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North K, Semrau KEA, Bellad RM, Dhaded SM, Das L, Behera JN, Hoffman I, Mvalo T, Kisenge R, Sudfeld CR, Somji S, Mokhtar RR, Vesel L, Goudar S, Vernekar SS, Siddhartha ES, Singh B, Koujalagi MB, Panda S, Kafansiyanji E, Nyirenda N, Phiri M, Saidi F, Masoud NS, Moshiro R, Tuller DE, Israel-Ballard K, Duggan CP, Lee ACC, Mansen KL, Young MF, Manji K. The Association Between Breastfeeding and Growth Among Infants with Moderately Low Birth Weight: A Prospective Cohort Study. J Pediatr 2024; 269:114003. [PMID: 38447758 PMCID: PMC11155439 DOI: 10.1016/j.jpeds.2024.114003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 01/18/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE To assess the association between breastfeeding competency, as determined by Latch, Audible swallowing, Type of nipple, Comfort, and Hold (LATCH) and Preterm Infant Breastfeeding Behavior Scale (PIBBS) scores, and exclusive breastfeeding and growth among infants with low birth weight (LBW) in India, Malawi, and Tanzania. STUDY DESIGN We conducted LATCH and PIBBS assessments among mother-infant dyads enrolled in the Low Birthweight Infant Feeding Exploration (LIFE) observational study of infants with moderately LBW (1500g-2499 g) in India, Malawi, and Tanzania. We analyzed feeding and growth patterns among this cohort. RESULTS We observed 988 infants. We found no association between LATCH or PIBBS scores and rates of exclusive breastfeeding at 4 or 6 months. Higher week 1 LATCH and PIBBS scores were associated with increased likelihood of regaining birth weight by 2 weeks of age [LATCH: aRR 1.42 (95% CI 1.15, 1.76); PIBBS: aRR 1.15 (95% CI 1.07, 1.23); adjusted for maternal age, parity, education, residence, delivery mode, LBW type, number of offspring, and site]. Higher PIBBS scores at 1 week were associated with improved weight gain velocity (weight-for-age z-score change) at 1, 4, and 6 months [adjusted beta coefficient: 1 month 0.04 (95% CI 0.01, 0.06); 4 month 0.04 (95% CI 0.01, 0.06); and 6 month 0.04 (95% CI 0.00, 0.08)]. CONCLUSION Although week 1 LATCH and PIBBS scores were not associated with rates of exclusive breastfeeding, higher scores were positively associated with growth metrics among infants with LBW, suggesting that these tools may be useful to identify dyads who would benefit from early lactation support.
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Affiliation(s)
- Krysten North
- Department of Pediatrics, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Katherine E A Semrau
- Harvard Medical School, Boston, MA; Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA
| | - Roopa M Bellad
- Department of Pediatrics, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
| | - Sangappa M Dhaded
- Department of Pediatrics, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
| | - Leena Das
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research and Capital Hospital, Bhubaneswar, Odisha, India
| | | | - Irving Hoffman
- University of North Carolina Project Malawi, Lilongwe, Malawi; Department of Medicine, Institute of Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, NC
| | - Tisungane Mvalo
- University of North Carolina Project Malawi, Lilongwe, Malawi; Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, NC
| | - Rodrick Kisenge
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Christopher R Sudfeld
- Departments of Global Health and Population and Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sarah Somji
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Rana R Mokhtar
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA
| | - Linda Vesel
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA
| | - Shivaprasad Goudar
- Department of Pediatrics, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
| | - Sunil S Vernekar
- Department of Pediatrics, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
| | - E S Siddhartha
- Department of Paediatrics, J J M Medical College, Davangere, Karnataka, India
| | - Bipsa Singh
- Department of Paediatrics, Shri Jagannath Medical College and Hospital, Puri, Odisha, India
| | - M B Koujalagi
