Post Discharge Feeding Practices in Very Low Birth Weight (VLBW) Infants

Background: Most of the studies show that a large number of very low birth weight infants (VLBW) show poor growth on follow up. These babies are born growth retarded, at discharge remain malnourished and subsequently continue to have poor growth probably due to inadequate nutrition and delayed introduction of complementary foods. Our hypothesis is that delay in starting semisolids causes persistence of poor growth pattern in growth failure.

Objectives: To study the effect of post discharge feeding practices on the growth of VLBW infants.

Methods: This was a prospective, descriptive, mixed longitudinal study done in the high risk follow up clinic of a tertiary care centre. VLBW infants who were less than 34 weeks of gestation were enrolled for the study. At discharge their feeding practices which included method of feeding, type of feed, post conceptional age, weight and head circumference were recorded. During follow up at 1,3,6,9,12 months of chronological age feeding practices were again reviewed which included method of feeding, type of feed, whether complementary feeds have been started or not, if yes then when, how many items being given were recorded. Weight, length and head circumference were also recorded at the above visits.

Results: A total of 74 babies were enrolled for this study over a period of 6 months. Six babies had more than 1 visit. The mean birth weight, gestation and head circumference at birth were 1246 ± 190 g, 31 ± 1.7 wks and 27.9 ± 1.6 respectively. Ninety seven percent (97%) mothers of these babies were between 20-34 years, 33% were graduate and 87% were house wife. Seventy percent (70%) parents were living in a joint family. Sixty four percent (64%) were appropriate for date and 65% were males. All the babies had multiple neonatal problems. The mean duration of hospital stay was 26 ± 19 days. At the time of discharge the PCA was 35 ± 2.3 wks, weight 1453 ± 218 g, head circumference was 29.5 ± 1.5 cm. After discharge at chronological ages of 1 (n=19), 3 (n=21), 6 (n=8), 9 (n=15) and 12 (n=17) months, their weight, head circumference and length were less than 5^th centile as per standard growth charts. At discharge, only 11% of these babies were on full breast feeds, 33% on spoon feeds with expressed breast milk/formula and 56% were on both. At 3 month follow up, full breast feeding rate improved upto 67% but at 6, 9 and 12 months breast feeding rate decreased to 50%,14%, and 6% respectively. Formula feed increased from 10% at 1 month to 94 % at 12 months. Complementary feeding was being given in 5.7% babies at 3 mo, 50% at 6 mo,93% at 9 mo and all babies were on semisolids by 12 months. Semisolids were given 3 times/day (average 3-4 items) in 25% at 6 mo, 43% at 9 mo and 53% at 12 months. Only 47% babies were receiving all types of food at 1 year.

Conclusion: VLBW infants continue to have poor growth rate after discharge. Milk continues to be the major diet till 1 year. Weaning is introduced late and slowly. Early and aggressive weaning may improve the growth status which needs further study.