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Nutritional Management of Low Birth Weight and Preterm Infants in Low- and Low Middle-Income Countries.

Neonatology
January 1, 2025
Maha Azhar et al. (6 authors)
Journal ArticleReviewMeta-AnalysisSystematic ReviewHuman Study
Study Details

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

Extracted Claims (18)
InterventionDirectionEndpointPopulationDosageImpactClaim #
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
Abstract

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.

Medical Subject Headings (MeSH)
HumansInfant, Low Birth WeightInfant, NewbornDeveloping CountriesInfant, PrematureBreast FeedingInfant MortalityInfant Nutritional Physiological PhenomenaEnteral NutritionInfantInfant FormulaDietary Supplements
Study Links
Quality Scores
Safety90
Efficacy85/10
Quality80/10
Citation Metrics
Total Citations2
Citations/Year2.0
Research Impact Scores
APT Score0.05
Weight Score2.89
Normalized Score0.86
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