Feeding Interventions for Infants with Growth Failure in the First Six Months of Life: A Systematic Review

Abstract

<jats:p>(1) Introduction: Current evidence on managing infants under six months with growth failure or other nutrition-related risk is sparse and low quality. This review aims to inform research priorities to fill this evidence gap, focusing on breastfeeding practices. (2) Methods: We searched PubMed, CINAHL Plus, and Cochrane Library for studies on feeding interventions that aim to restore or improve the volume or quality of breastmilk and breastfeeding when breastfeeding practices are sub-optimal or prematurely stopped. We included studies from both low- and middle-income countries and high-income countries. (3) Results: Forty-seven studies met the inclusion criteria. Most were from high-income countries (n = 35, 74.5%) and included infants who were at risk of growth failure at birth (preterm infants/small for gestational age) and newborns with early growth faltering. Interventions included formula fortification or supplementation (n = 31, 66%), enteral feeds (n = 8, 17%), cup feeding (n = 2, 4.2%), and other (n = 6, 12.8%). Outcomes included anthropometric change (n = 40, 85.1%), reported feeding practices (n = 16, 34%), morbidity (n = 11, 23.4%), and mortality (n = 5, 10.6%). Of 31 studies that assessed formula fortification or supplementation, 30 reported anthropometric changes (n = 17 no effect, n = 9 positive, n = 4 mixed), seven morbidity (n = 3 no effect, n = 2 positive, n = 2 negative), five feeding (n = 2 positive, n = 2 no effect, n = 1 negative), and four mortality (n = 3 no effect, n = 1 negative). Of eight studies that assessed enteral feed interventions, seven reported anthropometric changes (n = 4 positive, n = 3 no effect), five feeding practices (n = 2 positive, n = 2 no effect, n = 1 negative), four morbidity (n = 4 no effect), and one reported mortality (n = 1 no effect). Overall, interventions with positive effects on feeding practices were cup feeding compared to bottle-feeding among preterm; nasogastric tube feed compared to bottle-feeding among low birth weight preterm; and early progressive feeding compared to delayed feeding among extremely low birth weight preterm. Bovine/cow milk feeding and high volume feeding interventions had an unfavourable effect, while electric breast pump and Galactagogue had a mixed effect. Regarding anthropometric outcomes, overall, macronutrient fortified formula, cream supplementation, and fortified human milk formula had a positive effect (weight gain) on preterm infants. Interventions comparing human breastmilk/donor milk with formula had mixed effects. Overall, only human milk compared to formula intervention had a positive effect on morbidity among preterm infants, while none of the interventions had any positive effect on mortality. Bovine/cow milk supplementation had unfavourable effects on both morbidity and mortality. (4) Conclusion: Future research should prioritise low- and middle-income countries, include infants presenting with growth failure in the post-neonatal period and record effects on morbidity and mortality outcomes.</jats:p>

Mixed Infant Feeding Is Not Associated With Increased Risk of Decelerated Growth Among WIC-Participating Children in Southern California

“…Results suggest this support may be important, particularly for parents of fully breastfed infants during the complementary feeding transition. A recent review of interventions for growth faltering among infants younger than 6 months found mixed results among studies comparing the impacts of formula and breastmilk on growth among children with growth failure or other nutritional risks (23). Similar to the results in this study, another review found that formula contributed to faster and more linear growth among pre-term and low birthweight infants than breastmilk (24); however, these prior results are not directly comparable to those of the present study because the prior study did not include full term and normal birthweight infants while the present study did.…”

Mixed-methods, descriptive and observational cohort study examining feeding and growth patterns among low birthweight infants in India, Malawi and Tanzania: the LIFE study protocol

“… 18 The World Health Organization (WHO) feeding guidelines for LBW infants were published in 2011 19 ; however, most of the recommendations are based on low quality evidence; even so, the majority of available evidence was from high-income countries, and most data were limited to very LBW infants (<1.5 kg) even though the majority of LBW infants are born between 1.5 kg to <2.5 kg. 12 20 …”

“…Additionally, LBW infants face increased risks for morbidity, neurodevelopmental impairments and growth faltering as well as challenges related to breast feeding, particularly its initiation and exclusivity in early infancy 2 8–12. Inadequate and insufficient feeding contributes to poor growth outcomes, such as stunting, wasting and underweight, for which the risk among LBW infants is already increased 13.…”

“…Generally, studies capturing evidence on optimal milk type and content for moderately LBW infants (1.5 kg to <2.5 kg) in low-resource settings are lacking, hindering the proper management of nutritionally at-risk newborns 18. The World Health Organization (WHO) feeding guidelines for LBW infants were published in 201119; however, most of the recommendations are based on low quality evidence; even so, the majority of available evidence was from high-income countries, and most data were limited to very LBW infants (<1.5 kg) even though the majority of LBW infants are born between 1.5 kg to <2.5 kg 12 20…”

Infant malnutrition in low- and middle-income countries: assessment and prevalence of small and nutritionally at-risk infants aged under 6 months in 54 Demographic & Health Survey datasets

“…Though many of the recommendations in these WHO guidelines were ‘strong’, the underlying evidence-base was recognised as being sparse and overall low quality. Many research and programmatic gaps remain (9, 10).…”