proportion of and factors associated with sub-optimal feeding among very low birth weight infants admitted to the special care unit, kawempe hospital

Description

Introduction: Over 60% of the Very Low Birth Weight (VLBW) infants born worldwide are born in sub-Saharan African countries. In Uganda, the prevalence of VLBW is currently 12%. VLBW infants are born nutritionally disadvantaged, as they are suddenly and prematurely moved from a nutrient-rich to a nutrient-deficient environment. In addition, VLBW infants have an immature and poorly developed suckling reflex and are therefore prone to sub-optimal feeding, especially in the first 2 weeks of life. However, the adequacy of feeding amongst VLBW infants and the effect of feeding on their growth velocities had hitherto not been evaluated in our setting. Objectives: This study aimed to estimate the proportion of VLBW infants receiving sub-optimal feeds, the associated factors; and the effect of sub-optimal feeding on growth velocities of VLBW infants admitted in the Special Care Unit, Kawempe Hospital. Methodology: This was a prospective cohort study among VLBW infants admitted in the SCU, Kawempe Hospital conducted between October 2019 and January 2020. Infants were recruited on day two of life and followed up till day seven of life, discharge or death. Data was collected on infant and maternal characteristics, feeding practices and weight changes. The proportion of infants who received sub-optimal feeding was computed. Logistic regression analysis was used to determine the factors associated with sub-optimal feeding. The strength of the association between sub-optimal feeding and growth velocity was obtained as an odds ratio. A comparison was then made between growth velocity among infants who received sub-optimal feeding and growth velocity among those that received optimal feeding. Results: A total of 370 VLBW infants, with a M:F ratio of 1:1 and a mean gestational age 32 weeks were enrolled. Of these, 333 (90%) had sub-optimal feeding. The factors associated with sub-optimal feeding included: no initiation of enteral feeds [AOR= 11.03, 95%, CI (1.34 to 90.77)] and mother’s final score on the social support scale [AOR= 2.78, 95%, CI (1.14 to 6.82)]. Sub-optimal feeding was significantly associated with sub-optimal growth velocity [OR= 6.81, 95%, CI (2.74 to 16.97)]. A total of 158 infants made it to day 7. Among these, 30 had optimal feeding and 24 (80%) of them achieved optimal growth velocity. The remaining 128 infants had sub-optimal feeding, and 20 (15.6%) had optimal growth velocity. A total of 124 (33.5%) of the enrolled infants died during the study period. Conclusions: The proportion of VLBW infants with sub-optimal feeding was very high. In addition, nearly all infants who received sub-optimal feeding had sub-optimal growth. The factors associated with sub-optimal feeding were no initiation of feeds and moderate social support of the mother. Recommendations: Clinicians in the SCU, Kawempe Hospital should initiate enteral feeds among VLBW infants within the first 48 hours of life as long as there are no contraindications to enteral feeding. In addition, the leadership and administration of SCU, Kawempe Hospital should support mothers of VLBW infants to provide alternative feeds in case they are unable to provide optimal amounts of breastmilk within the first 48 hours. Alternatives could include establishing a breastmilk bank. Furthermore, mothers to VLBW infants should be supported to receive psycho-social support, especially from significant others such as partners, family, and friends, as they cater for their VLBW infants. Further studies are recommended with the following: longer follow-up period, studying the longer-term effects of sub-optimal feeding on growth velocity, cognition, nutrition, and the impact of health system factors on sub-optimal feeding of VLBW infants.