An Overview of Guidelines for Supplemental Feeding of Infants in Swedish Maternity Clinics

This study aims to describe the local guidelines for the supplemental feeding of infants of Swedish women’s clinics with maternity wards. Purposeful sampling was used during a four-week data collection time in 2019. Guidelines from 41 of the 43 Swedish women’s clinics with maternity wards were analysed using qualitative and quantitative content analysis. The information provided, and length of the guidelines varied widely in 38 guidelines. Feeding methods were included in 28 guidelines, but 10 provided no information about feeding methods. The most common feeding methods were cup feeding and feeding probes. Suggestions for supplemental feeding included infant formula (32), breast milk (27) and no suggestions (6). The methods to support breastfeeding were skin-to-skin contact (25), breastfeeding freely (22), a caring plan (18), extra supervision (3), optimising the caring environment (2), supplying a breast pump (1) and breastfeeding observation (1). Twenty-two guidelines included information about how long formula should be given and that the feeding should be phased out gradually. We conclude that a national guideline for the supplemental feeding of infants is needed to ensure equal best practice care for infant safety and the support of parents to increase the breastfeeding rate. More national guidelines are needed in general because it is easier to update only one set of guidelines.

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

(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.

TO COMPARE GAVAGE, CUP AND PALADY FEEDING METHODS IN TERMS OF ECONOMY IN PRETERM NEWBORN

Background: UNICEF and WHO recommended that children be exclusively breastfed during the first six months of life. Breast milk is uncontaminated and contains all nutrients necessary for children in the first few months of life. Methods: This randomized control trial conducted at Umaid hospital, attached to Dr. S.N Medical College, Jodhpur. All preterm neonates with a gestational age between 30 to 34 weeks as defined below were included in the study after a written informed consent. A total of 100 neonates, those meeting the inclusion criteria were taken in the study. These neonates were randomized into four groups – NG group, OG group, Palady group, and Cup group by block randomization comprising of 25 neonates each. Results- The mean expenditure in NG, OG, PALADY and CUP groups were 15427±10317 Rs., 17065±6807 Rs., 9231±1790 Rs. and 7319±1657 Rs. respectively. The difference was statistically significant for NG vs PALADY, NG vs CUP, OG vs PALADY, OG vs CUP and PALADY vs CUP. Conclusion: we conclude that feeding in preterm low birth weight neonates who cannot breast feed is best achieved by cup which was found to be the most economical method. Neonates on cup feeding required less expertise. Once mastered under supervision, cup feeding can be used independently in-home setting and in remote areas with less technical manpower at hand. Keywords: Feeding, Cup, Palady, OG.

Mode of gavage feeding: does it really matters

Background: The establishment of safe oral feeding in preterm or low birth weight infants may be delayed because of poor co-ordination of sucking and swallowing, neurological immaturity and respiratory distress. Enteral feeds may be delivered through a catheter (feeding tube) passed via the nose or via the mouth. This study was planned to compare oro-gastric and naso-gastric route for placing feeding tube to see duration to achieve full feeding.Methods: The study was conducted in in-patient of SCNU (Sick Newborn Care Unit) of Department of Paediatrics. All patients (200 newborns) in the study were randomly enrolled in groups as per gestational weeks between 28-34 weeks by using New Ballard Scoring (NBS) chart at the time of admission.Results: The mean duration to achieve full feeding either by direct breast feeding or cup feeding in oro-gastric and naso-gastric tube groups are (6.18±0.61) and (6.47±0.59) days respectively. This study will help in the individualization of the mode of gavage feeding in various institutions across the country.Conclusions: In the present study the episodes of non-intentional removal and displacement are more in OGT group and it is statistically significant (p = 0.012 and p <0.0001 respectively). The episodes of feed intolerance are more.