Nutritional evaluation and growth of infants in a Rwandan neonatal follow‐up clinic

Abstract

Children born preterm, low birth weight (LBW) or with other perinatal risk factors are at high‐risk of malnutrition. Regular growth monitoring and early intervention are essential to promote optimal feeding and growth; however, monitoring growth in preterm infants can be complex. This study evaluated growth monitoring of infants under 6 months enrolled in Paediatric Development Clinics (PDCs) in rural Rwanda. We reviewed electronic medical records (EMR) of infants enrolled in PDCs before age 2 months with their first visit between January 2015 and December 2016 and followed them until age 6 months. Nurse classification of anthropometric measures and nutritional status were extracted from the EMR. Interval growth and length‐for‐age, weight‐for‐length, and weight‐for‐age z‐scores were calculated using World Health Organization anthropometry software as a ‘gold standard’ comparison to nurse classifications. Two hundred and ninety‐four patients enrolled and had 2,033 visits during the study period. Referral reasons included prematurity/LBW (73.8%) and hypoxic ischemic encephalopathy (28.2%). Nurses assessed interval growth at 58.7% of visits, length‐for‐age at 66.4%, weight‐for‐length at 65.6% and weight‐for‐age at 66.4%. Nurses and gold standard assessment agreed on interval growth at 53.3% of visits and length‐for‐age at 63.7%, weight‐for‐length at 78.2% and weight‐for‐age at 66.3%. At 6 months, 46.5% were stunted, 19.9% were wasted and 44.2% were underweight. There were significant challenges to optimizing growth and growth monitoring among high‐risk infants served by PDCs, including incomplete and inaccurate assessments. Developing tools for clinician decision support in assessing growth and providing specialized nutritional counselling are essential to supporting optimal outcomes in this population.

Neurodevelopmental outcomes of preterm babies during infancy in Eastern Uganda: a prospective cohort study

“…The first 6 months of life is a critical period of catch-up growth and development for preterm babies [ 19 , 20 ]. There is evidence of significant growth faltering at 6 months of age among infants born preterm [ 21 ]. However, there is limited information on the risk of neurodevelopmental disability (NDD) around this period.…”

Complementary Feeding Practices and Childhood Malnutrition in South Africa: The Potential of Moringa Oleifera Leaf Powder as a Fortificant: A Narrative Review

“…Furthermore, the second highest percentage (28.5%) of stunting was found in the KZN province in SA, and children residing in rural areas were the most affected by stunting (29%) in comparison to their urban counterparts (26%) [3]. Stunting is irreversible after the age of two [18,19]. It has several negative effects, such as poor growth and development and irreversible physical and cognitive damage caused by persistent nutritional deprivation [20][21][22].…”

Evaluation of an mHealth tool to improve nutritional assessment among infants under 6 months in paediatric development clinics in rural Rwanda: Quasi‐experimental study

“…However, challenges among health care providers in using child growth charts have been reported, including misinterpretation of growth trajectories, poor plotting, inappropriate growth classifications, wrong rating of weight gain and under-consideration of slow weight gain in taking actions (Bradford et al, 2020;Ezeofor et al, 2017;Mutoro & Wright, 2013). The possibility of incorrect classification and decision is even greater among preterm born infants, for whom a corrected age must be calculated prior to using the WHO growth charts (Villar et al, 2018).…”

“…World Health Organization (WHO) growth charts are often used to assess child growth through calculation of z‐scores, including weight‐for‐length/height (WFL/H), weight‐for‐age (WFA), length/height‐for‐age (L/HFA) and head circumference‐for‐age among children under five (World Health Organization [WHO], 2006). However, challenges among health care providers in using child growth charts have been reported, including misinterpretation of growth trajectories, poor plotting, inappropriate growth classifications, wrong rating of weight gain and under‐consideration of slow weight gain in taking actions (Bradford et al, 2020; Ezeofor et al, 2017; Mutoro & Wright, 2013). The possibility of incorrect classification and decision is even greater among preterm born infants, for whom a corrected age must be calculated prior to using the WHO growth charts (Villar et al, 2018).…”

“…To help infants achieve good nutritional outcomes, nurses provide nutritional care through growth monitoring, counselling and interventions such as supplementary foods for mothers to support breastfeeding or infant formula when medically necessary. However, challenges such as difficulties among providers in calculating corrected age, interval growth and correct plotting on WHO growth charts were identified (Beck et al, 2018; Bradford et al, 2020). An mHealth application tool on an Android tablet was developed with the objective to support nurses in completing accurate child growth classification; decision making aligned with the nutrition protocol; and early identification of inadequate interval growth, WFL/H, WFA and L/HFA z‐scores.…”