
Insights
Optimizing nutrition for preterm and low birth weight (LBW) infants is crucial. Breast milk and micronutrient supplementation improve outcomes, while fortified formulas aid growth when breast milk is unavailable, especially in LMICs.
Area of Science:
- Neonatal Nutrition
- Pediatric Public Health
- Global Health
Background:
- Preterm and low birth weight (LBW) infants face higher morbidity and mortality risks.
- Over 20 million LBW infants are born annually, primarily in lower-middle-income countries (LMICs).
- Optimizing feeding strategies is vital for vulnerable infants with increased nutritional needs.
Purpose of the Study:
- To update evidence on feeding strategies for preterm and LBW infants.
- To analyze data from low-income country (LIC) and LMIC settings.
- To conduct revised meta-analyses for these specific contexts.
Main Methods:
- Updated systematic reviews from the Every Newborn Series (2014).
- Extracted data specific to LIC and LMIC settings.
- Performed revised meta-analyses to assess feeding interventions.
Main Results:
- Early enteral feeding reduced neonatal mortality overall, but not in LIC/LMIC settings.
- Breastfeeding promotion increased early and exclusive breastfeeding rates in LMICs.
- Formula feeding in LIC/LMICs was associated with increased neonatal mortality and necrotizing enterocolitis.
- Breast milk fortification and nutrient-enriched formulas improved growth.
- Iron and vitamin A supplementation reduced anemia and mortality in LMICs.
- Benefits of micronutrient supplementation (zinc, calcium, vitamin D) outweigh risks for preterm/LBW infants.
Conclusions:
- Adequate nutritional support is essential for preterm/LBW infants' health, growth, and development.
- Breast milk and micronutrient supplementation are key for reducing diarrhea and mortality.
- Fortified formulas or nutrient-enriched options are crucial when breast milk is unavailable, particularly in LMICs.
- Further large-scale randomized trials in LMICs are needed to strengthen evidence.
Introduction:
Preterm and low birth weight (LBW) infants are at an increased risk of morbidity and mortality compared with their term counterparts, with more than 20 million LBW infants born each year, the majority in lower middle-income countries (LMICs). Given the increased vulnerability and higher nutritional needs of these infants, optimizing feeding strategies may play a crucial role in improving their health outcomes.
Methods:
We updated evidence of Every Newborn Series published in The Lancet 2014 by identifying relevant systematic reviews, extracting low-income country (LIC) and LMIC data, and conducting revised meta-analysis for these contexts.
Results:
We found 15 reviews; the evidence showed that early initiation of enteral feeding reduced neonatal mortality overall, but not in LIC/LMIC settings. Breastfeeding promotion interventions increased the prevalence of early initiation of breastfeeding and exclusive breastfeeding at 3 and 6 months of age in LMIC settings. There was an increased risk of neonatal mortality with formula milk in LIC/LMIC settings. Despite contributing to greater weight gain, there was a higher risk of necrotizing enterocolitis with formula milk overall. Breast milk fortification and nutrient-enriched formula improved growth outcomes. Iron and vitamin A supplementation reduced anemia and mortality rates (LMIC), respectively. The evidence also suggested that benefits of various different micronutrient supplementation interventions such as zinc, calcium/phosphorous, and vitamin D, outweigh the risks since our review demonstrates little to no adverse effects deriving from their supplementation, particularly for a breastfed preterm and/or LBW infant.
Conclusion:
Early adequate nutritional support of preterm or LBW infant is paramount to averse adverse health outcomes, contribute to normal growth, resistance to infection, and optimal development. Breast milk feeding and micronutrient supplementation are crucial to reduce diarrhea incidence and mortality respectively while feed fortification or nutrient-enriched formula, when breast milk is not available, to enhance better growth especially in LMICs where there is higher population of growth restriction and stunting. This review also highlights need for randomized trials in LMICs at large scale to further strengthen the evidence.
Introduction:
Preterm and low birth weight (LBW) infants are at an increased risk of morbidity and mortality compared with their term counterparts, with more than 20 million LBW infants born each year, the majority in lower middle-income countries (LMICs). Given the increased vulnerability and higher nutritional needs of these infants, optimizing feeding strategies may play a crucial role in improving their health outcomes.
Methods:
We updated evidence of Every Newborn Series published in The Lancet 2014 by identifying relevant systematic reviews, extracting low-income country (LIC) and LMIC data, and conducting revised meta-analysis for these contexts.
Results:
We found 15 reviews; the evidence showed that early initiation of enteral feeding reduced neonatal mortality overall, but not in LIC/LMIC settings. Breastfeeding promotion interventions increased the prevalence of early initiation of breastfeeding and exclusive breastfeeding at 3 and 6 months of age in LMIC settings. There was an increased risk of neonatal mortality with formula milk in LIC/LMIC settings. Despite contributing to greater weight gain, there was a higher risk of necrotizing enterocolitis with formula milk overall. Breast milk fortification and nutrient-enriched formula improved growth outcomes. Iron and vitamin A supplementation reduced anemia and mortality rates (LMIC), respectively. The evidence also suggested that benefits of various different micronutrient supplementation interventions such as zinc, calcium/phosphorous, and vitamin D, outweigh the risks since our review demonstrates little to no adverse effects deriving from their supplementation, particularly for a breastfed preterm and/or LBW infant.
Conclusion:
Early adequate nutritional support of preterm or LBW infant is paramount to averse adverse health outcomes, contribute to normal growth, resistance to infection, and optimal development. Breast milk feeding and micronutrient supplementation are crucial to reduce diarrhea incidence and mortality respectively while feed fortification or nutrient-enriched formula, when breast milk is not available, to enhance better growth especially in LMICs where there is higher population of growth restriction and stunting. This review also highlights need for randomized trials in LMICs at large scale to further strengthen the evidence.
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