Feeding Low Birth Weight Infants Research Articles

Effect of Designed Nutritional Guidelines on Nurses’ Performance regarding Feeding of LowBirth-Weight Infants

Low birth weight is one of the most serious challenges in maternal and childhealth in both developed and developing countries.

Effectiveness of a short-structured training programme on knowledge of healthcare providers and programme managers involved in maternal and child health programmes in Odisha, India: a quality improvement study

ObjectiveTo evaluate the effectiveness of training programme on knowledge related to new interventions proposed under India Newborn Action Plan (INAP) and Integrated Action Plan against Pneumonia and Diarrhoea (IAPPD).DesignQuality improvement...

Human milk banks: a need for further evidence and guidance

Human milk banks: a need for further evidence and guidance

Continuous versus intermittent bolus milk feeding in preterm infants: a meta-analysis

ObjectivesTo analyze the evidence comparing the benefits and risks of continuous versus intermittent milk feeding in low birth weight (LBW) infants.MethodsThree electronic databases were searched and screened to identify randomized controlled trials of continuous and intermittent milk feeding of LBW infants up to October 2016.ResultsEight trials were included in this meta-analysis. Continuous feeding had no effect on days to full feeds and time to regain birth weight. There were no significant differences in the number of apneas, invasive ventilation, changes in body length, occipitofrontal circumference, skinfold thickness, and total protein, and in the number of stools between the two feeding strategies. Continuous feeding was associated with higher gastric residual volume, noninvasive ventilation, weight gain, increase in bilirubin, and longer nil by mouth. There were no significant differences in adverse events and confounders between the two feeding strategies.ConclusionsContinuous milk feeding was superior to intermittent feeding in LBW infants in terms of weight gain. However, continuous feeding was also associated with increased nil by mouth duration, increased bilirubin, increased noninvasive support, and increased gastric residuals. Continuous feeding thus confers advantages in terms of weight gain, but also has disadvantages compared with bolus feeding.

Call to action for equitable access to human milk for vulnerable infants

Call to action for equitable access to human milk for vulnerable infants

Erratum to: World Health Organization Guidelines for Feeding Low Birth Weight Infants: Effects of Implementation in First Referral Level Health Facilities in India : Investigators of WHO LBW Feeding Study Group, Delhi, India.

Objective To evaluate the effect of implementing World Health Organization (WHO) low birth weight (LBW) feeding guidelines in First Referral Level health facilities in India. Methods This was a before-and-after study conducted at two First ReferralLevelhealth facilities in India.In the preandpost implementation periods of 4 mo each, the authors compared knowledge and skills of health care providers (HCPs) with regard to feeding of LBW infants using multiple choice and short answer questions and objective structured clinical examinations. The authors also enrolled in the two periods, separate cohorts of LBW infants along with their mothers at birth, and followed them till 2 wk of age or death/discharge. Quality of care received by the infants was assessed at 24–48 h and at discharge/2 wk using pre-determined parameters based on which quality scores were assigned by experienced neonatologists. Knowledge and skills of the mothers were also assessed at thesetime points through semi structuredquestionnaires and observation checklists. Guidelines were implemented using specially prepared training material through seminars, workshops, refresher courses and on-job support. Results Overall knowledge (62 ± 16 vs. 75 ± 15, n = 55; p < 0.01) and skill scores (298 ± 37 vs. 348 ± 52, p <0 .05) of HCPs improved. Correct knowledge increased among the mothers at the time of discharge (7.1 % vs. 63.4 %; p <0 .01). However, there was no improvement in maternal feeding skills at either 24–48 h or at discharge and key feeding practicesremainedunchanged.Thoughtherewasincreaseduptake of kangaroo mother care (0 vs. 21.9 %; p < 0.01) and alternate methods of feeding (15.9 % vs. 31.7 %; p = 0.03) by discharge/14 d, there was no significant improvement in overall quality of care of LBW infants (4.8 % vs. 6.7 %; p =0 .55). Conclusions FortheGuidelinestobefullyeffective,additional efforts on part of HCPs/additional staff and efforts to promote generic early feeding practices in addition to LBW focused guidelines would be required.

World Health Organization Guidelines for Feeding Low Birth Weight Infants: Effects of Implementation in First Referral Level Health Facilities in India.

