Feeding practices and growth patterns of moderately low birthweight infants in resource-limited settings: results from a multisite, longitudinal observational study
Authors: Vesel Linda , Bellad Roopa M , Manji Karim , Saidi Friday , Velasquez Esther , Sudfeld Christopher R , Miller Katharine , Bakari Mohamed , Lugangira Kristina , Kisenge Rodrick , Salim Nahya , Somji Sarah , Hoffman Irving , Msimuko Kingsly , Mvalo Tisungane , Nyirenda Fadire , Phiri Melda , Das Leena , Dhaded Sangappa , Goudar Shivaprasad S , Herekar Veena , Kumar Yogesh , Koujalagi M B , Guruprasad Gowdar , Panda Sanghamitra , Shamanur Latha G , Somannavar Manjunath , Vernekar Sunil S , Misra Sujata , Adair Linda , Bell Griffith , Caruso Bethany A , Duggan Christopher , Fleming Katelyn , Israel-Ballard Kiersten , Fishman Eliza , Lee Anne C C , Lipsitz Stuart , Mansen Kimberly L , Martin Stephanie L , Mokhtar Rana R , North Krysten , Pote Arthur , Spigel Lauren , Tuller Danielle E , Young Melissa , Semrau Katherine E A 
Published: February 2023

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.