BMJ Open (Feb 2023)
Feeding practices and growth patterns of moderately low birthweight infants in resource-limited settings: results from a multisite, longitudinal observational study
- Christopher R Sudfeld,
- Karim Manji,
- Rodrick Kisenge,
- Mohamed Bakari,
- Tisungane Mvalo,
- Irving Hoffman,
- Stuart Lipsitz,
- Melda Phiri,
- Christopher Duggan,
- Anne C C Lee,
- Griffith Bell,
- Lauren Spigel,
- Bethany A Caruso,
- Nahya Salim,
- Katherine E A Semrau,
- Yogesh Kumar,
- Shivaprasad S Goudar,
- Linda Vesel,
- Melissa Young,
- Esther Velasquez,
- Friday Saidi,
- Roopa M Bellad,
- Leena Das,
- Sangappa Dhaded,
- Gowdar Guruprasad,
- Sujata Misra,
- Sanghamitra Panda,
- Latha G Shamanur,
- Sunil S Vernekar,
- Sarah Somji,
- Linda Adair,
- Kiersten Israel-Ballard,
- Stephanie L Martin,
- Kimberly L Mansen,
- Krysten North,
- Eliza Fishman,
- Katelyn Fleming,
- Danielle E Tuller,
- Katharine Miller,
- Kristina Lugangira,
- Kingsly Msimuko,
- Fadire Nyirenda,
- Veena Herekar,
- M B Koujalagi,
- Manjunath Somannavar,
- Rana R Mokhtar,
- Arthur Pote
Affiliations
- Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Karim Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Rodrick Kisenge
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Mohamed Bakari
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Tisungane Mvalo
- University of North Carolina Project Malawi, Lilongwe, Malawi
- Irving Hoffman
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
- Stuart Lipsitz
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women`s Hospital, Boston, Massachusetts, USA
- Melda Phiri
- University of North Carolina Project Malawi, Lilongwe, Malawi
- Christopher Duggan
- Center for Nutrition, Boston Children’s Hospital, Boston, Massachusetts, USA
- Anne C C Lee
- Department of Pediatric Newborn Medicine, Brigham and Women`s Hospital, Boston, Massachusetts, USA
- Griffith Bell
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women`s Hospital, Boston, Massachusetts, USA
- Lauren Spigel
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women`s Hospital, Boston, Massachusetts, USA
- Bethany A Caruso
- Hubert Department of Global Health, Emory University School of Public Health, Atlanta, Georgia, USA
- Nahya Salim
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Katherine E A Semrau
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women`s Hospital, Boston, Massachusetts, USA
- Yogesh Kumar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India
- Shivaprasad S Goudar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India
- Linda Vesel
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women`s Hospital, Boston, Massachusetts, USA
- Melissa Young
- Hubert Department of Global Health, Emory University School of Public Health, Atlanta, Georgia, USA
- Esther Velasquez
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California, USA
- Friday Saidi
- University of North Carolina Project Malawi, Lilongwe, Malawi
- Roopa M Bellad
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India
- Leena Das
- Department of Paediatrics, SCB Medical College & Hospital, Cuttack, Orissa, India
- Sangappa Dhaded
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India
- Gowdar Guruprasad
- Department of Paediatrics, JJM Medical College, Davangere, Karnataka, India
- Sujata Misra
- Department of Paediatrics, SCB Medical College & Hospital, Cuttack, Orissa, India
- Sanghamitra Panda
- Department of Paediatrics, City Hospital, Cuttack, Orissa, India
- Latha G Shamanur
- Department of Paediatrics, SS Institute of Medical Sciences and Research Center, Davangere, Karnataka, India
- Sunil S Vernekar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India
- Sarah Somji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Linda Adair
- Department of Nutrition, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- Kiersten Israel-Ballard
- Maternal, Newborn, Child Health and Nutrition Program, PATH, Seattle, Washington, USA
- Stephanie L Martin
- Department of Nutrition, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- Kimberly L Mansen
- Maternal, Newborn, Child Health and Nutrition Program, PATH, Seattle, Washington, USA
- Krysten North
- Department of Pediatric Newborn Medicine, Brigham and Women`s Hospital, Boston, Massachusetts, USA
- Eliza Fishman
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women`s Hospital, Boston, Massachusetts, USA
- Katelyn Fleming
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women`s Hospital, Boston, Massachusetts, USA
- Danielle E Tuller
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women`s Hospital, Boston, Massachusetts, USA
- Katharine Miller
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women`s Hospital, Boston, Massachusetts, USA
- Kristina Lugangira
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Kingsly Msimuko
- University of North Carolina Project Malawi, Lilongwe, Malawi
- Fadire Nyirenda
- University of North Carolina Project Malawi, Lilongwe, Malawi
- Veena Herekar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India
- M B Koujalagi
- Department of Paediatrics, JJM Medical College, Davangere, Karnataka, India
- Manjunath Somannavar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India
- Rana R Mokhtar
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women`s Hospital, Boston, Massachusetts, USA
- Arthur Pote
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women`s Hospital, Boston, Massachusetts, USA
- DOI
- https://doi.org/10.1136/bmjopen-2022-067316
- Journal volume & issue
-
Vol. 13,
no. 2
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.
