Feeding practices and growth patterns of moderately low birthweight infants in resource-limited settings: results from a multisite, longitudinal observational study

Abstract

ObjectivesTo 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.DesignProspective observational cohort study.Setting and participantsStable, 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 interestKey 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.ResultsBetween 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.ConclusionLBW 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 numberNCT04002908.

Lessons learned in implementing the Low Birthweight Infant Feeding Exploration study: A large, multi‐site observational study

“…The variety of methods complemented each other; the quantitative data provided an overview of infant care, while the direct observation or interviews provided nuance. Further, with the use of traditional academic reporting, abstracts at international conferences and use of webinars and social media to share results in a lay person‐accessible executive summary, we have communicated our findings widely to many key audiences 9–11,17,18 …”

“…Since 2019, the LIFE study has been completed with high rates of follow-up and has advanced our understanding of 75-100% missing 51-75% missing 26-50% missing 0-25% missing MLBW infant feeding and care. 9,10 With our results in mind, we share four key lessons learned during the implementation of this multi-country study around working with vulnerable populations, pursuing multi-country studies while accounting for disruptions, ensuring that the evidence-base for trials/interventions is solid, and considering which methods are needed to solicit the strongest evidence for impact.…”

“…Further, with the use of traditional academic reporting, abstracts at international conferences and use of webinars and social media to share results in a lay person-accessible executive summary, we have communicated our findings widely to many key audiences. [9][10][11]17,18 4) co-presentation of research findings locally and globally. Although these practices may seem obvious, there are still plenty of reports of parachute science, 19 poor collaborative practices and limited engagement with data collectors and clinicians at the frontlines of care.…”

“…Across the LIFE study, operationalisation of the study required consideration of contextual realities, engagement of facility leadership and staff, modification of study protocols, and solution-oriented approach to address challenges. Primary study results were recently published and additional manuscripts are forthcoming 10 ; here, we focus on data and experiences that affected study implementation.…”

Delivering on the Promise of Human Milk for Extremely Preterm Infants in the NICU

“…Currently, donor human milk feeding for preterm infants is challenging in resource-limited settings due to lack of established infrastructure. 6,7 Both the American Academy of Pediatrics 8 and the World Health Organization recommend donor human milk over preterm infant formula for alternative feeding of very-low-birth-weight infants (<1500 g). These recommendations are based on randomized clinical trial (RCT) evidence for reduction in risk of necrotizing enterocolitis, but not other benefits such as neurodevelopment because prior RCTs of donor human milk vs formula were null with respect to neurodevelopment.…”