To evaluate the effect of implementing World Health Organization (WHO) low birth weight (LBW) feeding guidelines in First Referral Level health facilities in India. This was a before-and-after study conducted at two First Referral Level health facilities in India. In the pre and post implementation periods of 4mo each, the authors compared knowledge and skills of health care providers (HCPs) with regard to feeding of LBW infants using multiple choice and short answer questions and objective structured clinical examinations. The authors also enrolled in the two periods, separate cohorts of LBW infants along with their mothers at birth, and followed them till 2wk of age or death/discharge. Quality of care received by the infants was assessed at 24-48h and at discharge/2wk using pre-determined parameters based on which quality scores were assigned by experienced neonatologists. Knowledge and skills of the mothers were also assessed at these time points through semi structured questionnaires and observation checklists. Guidelines were implemented using specially prepared training material through seminars, workshops, refresher courses and on-job support. Overall knowledge (62±16 vs. 75±15, n=55; p<0.01) and skill scores (298±37 vs. 348±52, p<0.05) of HCPs improved. Correct knowledge increased among the mothers at the time of discharge (7.1% vs. 63.4%; p<0.01). However, there was no improvement in maternal feeding skills at either 24-48h or at discharge and key feeding practices remained unchanged. Though there was increased uptake of kangaroo mother care (0 vs. 21.9%; p<0.01) and alternate methods of feeding (15.9% vs. 31.7%; p=0.03) by discharge/14 d, there was no significant improvement in overall quality of care of LBW infants (4.8% vs. 6.7%; p=0.55). For the Guidelines to be fully effective, additional efforts on part of HCPs/additional staff and efforts to promote generic early feeding practices in addition to LBW focused guidelines would be required.

Improved outcomes of feeding low birth weight infants with predominantly raw human milk versus donor banked milk and formula

Objectives: To investigate the benefits of treating low birth weight infants predominantly with mother’s own raw milk and early initiation of breastfeeding (raw human milk/breast-fed infants), in comparison to feeding only with donor banked milk (until the third week of life) and afterwards a preterm formula until hospital discharge (donor banked/formula-fed infants).Methods: One hundred and ninety-two predominantly raw human milk-fed infants (70% of raw and 30% of donor milk) were matched to 192 donor/formula-fed ones (on 1:1 ratio). Aggressive nutrition policy and targeted fortification of human milk were implemented in both groups.Results: The two groups show similar demographic and perinatal characteristics. Predominantly raw milk-fed infants regained earlier their birth weight, suffered less episodes of feeding intolerance and presented a higher body length and head circumference at discharge (p < 0.001). Those treated mainly with their mothers’ milk were able to initiate breastfeeding almost 2 weeks earlier compared to those fed with donor milk who achieved to be bottle-fed later on post-conceptual age (p < 0.001). Infants being breastfed until the 8th month of life conducted less visits for a viral infection to a pediatrician compared to those in the other group (p < 0.001).Conclusions: Feeding predominantly with mother’s raw milk seems to result in optimal neonatal outcomes.

Do mothers understand healthy eating principles for low-birth-weight infants?

To describe feeding patterns and mothers' perceptions of desirable feeding practices in low-birth-weight (LBW) infants after hospital discharge in England and to test for the association of inappropriate practices/perceptions with identifiable demographics. Postal questionnaires from 198 mothers of LBW infants in London, Liverpool and Winchester were analysed regarding infant demographics, mothers' demographics, infant milks used, solid feeding practices and mothers' perceptions of infant feeding practices. At birth, the median weight, independent of gestational age, was 1.80 kg (range 0.6-2.50 kg) and 37.1% of infants received breast milk exclusively; 83.7% were breast-fed at some stage, a practice favoured more by first-time mothers (90.2%) than multiparous mothers (73.4%) (P = 0.004) as well as by mothers of higher social groups (P = 0.019). The median age of solid food introduction was 17 postnatal weeks (range 8-36 weeks); the timing correlated strongly with infant birth weight (P < 0.001). A high-fibre diet and a low-fat diet were incorrectly considered important for their infants by 67.1% and 51.6% of mothers, respectively. Regarding a high-fibre diet as important was associated with being a multiparous mother (P = 0.006), while regarding a low-fat diet as important was associated with low social group (P = 0.018). A quarter of mothers did not consider 'plenty of calories' to be important for their infants, reflecting similar attitudes in 1990 for mothers of term infants; this incorrect attitude exhibited an association with being a first-time mother (P = 0.047). Infant feeding practices were very variable, showing poor concordance with national and international recommendations for term infants. In selecting foods for their infants, many mothers appeared to be applying principles more appropriate to planning a healthy diet for adults. There is an urgent need to develop and implement evidence-based guidelines for feeding LBW infants after hospital discharge, with special attention given to multiparous mothers as well as mothers from lower social groups.

