DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20210121

Postnatal growth in very low birth weight babies fed on exclusive human breast milk

Abhijit Bhattacharya, Sandeep Dhingra, Krishna M. Adhikari

Abstract


Background: Ideal preterm nutrition should sustain growth which mirrors the intrauterine fetal growth rate. Human milk provides complete nutrition to term infants and has been recommended as the exclusive source of feeding till first 6 months. Concern regarding growth faltering in preterms has precluded exclusive use of human milk for nutrition. The aim of this study was to document the growth rates of preterms fed exclusive human milk from birth to discharge from hospital.

Methods: This was a longitudinal cohort study in which all preterms admitted to neonatal intensive care unit (NICU) with very low birth weight (VLBW) and gestational age of ≤35 weeks were enrolled consecutively over a one-year period. Fluid, electrolyte and human milk intake was managed as per the NICU protocol. Vitamins and mineral supplements were added as per unit policy. Pre-feed weight, occipito-frontal circumference, and length was recorded at pre-determined intervals till discharge.

Results: Data of 37 infants was analysed. The most common morbidity was respiratory distress (29.73%) followed by birth asphyxia. Average time to regain birth weight was 13.61 days while mean increase in weight, length and OFC was 11.24 gm/kg/day, 0.60 cm/week and 0.59 cm/week respectively. The NICU length of stay varied from 9-76 days.

Conclusions: Exclusive use of human milk is reliable in achieving growth in preterm VLBW babies. Though the rate of growth is not comparable to intrauterine growth rates, nevertheless in the absence of accepted standards for postnatal growth in preterms on exclusive human milk, the results are reassuring.


Keywords


Growth rate, Human milk, Preterm infants, Very low birth weight

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References


Eidelman AI, Schanler RJ. Breastfeeding and the use of human milk. Pediatrics. 2012;129;e827.

World Health Organisation. Exclusive breastfeeding for six months best for babies everywhere: Statement 2011. Available at: https://www.who.int/news/item/15-01-2011-exclusive-breastfeeding-for-six-months-best-for-babies-everywhere#:~:text=WHO%20recommends%20mothers%20worldwide%20to,of%20two%20years%20or%20beyond. Accessed on 4 November 2020.

Schanler RJ, Hurst NM, Lau C. The use of human milk and breastfeeding in premature infants. Clin Perinatol. 1999;26(2):379-98.

Agostoni C, Buonocore G, Carnielli VP, De Curtis M, Darmaun D, Decsi T, et al. Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2010;50(1):85-91.

Narayanan I, Prakash K, Murthy NS, Gujral VV. Randomised controlled trial of effect of raw and holder pasteurised human milk and of formula supplements on incidence of neonatal infection. Lancet. 1984;2(8412):1111-3.

Joneja JM. Breast Milk: a vital defence against infection. Can Fam Phys. 1992;38:1849-55.

Lucas A, Morley R, Cole TJ, Lister G, Leeson-Payne C. Breast milk and subsequent intelligence quotient in children born preterm. Lancet. 1992;339(8788):261-4.

Vohr BR, Poindexter BB, Dusick AM, McKinley LT, Higgins RD, Langer JC, et al. Persistent beneficial effects of breast milk ingested in the neonatal intensive care unit on outcomes of extremely low birth weight infants at 30 months of age. Pediatrics. 2007;120 (4):e953-9.

Kuschel CA, Harding JE. Multicomponent fortified human milk for promoting growth in preterm infants. Cochrane database Syst Rev. 2004;2004(1):CD000343.

Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827-41.

Muhudhia SO, Musoke RN. Postnatal weight gain of exclusively breast fed preterm African infants. J Trop Pediatr. 1989;35(5):241-4.

Cole TJ, Statnikov Y, Santhakumaran S, Pan H, Modi N. Birth weight and longitudinal growth in infants born below 32 weeks’ gestation: a UK population study. Arch Dis Child Fet Neonat Ed. 2014;99(1):F34-40.

Adams-Chapman I, Hansen NI, Shankaran S, Bell EF, Boghossian NS, Murray JC, et al. Ten-year review of major birth defects in VLBW infants. Pediatrics. 2013;132(1):49-61.

Hack M, Fanaroff AA. Outcomes of children of extremely low birthweight and gestational age in the 1990s. Semin Neonatol. 2000;5(2):89-106.

Saluja S, Modi M, Kaur A, Batra A, Soni A, Garg P, et al. Growth of very low birth-weight indian infants during hospital stay. Indian Pediatr. 2010;47(10):851-6.

Stevenson DK, Wright LL, Lemons JA, Oh W, Korones SB, Papile LA, et al. Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, January 1993 through December 1994. Am J Obstet Gynecol. 1998;179(6):1632-9.

Owa JA, Osinaike AI. Neonatal morbidity and mortality in Nigeria. Indian J Pediatr. 1998;65(3):441-9.

Mathew G, Gupta V, Santhanam S, Rebekah G. Postnatal weight gain patterns in preterm very-low-birth-weight infants born in a tertiary care center in south India. J Trop Pediatr. 2018;64:126-31.