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

description: <p>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 &lt;2.50&thinsp;kg) infants were enrolled at birth from 12 secondary/tertiary facilities in India, Malawi and Tanzania and visited nine times over 6&thinsp;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&thinsp;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&thinsp;months. 231 (22.3%) did not regain birthweight by 2&thinsp;weeks; at 6&thinsp;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&thinsp;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&thinsp;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&thinsp;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.</p>