Plasma fatty-acid composition and antioxidant capacity in low birth-weight infants fed formula enriched with n−6 and n−3 long-chain polyunsaturated fatty acids from purified phospholipids

Objective: To determine whether a formula containing n−6 and n−3 long-chain polyunsaturated fatty acids (LCP) from purified phospholipids increases the content of 20:4n−6 and 22:6n−3 of plasma lipids and modifies the plasma antioxidant capacity in low-birth-weight infants.Study design: Seventeen infants were fed a conventional formula for low birth-weight infants (F), and 17 a formula containing n−6 and n−3 LCP from purified pig-brain phospholipids (LCP-F). Fourteen infants receiving human milk from a human milk bank were used as a reference (HM). Growth index were measured and blood samples were taken at entry and after 15 days and 30 days of feeding.Results: In infants fed LCP-F the levels of 22:6n−3 in total plasma lipids and in plasma phospholipids and triglycerides were higher than in infants fed F and closer to the levels of HM group throughout the study. Docosahexaenoic acid concentration in total plasma lipids was 3.46±0.19 mg/dl in infants fed LCP-F and 2.08±0.20 in infants fed F after 15 days of feeding (P<0.001), and 3.83±0.30 and 2.15±0.20 in infants fed LCP-F and F respectively, after 30 days of feeding (P<0.001). The concentration of 20:4n−6 in the LCP-F was significantly higher than in the F group at 15 and 30 days of feeding. Plasma antioxidant capacity did not differ significantly between the study groups.Conclusion:Feeding low birth-weight infants a formula containing LCP phospholipids results in an increase of n−3 and n−6 LCP in plasma towards that of infants fed human milk.

Sucking on the 'emptied' breast: non-nutritive sucking with a difference.

A simple method to promote the use of human milk and subsequent breast feeding in low birthweight infants was evaluated in 32 babies. In the 'intervention' group (n = 16; mean (SD) weight 1559 (228) g and length of gestation 33.2 (1.8) weeks), infants were allowed to suckle at the breast when their general condition permitted after as much milk as possible had been expressed, and were then given the full required feeds by tube. Full breast feeding was started as soon as the infant could suck adequately. Sixteen control infants (mean (SD) weight 1605 (198) g and length of gestation 34.1 (2.4) weeks), were breast fed in the conventional manner only after it had been established that they could suck well; until then they received all their feeds by tube. After discharge the mean (SD) periods of exclusive and total breast feeding were longer in the group that had received the intervention (3.7 (1.3) and 5.1 (2.2) months, respectively) than among the controls (1.9 (0.6) and 3.3 (1.9) months, respectively). This 'intervention' method helps to promote milk formation, provides sucking experience for low birthweight infants without interfering with their nutritional intake and consequent weight gain, and encourages subsequent breast feeding with its well recognised advantages.

Controlled trial of new formulae for feeding low birth weight infants

Over a 13-month period 85 babies were randomly allocated to one of three groups at birth. Babies in Group A were fed SMA Low Birth Weight, Group B Prematalac and Group C Preaptamil. A fourth group, the control group was fed expressed breast milk (EBM). The babies were studied when they were on full enteral feeds until weight was > 2.0 kg. Weight gain was greatest in Group B compared to the other three groups but there was no significant difference in gain of length or occipito-frontal circumference. The babies in Group B had a lower volume of feeds and lower energy intake than the other groups but had a significantly higher sodium intake which was reflected in higher mean sodium levels. This may have accounted for the increased weight gain. There was no significant difference in serum calcium, osmolality, total protein or haematocrit.

Breast feeding of low birthweight infants.

The incidence and length of breast feeding of LBW (less than or equal to 2500 grams) infants were investigated. A marked increase from 1979 to 1982 was noted: the incidence rose from 78% to 91% and the proportion of infants breast fed for 3 months rose from 54% to 67%. A breast feeding promotion programme did not influence the length of breast feeding of LBW infants within one year of the intervention. Smaller infants, those with RDS and those from lower social classes were breast fed less than others.

Craig's Care of the Newly Born Infant

The challenge perinatal health services the parents the fetus the newborn nursing care of the healthy newborn examination of the healthy newborn feeding low birth weight infants nursing care of low birth weight infants congenital abnormalities perinatal asphyxia perinatal injuries infection jaundice dyspnoea and cyanosis convulsions and other abnormal behaviour pallor, polycythaemia haemorrhage and purpura weight loss and other important signs practical procedures continuing care.

Donor breast milk.

A simple system for the collection and storage of human milk, as a voluntary community activity, is described. The case is made for preferring drip breast milk as the main source of human milk for the milk bank. The central place of precise pasteurization is emphasised as the essential feature for maintaining bacteriological quality control and simplicity of organisation. The suitability of donor breast milk for the nutrition of the low birthweight infant is discussed and evidence presented to indicate that low birthweight infants fed exclusively on donated human milk are of similar size to control term infants when assessed at 18 months corrected postnatal age. Emphasis is placed on the importance of controlled trials in relation to all innovations in feeding of low birthweight infants.

Orojejunal feeding in low birthweight infants.

Orojejunal feeding in low birthweight infants.

Improved tube for nasojejunal feeding in low birthweight infants.

A simple tube for nasojejunal feeding is described. 22 infants with birthweight less than 1500 g and 25 infants 1500--2000 g were fed during the first weeks of life. The tube elimintes many of the difficulties previously encountered with nasojejunal feeding.

Nutritional requirements and methods of feeding low birth weight infants

Nutritional requirements and methods of feeding low birth weight infants