Complementary feeding practices in preterm infants-A cross sectional study

Complementary feeding is defined as the process of providing food when breast milk or milk formula alone are no longer adequate to meet nutritional requirements. WHO recommends starting complementary feeding at 6 months of age and continues till 23 months. Breast feeding has to be continued along with complementary feeding. (4).  In LMIC’S National guidelines recommends complementary feeding begin at 6 months (4,64,65). After the age of 6 months, complementary feeding gives additional source of protein, iron, zinc, vitamin A and other essential micronutrients, prevents malnutrition, helps in cognitive, motor and socio-emotional development. reduces the risk of non-communicable diseases like Obesity, Type 1 diabetes. (14)

 According to the NFHS-5 data (2019–2021), in India, the percentage of children aged 6–8 months receiving solid or semi-solid food along with breastmilk is 52% in urban areas, 43.9% in rural areas, and 45.9% overall. Among breastfeeding children aged 6–23 months, only 11.8% received an adequate diet, while 12.7% of nonbreastfeeding children in the same age group received an adequate diet. Overall, only 11.3% of children aged 6– 23 months were reported to be receiving an adequate diet.

 In Karnataka, as per the NFHS-5 (2019–2020) data, 11.0% of breastfeeding children aged 6–23 months were receiving an adequate diet. Among non-breastfeeding children, this figure was 19.5%, with a total of 12.8% of children in this age group receiving an adequate diet.

 In Belgaum district, 35.6% of infants were introduced to complementary foods during their sixth month. Among mothers, 9.3% reported giving one complementary feed per day, 18% reported giving two feeds per day, while the remaining mothers reported giving complementary foods three or more times per day.(199)

 Preterm birth is defined as the birth of a baby before 37 completed weeks of gestation. Globally, the prevalence of prematurity is approximately 10–12%, and according to NFHS-5 data, the prevalence in India is around 12%. Prematurity is one of the leading causes of mortality and morbidity during the first year of life and contributes significantly to under-five mortality(2). In preterm infants, the development of a normal feeding pattern can be disrupted by extrauterine influences, resulting in dysphagia or abnormal swallowing. This may include impaired sucking, swallowing, or airway protection, which compromises the efficacy, adequacy, and most importantly, the safety of oral feeding. Dysphagia in preterm infants may reflect underlying anatomical or neurological abnormalities or injuries, or may simply be due to functional immaturity influenced by external sensory inputs(16). While feeding problems are seen in about 1% of the general pediatric population, the prevalence is significantly higher among preterm infants and is directly proportional to the degree of prematurity.(15) Residual feeding problems in growing preterm infants present with a wide range of phenotypes, including feeding tube dependency(30), nonspecific feeding difficulties, oral and feeding aversions(9,31,32). delayed transition to solid foods, difficulty with specific food textures (e.g., solids), and subtle swallowing dysfunctions. These feeding issues, compounded by delayed and inadequate nutrition, can lead to impaired growth and development in preterm infants.

A position paper done by Italian neonatal,paediatric and paediatric gastroenterology joint societies summarised current evidence regarding complementary feeding in preterm infants. However in India Guidelines for Complementry feeding not appropriate for preterm infants and lack of evidence-based recommendations and Indicators for adequate complementary feeding for preterm infants.