- Department of Paediatrics, J J M Medical College, Davangere, Karnataka, India
| | | | | | - Naomie Nyirenda
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Melda Phiri
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Friday Saidi
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Nahya S Masoud
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Robert Moshiro
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Danielle E Tuller
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Christopher P Duggan
- Division of Gastroenterology, Hepatology, and Nutrition, Center for Nutrition, Boston Children's Hospital, and Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA
| | - Anne C C Lee
- Department of Pediatrics, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Kimberly L Mansen
- Integrated Maternal and Child Health and Development, PATH, Seattle, WA
| | - Melissa F Young
- Hubert Department of Global Health, Emory University School of Public Health, Atlanta, GA
| | - Karim Manji
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
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Vesel L, Benotti E, Somji S, Bellad RM, Charantimath U, Dhaded SM, Goudar SS, Karadiguddi C, Mungarwadi G, Vernekar SS, Kisenge R, Manji K, Salim N, Samma A, Sudfeld CR, Hoffman IF, Mvalo T, Phiri M, Saidi F, Tseka J, Tsidya M, Caruso BA, Duggan CP, Israel-Ballard K, Lee AC, Mansen KL, Martin SL, North K, Young MF, Fishman E, Fleming K, Semrau KE, Spigel L, Tuller DE, Henrich N. Facilitators, barriers, and key influencers of breastfeeding among low birthweight infants: a qualitative study in India, Malawi, and Tanzania. Int Breastfeed J 2023; 18:59. [PMID: 37940987 PMCID: PMC10634072 DOI: 10.1186/s13006-023-00597-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 11/02/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Low birthweight (LBW) infants are at increased risk of morbidity and mortality. Exclusive breastfeeding up to six months is recommended to help them thrive through infection prevention, growth improvements, and enhancements in neurodevelopment. However, limited data exist on the feeding experiences of LBW infants, their caregivers and key community influencers. The qualitative component of the Low Birthweight Infant Feeding Exploration (LIFE) study aimed to understand practices, facilitators, and barriers to optimal feeding options in the first six months for LBW infants in low-resource settings. METHODS This study was conducted in four sites in India, Malawi, and Tanzania from July 2019 to August 2020. We conducted 37 focus group discussions with mothers and family members of LBW infants and community leaders and 142 in-depth interviews with healthcare providers, government officials, and supply chain and donor human milk (DHM) experts. Data were analyzed using a framework approach. RESULTS All participants believed that mother's own milk was best for LBW infants. Direct breastfeeding was predominant and feeding expressed breast milk and infant formula were rare. DHM was a new concept for most. Adequate maternal nutrition, lactation support, and privacy in the facility aided breastfeeding and expression, but perceived insufficient milk, limited feeding counseling, and infant immaturity were common barriers. Most believed that DHM uptake could be enabled through community awareness by overcoming misconceptions, safety concerns, and perceived family resistance. CONCLUSION This study fills an evidence gap in LBW infant feeding practices and their facilitators and barriers in resource-limited settings. LBW infants face unique feeding challenges such as poor latching and tiring at the breast. Similarly, their mothers are faced with numerous difficulties, including attainment of adequate milk supply, breast pain and emotional stress. Lactation support and feeding counseling could address obstacles faced by mothers and infants by providing psychosocial, verbal and physical support to empower mothers with skills, knowledge and confidence and facilitate earlier, more and better breast milk feeding. Findings on DHM are critical to the future development of human milk banks and highlight the need to solicit partnership from stakeholders in the community and health system.
