Influence of Neonatal Feeding Patterns on Weight Change During the Newborn Period Among Low-Birth-Weight Infants in Guinea-Bissau and Uganda

Objectives: Low birth weight (LBW) and early feeding patterns impact neonatal growth, yet there< is little data examining the relationship between feeding patterns and growth among LBW infants in low- and middle-income countries (LMIC). We assess relationships between feeding patterns and weight in the neonatal period among newborns with birth weight < 2000 g in Guinea-Bissau (N=60) and Uganda (N=60). Methods: 120 singleton infants with birthweights < 2000 g were enrolled between March 2020 and January 2021. Feeding and weight were recorded at 1, 2, 3, 4, 5, 12, and 30 days of age. Among the 104 neonates followed to Day 30, we examined 4 feeding parameters: any feeding in the first 24 hours, number of breastfeedings in first 24 hours, any formula in the first 30 days, and supplemental feeding (anything other than breastmilk) in the first 30 days. We assessed the relationship between the feeding and weight change using chi-square statistics, student's t-tests, and Pearson correlation coefficients. Results: Mean birth weight was 1758 ± 159 g (range 1210-1995). All infants initially experienced weight loss; weight gain began at a median of 3 days of age. At 5 days and 30 days of age, mean weight was 1674.3± 196.8 g and 2332.62 ± 452.1 g, respectively. In this cohort, during the first 30 days, all infants were breastfed and 23% also received supplementation. Notably, 12% received no feedings at all in the first 24 hours (22% in Uganda and 2% in Guinea-Bissau (p=.001)). Neither timing of feeding initiation nor supplemental feeding were associated with weight change over the first 30 days. Number of breastfeedings in the first 24 hours correlated with weight (r=0.267, p=0.005) and with weight change (r=0.222, p=0.020) at 5 days of age, although not at 30 days of age (r=0.117 and r=0.095, respectively). Among Uganda infants only, the day 30 correlations were 0.277 (p=.043) and 0.267 (p=.051), respectively. Conclusions: Number of breastfeedings in the first 24 hours of life significantly correlated with weight at day 5 and, for Uganda infants, at day 30. Further research should describe how breastfeeding in the first 24 hours of life affects long-term growth and outcomes among LBW infants in LMIC. Funding Sources: Bill and Melinda Gates Foundation.