Growth faltering in early infancy: highlights from a two-day scientific consultation

Aneja, Satinder; Kumar, Praveen; Choudhary, Tarun Shankar; Srivastava, Akanksha; Chowdhury, Ranadip; Taneja, Sunita; Bhandari, Nita; Daniel, Abner; Menon, Purnima; Chellani, Harish; Bahl, Rajiv; Bhan, Maharaj Kishan

doi:10.1186/s12919-020-00195-z

Cited by 10 publications

(6 citation statements)

References 18 publications

(20 reference statements)

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“…Undernutrition is estimated to be associated with up to 50% of all deaths in under-five children (6), and the risk of death increases with greater degrees of anthropometric deficit (7). Nevertheless, there is longstanding debate within the nutrition research and practice communities surrounding the most appropriate anthropometric measures to identify the risk of death (8, 9), especially for infants under six months of age (10). Low birthweight (11, 12), preterm birth (13–15), and sub-optimal breastfeeding practices (16) as well as maternal nutrition and vital status (17) are also well-established risk factors.…”

Section: Introductionmentioning

confidence: 99%

Cohort profile: The WHO Child Mortality Risk Stratification Multi-Country Pooled Cohort (WHO-CMRS) to identify predictors of mortality through early childhood

Schwinger,

Kaldenbach,

Berkley

et al. 2024

Preprint

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Purpose: To provide details of a pooled dataset that will be used to estimate absolute and relative mortality risks and other outcomes among children less than 59 months of age and the predictive performance of common risk exposures, both individually and in combination. Participants: Children from birth to five years of age recruited at health facilities or community settings into 33 longitudinal observational or intervention studies in 18 low-and middle-income countries. Findings to date: The dataset includes 75,287 children with a median age of 3 months (IQR 1, 12) at first measurement. In the pooled sample, 2,805 (3.7%) of the study children died. Data on birthweight was recorded in 18 studies, and gestational age in 13 studies. Among these, 14% of the included children were reported with low birthweight and 14% preterm birth. At first measurement, 33% of the children were stunted, 24% were wasted, and 35% underweight. 13% and 7% of caregivers reported that their child had acute diarrhoea or acute lower respiratory tract infection before the study visit, respectively. The proportion of children being breastfed at any study visit decreased from 99% at age <6 months to 77% in the age group 12-23 months. Child characteristics differed considerably between studies in the community and health care settings. The median study period was 15 months (IQR 7.6 to 18.4 months). Future plans: The WHO Child Mortality Risk Stratification Multi-Country Pooled Cohort (WHO-CMRS) provides a large dataset including child, parental, and household characteristics from a diverse range of geographical, community and health system settings; planned analyses will examine knowledge gaps with the aim of informing global guidelines and their derivatives such as clinical management tools and implementation guidance, and to inform future research agendas.

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Section: Introductionmentioning

confidence: 99%

Cohort profile: The WHO Child Mortality Risk Stratification Multi-Country Pooled Cohort (WHO-CMRS) to identify predictors of mortality through early childhood

Schwinger,

Kaldenbach,

Berkley

et al. 2024

Preprint

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“…Early life growth faltering (also referred to as failure to thrive) and malnutrition are major global public health problems [ 1 , 2 ]. Affected infants include several distinct but often overlapping subpopulations: infants born at-risk (e.g., preterm, low birth weight (LBW), and/or intra-uterine growth failure); infants with subsequent growth faltering and associated anthropometric deficits (e.g., low weight-for-age, weight-for-length) [ 3 , 4 ]. Globally, each year, some 14.6% (20.5 million) of births are LBW and 10·6% (14.8 million) babies are born preterm [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Postnatal Maternal or Caregiver Interventions on Outcomes among Infants under Six Months with Growth Faltering: A Systematic Review