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Affiliation(s)
- Linda Vesel
- Ariadne Labs at Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Emily Benotti
- Ariadne Labs at Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sarah Somji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Roopa M Bellad
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Umesh Charantimath
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Sangappa M Dhaded
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Chandrashekhar Karadiguddi
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Geetanjali Mungarwadi
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Sunil S Vernekar
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Rodrick Kisenge
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Karim Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nahya Salim
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Abraham Samma
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Christopher R Sudfeld
- Departments of Global Health and Population and Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Irving F Hoffman
- Institute for Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Tisungane Mvalo
- University of North Carolina Project Malawi, Lilongwe, Malawi
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Melda Phiri
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Friday Saidi
- University of North Carolina Project Malawi, Lilongwe, Malawi
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer Tseka
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Mercy Tsidya
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Bethany A Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Christopher P Duggan
- Departments of Global Health and Population and Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Center for Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Kiersten Israel-Ballard
- Ariadne Labs at Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Anne Cc Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Kimberly L Mansen
- Maternal, Newborn, Child Health and Nutrition Program, PATH, Seattle, WA, USA
| | - Stephanie L Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Krysten North
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Melissa F Young
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Eliza Fishman
- Ariadne Labs at Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Katelyn Fleming
- Ariadne Labs at Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Katherine Ea Semrau
- Ariadne Labs at Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Lauren Spigel
- Ariadne Labs at Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Danielle E Tuller
- Ariadne Labs at Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Natalie Henrich
- Ariadne Labs at Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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3
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Caruso BA, Paniagua U, Hoffman I, Manji K, Saidi F, Sudfeld CR, Vernekar SS, Bakari M, Duggan CP, Kibogoyo GC, Kisenge R, Somji S, Kafansiyanji E, Mvalo T, Nyirenda N, Phiri M, Bellad R, Dhaded S, K A C, Koppad B, Nabapure S, Nanda S, Singh B, Yogeshkumar S, Fleming K, North K, Tuller DE, Semrau KEA, Vesel L, Young MF. Safe infant feeding in healthcare facilities: Assessment of infection prevention and control conditions and behaviors in India, Malawi, and Tanzania. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001843. [PMID: 37289720 DOI: 10.1371/journal.pgph.0001843] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/29/2023] [Indexed: 06/10/2023]
Abstract
Infants need to receive care in environments that limit their exposure to pathogens. Inadequate water, sanitation, and hygiene (WASH) environments and suboptimal infection prevention and control practices in healthcare settings contribute to the burden of healthcare-associated infections, which are particularly high in low-income settings. Specific research is needed to understand infant feeding preparation in healthcare settings, a task involving multiple behaviors that can introduce pathogens and negatively impact health. To understand feeding preparation practices and potential risks, and to inform strategies for improvement, we assessed facility WASH environments and observed infant feeding preparation practices across 12 facilities in India, Malawi, and Tanzania serving newborn infants. Research was embedded within the Low Birthweight Infant Feeding Exploration (LIFE) observational cohort study, which documented feeding practices and growth patterns to inform feeding interventions. We assessed WASH-related environments and feeding policies of all 12 facilities involved in the LIFE study. Additionally, we used a guidance-informed tool to carry out 27 feeding preparation observations across 9 facilities, enabling assessment of 270 total behaviors. All facilities had 'improved' water and sanitation services. Only 50% had written procedures for preparing expressed breastmilk; 50% had written procedures for cleaning, drying, and storage of infant feeding implements; and 33% had written procedures for preparing infant formula. Among 270 behaviors assessed across the 27 feeding preparation observations, 46 (17.0%) practices were carried out sub-optimally, including preparers not handwashing prior to preparation, and cleaning, drying, and storing of feeding implements in ways that do not effectively prevent contamination. While further research is needed to improve assessment tools and to identify specific microbial risks of the suboptimal behaviors identified, the evidence generated is sufficient to justify investment in developing guidance and programing to strengthen infant feeding preparation practices to ensure optimal newborn health.
