Feeding practices and growth patterns of moderately low birthweight infants in resource-limited settings: results from a multisite, longitudinal observational study
Linda Vesel, Roopa Bellad, Karim Manji, Friday Saidi, Esther Velásquez, Christopher R. Sudfeld, Katharine Miller, Mohamed Bakari, Kristina Lugangira, Rodrick Kisenge, Nahya Salim, Sarah Somji, Irving Hoffman, Kingsly Msimuko, Tisungane Mvalo, Fadire Nyirenda, Melda Phiri, Leena Das, Sangappa Dhaded, Shivaprasad S. Goudar, Veena Herekar, Yogesh Kumar, M B Koujalagi, Gowdar Guruprasad, Sanghamitra Panda, Latha G Shamanur, Manjunath S. Somannavar, Sunil S. Vernekar, Sujata Misra, Linda S. Adair, Griffith Bell, Bethany A. Caruso, Christopher Duggan, Katelyn Fleming, Kiersten Israel‐Ballard, Eliza Fishman, Anne CC Lee, Stuart R. Lipsitz, Kimberly Mansen, Stéphanie Martin, Rana Mokhtar, Krysten North, Arthur Pote, Lauren Spigel, Danielle E Tuller, Melissa Young, Katherine Semrau
Abstract
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.