Article type
Abstract
Introduction
Preterm and LBW infants are at an increased risk of morbidity and mortality, with more than 80% of all newborn deaths occurring in the Low and Lower Middle Income Countries (LICs and 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. This systematic review aims to assess the effectiveness of different feeding supplementation interventions that promote health status of preterm/LBW infants, with a particular focus on LMIC settings.
Methods
We updated the evidence of Every Newborn Series published in The Lancet in 2014 by identifying new relevant systematic reviews; followed by extraction of LIC and LMIC data and creating new forest plots with revised estimates. We used the same search strategy as in the original review; and where not given, we used MeSH terms mentioned in the review to develop a new search strategy and run on databases including PubMed, Cochrane library, Cinahl and Embase.
Results
We found 15 reviews assessing the effect of feeding and supplementation interventions in preterm and LBW infants. We found that early initiation of enteral feeding reduced the neonatal mortality in overall but not in LMICs. Breastfeeding interventions increased the prevalence of initiation of breastfeeding and exclusive breastfeeding at three and six months of age in LMICs. Formula milk increased the risk of neonatal mortality when compared to breastmilk in LMICs but not in overall settings. Albeit contributing to greater weight gain, there was a higher risk of necrotizing enterocolitis with formula milk. The benefits of supplementation interventions such as iron, zinc, calcium and vitamin D, outweigh the risks since the evidence demonstrates little to no adverse effects deriving from their supplementation, particularly for a breastfed preterm/LBW infant.
Conclusion
Early adequate nutritional support of preterm/LBW infant is paramount to hinder adverse metabolic outcomes, contribute to normal growth, resistance to infection, long term health and optimal development. This review also highlights the gaps existing in the literature on such infant’s feeding and supplementation in LMICs, and need for randomized trials in LMICs at large scale to address these issues.
Preterm and LBW infants are at an increased risk of morbidity and mortality, with more than 80% of all newborn deaths occurring in the Low and Lower Middle Income Countries (LICs and 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. This systematic review aims to assess the effectiveness of different feeding supplementation interventions that promote health status of preterm/LBW infants, with a particular focus on LMIC settings.
Methods
We updated the evidence of Every Newborn Series published in The Lancet in 2014 by identifying new relevant systematic reviews; followed by extraction of LIC and LMIC data and creating new forest plots with revised estimates. We used the same search strategy as in the original review; and where not given, we used MeSH terms mentioned in the review to develop a new search strategy and run on databases including PubMed, Cochrane library, Cinahl and Embase.
Results
We found 15 reviews assessing the effect of feeding and supplementation interventions in preterm and LBW infants. We found that early initiation of enteral feeding reduced the neonatal mortality in overall but not in LMICs. Breastfeeding interventions increased the prevalence of initiation of breastfeeding and exclusive breastfeeding at three and six months of age in LMICs. Formula milk increased the risk of neonatal mortality when compared to breastmilk in LMICs but not in overall settings. Albeit contributing to greater weight gain, there was a higher risk of necrotizing enterocolitis with formula milk. The benefits of supplementation interventions such as iron, zinc, calcium and vitamin D, outweigh the risks since the evidence demonstrates little to no adverse effects deriving from their supplementation, particularly for a breastfed preterm/LBW infant.
Conclusion
Early adequate nutritional support of preterm/LBW infant is paramount to hinder adverse metabolic outcomes, contribute to normal growth, resistance to infection, long term health and optimal development. This review also highlights the gaps existing in the literature on such infant’s feeding and supplementation in LMICs, and need for randomized trials in LMICs at large scale to address these issues.