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Affiliation(s)
- Bethany A Caruso
- Hubert Department of Global Health, Emory University School of Public Health, Atlanta, Georgia, United States of America
| | - Uriel Paniagua
- Department of Epidemiology, Emory University School of Public Health, Atlanta, Georgia, United States of America
| | - Irving Hoffman
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Karim Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Friday Saidi
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Sunil S Vernekar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India
| | - Mohamed Bakari
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Christopher P Duggan
- Center for Nutrition, Boston Children's Hospital, Boston, Massachusetts, United States of America
- Division of Nutrition, Harvard Medical School, Boston, Massachusetts, United States of America
| | - George C Kibogoyo
- 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
| | - Sarah Somji
- 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
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Naomie Nyirenda
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Melda Phiri
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Roopa Bellad
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India
| | - Sangappa Dhaded
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India
| | - Chaya K A
- Bapuji Child Health Institute & Research Centre, Davangere, Karnataka, India
| | - Bhavana Koppad
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India
| | - Shilpa Nabapure
- SS Institute of Medical Sciences & Research Centre, Davangere, Karnataka, India
| | - Saumya Nanda
- Shri Jagannath Medical College and Hospital, Puri, Odisha, India
| | - Bipsa Singh
- Shri Jagannath Medical College and Hospital, Puri, Odisha, India
| | - S Yogeshkumar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India
| | - Katelyn Fleming
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Krysten North
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Danielle E Tuller
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Katherine E A Semrau
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Linda Vesel
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Melissa F Young
- Hubert Department of Global Health, Emory University School of Public Health, Atlanta, Georgia, United States of America
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4
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Semrau KEA, Mokhtar RR, Manji K, Goudar SS, Mvalo T, Sudfeld CR, Young MF, Caruso BA, Duggan CP, Somji SS, Lee ACC, Bakari M, Lugangira K, Kisenge R, Adair LS, Hoffman IF, Saidi F, Phiri M, Msimuko K, Nyirenda F, Michalak M, Dhaded SM, Bellad RM, Misra S, Panda S, Vernekar SS, Herekar V, Sommannavar M, Nayak RB, Yogeshkumar S, Welling S, North K, Israel-Ballard K, Mansen KL, Martin SL, Fleming K, Miller K, Pote A, Spigel L, Tuller DE, Vesel L. Facility-based care for moderately low birthweight infants in India, Malawi, and Tanzania. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001789. [PMID: 37075019 PMCID: PMC10115266 DOI: 10.1371/journal.pgph.0001789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 03/13/2023] [Indexed: 04/20/2023]
Abstract
Globally, increasing rates of facility-based childbirth enable early intervention for small vulnerable newborns. We describe health system-level inputs, current feeding, and discharge practices for moderately low birthweight (MLBW) infants (1500-<2500g) in resource-constrained settings. The Low Birthweight Infant Feeding Exploration study is a mixed methods observational study in 12 secondary- and tertiary-level facilities in India, Malawi, and Tanzania. We analyzed data from baseline facility assessments and a prospective cohort of 148 MLBW infants from birth to discharge. Anthropometric measuring equipment (e.g., head circumference tapes, length boards), key medications (e.g., surfactant, parenteral nutrition), milk expression tools, and human milk alternatives (e.g., donor milk, formula) were not universally available. MLBW infants were preterm appropriate-for-gestational age (38.5%), preterm large-for-gestational age (3.4%), preterm small-for-gestational age (SGA) (11.5%), and term SGA (46.6%). The median length of stay was 3.1 days (IQR: 1.5, 5.7); 32.4% of infants were NICU-admitted and 67.6% were separated from mothers at least once. Exclusive breastfeeding was high (93.2%). Generalized group lactation support was provided; 81.8% of mother-infant dyads received at least one session and 56.1% had 2+ sessions. At the time of discharge, 5.1% of infants weighed >10% less than their birthweight; 18.8% of infants were discharged with weights below facility-specific policy [1800g in India, 1500g in Malawi, and 2000g in Tanzania]. Based on descriptive analysis, we found constraints in health system inputs which have the potential to hinder high quality care for MLBW infants. Targeted LBW-specific lactation support, discharge at appropriate weight, and access to feeding alternatives would position MLBW for successful feeding and growth post-discharge.
