Neonatal diet and growth outcomes in hospitalised very preterm infants: an observational study in middle income countries in Africa, Asia, and Latin America

Abstract

Background Up-to-date data from middle-income countries are needed to inform in-hospital feeding practices among small, vulnerable newborns. We aimed to quantify growth indicators and their associations with in-hospital diet for infants born very preterm or with a very low birth weight (VLBW) of 401–1500 g in 12 middle income countries in Africa, Asia, and Latin America. Methods We performed an observational cohort study of infants born at 22–29 weeks’ gestation or VLBW from 2018 to 2024 among Vermont Oxford Network member hospitals in 12 middle income countries. We used linear regression to estimate adjusted mean change in weight and head circumference (z-scores based on Fenton reference) from birth to hospital discharge by category of enteral diet at discharge/transfer (human milk only, mixed (human milk with formula and/or fortifier), and formula only), adjusting for confounders, in the entire cohort and stratified by birth weight and foetal growth status. Results Among 35 843 infants, the median length of stay was 50 days (interquartile range = 37, 65). Eighty-four percent were receiving at least some human milk at discharge (34% human milk only, 50% mixed, 16% formula only). Adjusted mean weight z-score declined by 1.40 in the human milk only group, 1.32 in the mixed group, and 1.17 in the formula only group. The adjusted estimated difference between mixed diet and formula only groups was 0.15 z-scores (95% confidence interval (CI) = 0.10, 0.20), and between the mixed and human milk only groups was 0.08 (95% CI = 0.00, 0.15). Head growth differed little between groups. Conclusions Human milk use was high at discharge in this vulnerable population of infants born at 22–29 weeks or VLBW in middle- income countries. Infants fed a mixed diet gain weight more slowly than infants fed only formula. Rigorous intervention studies are needed determine optimal nutrient delivery strategies for infants fed human milk in this context.