Rana,

Sirwani,

Mohandas

et al. 2024

Nutrients

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The care of infants at risk of poor growth and development is a global priority. To inform new WHO guidelines update on prevention and management of growth faltering among infants under six months, we examined the effectiveness of postnatal maternal or caregiver interventions on outcomes among infants between 0 and 6 months. We searched nine electronic databases from January 2000 to August 2021, included interventional studies, evaluated the quality of evidence for seven outcome domains (anthropometric recovery, child development, anthropometric outcomes, mortality, readmission, relapse, and non-response) and followed the GRADE approach for certainty of evidence. We identified thirteen studies with preterm and/or low birth weight infants assessing effects of breastfeeding counselling or education (n = 8), maternal nutrition supplementation (n = 2), mental health (n = 1), relaxation therapy (n = 1), and cash transfer (n = 1) interventions. The evidence from these studies had serious indirectness and high risk of bias. Evidence suggests breastfeeding counselling or education compared to standard care may increase infant weight at one month, weight at two months and length at one month; however, the evidence is very uncertain (very low quality). Maternal nutrition supplementation compared to standard care may not increase infant weight at 36 weeks postmenstrual age and may not reduce infant mortality by 36 weeks post-menstrual age (low quality). Evidence on the effectiveness of postnatal maternal or caregiver interventions on outcomes among infants under six months with growth faltering is limited and of ‘low’ to ‘very low’ quality. This emphasizes the urgent need for future research. The protocol was registered with PROSPERO (CRD42022309001).

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“…Critically, kangaroo mother care (KMC) and best breastfeeding practices are rarely fully addressed in available studies [ 6 , 24 , 36 , 41 ]. A recent scientific consultation addressing growth faltering in India highlighted some of these research gaps as well as the inadequate follow-up after transitioning from facility-based services to the home-setting [ 42 ]. Further strategies that are now standard of care in clinical settings in many middle- and high-income countries to preserve human milk feeding in very preterm and medically compromised infants such as increasing feeding volumes, nutrient-enriching expressed human milk with commercial fortifiers or less costing nutrient modulars (e.g.…”

Section: Introductionmentioning

confidence: 99%

Critical research gaps in treating growth faltering in infants under 6 months: A systematic review and meta-analysis

Tomori,

O’Connor,

Ververs

et al. 2024

PLOS Glob Public Health

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In 2020, 149.2 million children worldwide under 5 years suffered from stunting, and 45.4 million experienced wasting. Many infants are born already stunted, while others are at high risk for growth faltering early after birth. Growth faltering is linked to transgenerational impacts of poverty and marginalization. Few interventions address growth faltering in infants under 6 months, despite a likely increasing prevalence due to the negative global economic impacts of the COVID-19 pandemic. Breastfeeding is a critical intervention to alleviate malnutrition and improve child health outcomes, but rarely receives adequate attention in growth faltering interventions. A systematic review and meta-analysis were undertaken to identify and evaluate interventions addressing growth faltering among infants under 6 months that employed supplemental milks. The review was carried out following guidelines from the USA National Academy of Medicine. A total of 10,405 references were identified, and after deduplication 7390 studies were screened for eligibility. Of these, 227 were assessed for full text eligibility and relevance. Two randomized controlled trials were ultimately included, which differed in inclusion criteria and methodology and had few shared outcomes. Both studies had small sample sizes, high attrition and high risk of bias. A Bangladeshi study (n = 153) found significantly higher rates of weight gain for F-100 and diluted F-100 (DF-100) compared with infant formula (IF), while a DRC trial (n = 146) did not find statistically significant differences in rate of weight gain for DF-100 compared with IF offered in the context of broader lactation and relactation support. The meta-analysis of rate of weight gain showed no statistical difference and some evidence of moderate heterogeneity. Few interventions address growth faltering among infants under 6 months. These studies have limited generalizability and have not comprehensively supported lactation. Greater investment is necessary to accelerate research that addresses growth faltering following a new research framework that calls for comprehensive lactation support.

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Growth faltering in early infancy: highlights from a two-day scientific consultation

Cited by 10 publications

References 18 publications

Cohort profile: The WHO Child Mortality Risk Stratification Multi-Country Pooled Cohort (WHO-CMRS) to identify predictors of mortality through early childhood

Cohort profile: The WHO Child Mortality Risk Stratification Multi-Country Pooled Cohort (WHO-CMRS) to identify predictors of mortality through early childhood

Effectiveness of Postnatal Maternal or Caregiver Interventions on Outcomes among Infants under Six Months with Growth Faltering: A Systematic Review

Critical research gaps in treating growth faltering in infants under 6 months: A systematic review and meta-analysis

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