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Affiliation(s)
- Katherine E. A. Semrau
- Ariadne Labs at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Rana R. Mokhtar
- Ariadne Labs at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Karim Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Shivaprasad S. Goudar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
| | - Tisungane Mvalo
- University of North Carolina Project Malawi, Lilongwe, Malawi
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Christopher R. Sudfeld
- Department of Global Health and Population and Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Melissa F. Young
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Bethany A. Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Christopher P. Duggan
- Center for Nutrition, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Sarah S. Somji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Anne C. C. Lee
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Mohamed Bakari
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kristina Lugangira
- 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
| | - Linda S. Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Irving F. Hoffman
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Friday Saidi
- University of North Carolina Project Malawi, Lilongwe, Malawi
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Melda Phiri
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Kingsly Msimuko
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Fadire Nyirenda
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | | | - Sangappa M. Dhaded
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
| | - Roopa M. Bellad
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
| | - Sujata Misra
- Department of Obstetrics and Gynaecology, SCB Medical College and Hospital, Cuttack, Odisha, India
- Department of Obstetrics and Gynaecology, FM Medical College, Balasore, Odisha, India
| | - Sanghamitra Panda
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
- Department of Obstetrics and Gynaecology, City Hospital, Cuttack, Odisha, India
| | - Sunil S. Vernekar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
| | - Veena Herekar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
| | - Manjunath Sommannavar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
| | - Rashmita B. Nayak
- Department of Paediatrics, SCB Medical College and Hospital, Cuttack, Odisha, India
| | - S. Yogeshkumar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
| | - Saraswati Welling
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
| | - Krysten North
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Kiersten Israel-Ballard
- Maternal, Newborn, Child Health and Nutrition Program, PATH, Seattle, Washington, United States of America
| | - Kimberly L. Mansen
- Maternal, Newborn, Child Health and Nutrition Program, PATH, Seattle, Washington, United States of America
| | - Stephanie L. Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Katelyn Fleming
- Ariadne Labs at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Katharine Miller
- Ariadne Labs at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Arthur Pote
- Ariadne Labs at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Lauren Spigel
- Ariadne Labs at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Danielle E. Tuller
- Ariadne Labs at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Linda Vesel
- Ariadne Labs at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Vesel L, Bellad RM, Manji K, Saidi F, Velasquez E, Sudfeld CR, Miller K, Bakari M, Lugangira K, Kisenge R, Salim N, Somji S, Hoffman I, Msimuko K, Mvalo T, Nyirenda F, Phiri M, Das L, Dhaded S, Goudar SS, Herekar V, Kumar Y, Koujalagi MB, Guruprasad G, Panda S, Shamanur LG, Somannavar M, Vernekar SS, Misra S, Adair L, Bell G, Caruso BA, Duggan C, Fleming K, Israel-Ballard K, Fishman E, Lee ACC, Lipsitz S, Mansen KL, Martin SL, Mokhtar RR, North K, Pote A, Spigel L, Tuller DE, Young M, Semrau KEA. Feeding practices and growth patterns of moderately low birthweight infants in resource-limited settings: results from a multisite, longitudinal observational study. BMJ Open 2023; 13:e067316. [PMID: 36792338 PMCID: PMC9933750 DOI: 10.1136/bmjopen-2022-067316] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
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.
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Affiliation(s)
- Linda Vesel
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Roopa M Bellad
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India
| | - Karim Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Friday Saidi
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Esther Velasquez
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California, USA
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Katharine Miller
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mohamed Bakari
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kristina Lugangira
- 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
| | - Nahya Salim
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sarah Somji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Irving Hoffman
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Kingsly Msimuko
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Tisungane Mvalo
- University of North Carolina Project Malawi, Lilongwe, Malawi
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Fadire Nyirenda
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Melda Phiri
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - 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
| | - Shivaprasad S Goudar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India
| | - Veena Herekar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India
| | - Yogesh Kumar
- 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
| | - Gowdar Guruprasad
- Department of Paediatrics, JJM Medical College, Davangere, Karnataka, India
| | | | - Latha G Shamanur
- Department of Paediatrics, SS Institute of Medical Sciences and Research Center, Davangere, Karnataka, India
| | - Manjunath Somannavar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India
| | - Sunil S Vernekar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India
| | - Sujata Misra
- Department of Paediatrics, SCB Medical College & Hospital, Cuttack, Orissa, India
| | - Linda Adair
- Department of Nutrition, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Griffith Bell
- 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
| | - Christopher Duggan
- Center for Nutrition, Boston Children'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
| | | | - Eliza Fishman
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anne C C Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stuart Lipsitz
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kimberly L Mansen
- 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
| | - Rana R Mokhtar
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Krysten North
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Arthur Pote
- 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
| | - Danielle E Tuller
- 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
| | - Katherine E A Semrau
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
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6
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Subramanian L, Desai M, Miller KA, Healey AJ, Henrich N. The Atlas Context Data Repository: A Feasible, Acceptable, and Useful Prototype for Context Data Collection and Future Predictive Analysis. Jt Comm J Qual Patient Saf 2022; 48:250-261. [DOI: 10.1016/j.jcjq.2022.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 11/25/2022]
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