Nutritional Management of Low Birth Weight and Preterm Infants in Low- and Low Middle-Income Countries.
Study Goal
The researchers aimed to evaluate the effectiveness and safety of breastfeeding and other feeding strategies for preterm and low birth weight infants, particularly in low- and middle-income countries.
Results Summary
Breastfeeding promotion increased early initiation and exclusive breastfeeding rates at 3 and 6 months in LMICs. Formula milk was associated with higher neonatal mortality and necrotizing enterocolitis risk, while breast milk fortification and micronutrient supplementation improved growth and reduced mortality.
Population
Preterm and low birth weight infants, primarily in low- and middle-income countries.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
early initiation of enteral feeding | decrease | neonatal mortality | overall | - | reduced | #1 |
early initiation of enteral feeding | no change | neonatal mortality | LIC/LMIC settings | - | not reduced | #2 |
Breastfeeding promotion interventions | increase | prevalence of early initiation of breastfeeding | LMIC settings | - | increased | #3 |
Breastfeeding promotion interventions | increase | exclusive breastfeeding at 3 and 6 months of age | LMIC settings | - | increased | #4 |
formula milk | increase | neonatal mortality | LIC/LMIC settings | - | increased risk | #5 |
formula milk | increase | weight gain | overall | - | contributing to greater | #6 |
formula milk | increase | necrotizing enterocolitis | overall | - | higher risk | #7 |
Breast milk fortification | increase | growth outcomes | - | - | improved | #8 |
nutrient-enriched formula | increase | growth outcomes | - | - | improved | #9 |
Iron supplementation | decrease | anemia | LMIC | - | reduced | #10 |
vitamin A supplementation | decrease | mortality rates | LMIC | - | reduced | #11 |
zinc supplementation | no change | adverse effects | breastfed preterm and/or LBW infant | little to no | benefits outweigh the risks | #12 |
calcium/phosphorous supplementation | no change | adverse effects | breastfed preterm and/or LBW infant | little to no | benefits outweigh the risks | #13 |
vitamin D supplementation | no change | adverse effects | breastfed preterm and/or LBW infant | little to no | benefits outweigh the risks | #14 |
Breast milk feeding | decrease | diarrhea incidence | - | - | crucial to reduce | #15 |
micronutrient supplementation | decrease | mortality | - | - | crucial to reduce | #16 |
feed fortification | increase | growth | LMICs | - | to enhance better | #17 |
nutrient-enriched formula | increase | growth | LMICs | - | to enhance better | #18 |
INTRODUCTION: Preterm and low birth weight (LBW) infants are at an increased risk of morbidity and mortality compared with their term counterparts, with more than 20 million LBW infants born each year, the majority in lower middle-income countries (LMICs). Given the increased vulnerability and higher nutritional needs of these infants, optimizing feeding strategies may play a crucial role in improving their health outcomes. METHODS: We updated evidence of Every Newborn Series published in The Lancet 2014 by identifying relevant systematic reviews, extracting low-income country (LIC) and LMIC data, and conducting revised meta-analysis for these contexts. RESULTS: We found 15 reviews; the evidence showed that early initiation of enteral feeding reduced neonatal mortality overall, but not in LIC/LMIC settings. Breastfeeding promotion interventions increased the prevalence of early initiation of breastfeeding and exclusive breastfeeding at 3 and 6 months of age in LMIC settings. There was an increased risk of neonatal mortality with formula milk in LIC/LMIC settings. Despite contributing to greater weight gain, there was a higher risk of necrotizing enterocolitis with formula milk overall. Breast milk fortification and nutrient-enriched formula improved growth outcomes. Iron and vitamin A supplementation reduced anemia and mortality rates (LMIC), respectively. The evidence also suggested that benefits of various different micronutrient supplementation interventions such as zinc, calcium/phosphorous, and vitamin D, outweigh the risks since our review demonstrates little to no adverse effects deriving from their supplementation, particularly for a breastfed preterm and/or LBW infant. CONCLUSION: Early adequate nutritional support of preterm or LBW infant is paramount to averse adverse health outcomes, contribute to normal growth, resistance to infection, and optimal development. Breast milk feeding and micronutrient supplementation are crucial to reduce diarrhea incidence and mortality respectively while feed fortification or nutrient-enriched formula, when breast milk is not available, to enhance better growth especially in LMICs where there is higher population of growth restriction and stunting. This review also highlights need for randomized trials in LMICs at large scale to further strengthen the evidence. INTRODUCTION: Preterm and low birth weight (LBW) infants are at an increased risk of morbidity and mortality compared with their term counterparts, with more than 20 million LBW infants born each year, the majority in lower middle-income countries (LMICs). Given the increased vulnerability and higher nutritional needs of these infants, optimizing feeding strategies may play a crucial role in improving their health outcomes. METHODS: We updated evidence of Every Newborn Series published in The Lancet 2014 by identifying relevant systematic reviews, extracting low-income country (LIC) and LMIC data, and conducting revised meta-analysis for these contexts. RESULTS: We found 15 reviews; the evidence showed that early initiation of enteral feeding reduced neonatal mortality overall, but not in LIC/LMIC settings. Breastfeeding promotion interventions increased the prevalence of early initiation of breastfeeding and exclusive breastfeeding at 3 and 6 months of age in LMIC settings. There was an increased risk of neonatal mortality with formula milk in LIC/LMIC settings. Despite contributing to greater weight gain, there was a higher risk of necrotizing enterocolitis with formula milk overall. Breast milk fortification and nutrient-enriched formula improved growth outcomes. Iron and vitamin A supplementation reduced anemia and mortality rates (LMIC), respectively. The evidence also suggested that benefits of various different micronutrient supplementation interventions such as zinc, calcium/phosphorous, and vitamin D, outweigh the risks since our review demonstrates little to no adverse effects deriving from their supplementation, particularly for a breastfed preterm and/or LBW infant. CONCLUSION: Early adequate nutritional support of preterm or LBW infant is paramount to averse adverse health outcomes, contribute to normal growth, resistance to infection, and optimal development. Breast milk feeding and micronutrient supplementation are crucial to reduce diarrhea incidence and mortality respectively while feed fortification or nutrient-enriched formula, when breast milk is not available, to enhance better growth especially in LMICs where there is higher population of growth restriction and stunting. This review also highlights need for randomized trials in LMICs at large scale to further strengthen the evidence.