Low-birthweight Infant Feeding Exploration
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 3,188
- 试验地点
- 3
- 主要终点
- Length-for-Age Z-score
研究概览
简要总结
Globally, 15% of all babies, amounting to 20 million infants each year, are born low birthweight (LBW), defined less than 2500 grams (5.5 lbs). Compared to normal weight infants, LBW infants are at higher risk of morbidity, mortality, and poor growth (Risnes et al 2011; Larroque et al 2001; WHO 2006). The main causes of LBW are preterm birth, intrauterine growth restriction (IUGR), or their combination. Unfortunately, there is a paucity of information around feeding practices and optimal feeding strategies for this population, particularly for LBW infants who struggle with breastfeeding or growth. This study hopes to address these gaps.
详细描述
The Low-birthweight Infant Feeding Exploration (LIFE)(original grant 0-6 months of age) and the 6- month extension (6-12 months of age) will fill a critical data gap in the field of newborn care regarding vulnerability and feeding of LBW infants. The investigators aim to establish the background information required to set up and test the most efficient and feasible infant feeding strategies for LBW infants: first to support breastfeeding, and then to support infants who are nutritionally at risk in the first 6 month of life in low and middle income countries (LMIC). The investigators will explore all three infant feeding options currently included in the WHO guidelines for LBW infants (WHO 2011), namely mother's own milk (MOM), donor human milk (DHM), and breast milk substitute or formula (BMS), in that order. This work will provide much-needed evidence to inform infant feeding guidelines.
In addition, this 6-month extension will allow for a more comprehensive exploration and understanding of feeding options for LBW infants from 6 to 12 months of age, accounting for timing of introduction of complementary liquids and foods, changes in feeding types, growth and health outcomes over the entire infancy period. This will contribute significantly and allow for high quality data to describe the burden of disease across sites. Specifically, we will be able to describe the following for LBW infants:
- Growth trajectories from 0 to 12 months of age
- Patterns and timing of complementary feeding and continued breastfeeding/breastmilk consumption
- Common infant morbidities and timing of mortality
- Maternal demographics, well-being and environmental factors affecting infant feeding and growth
The overall study goal is to understand feeding options for LBW infants in LMIC settings, including current feeding practices, health outcomes, and potential interventions. The study will take place in four study sites located in three countries: Tanzania, Malawi, and India. Each study site will encompass 2 to 5 individual study facilities. The three study objectives under the goal include:
- Understand the current practices and standard of care (SOC) for feeding LBW infants
- Define and document the key outcomes (including growth, morbidity, and lack of success on MOM) for LBW infants under current practices
- Assess the acceptability and feasibility of a system-level IYCF intervention and the proposed infant feeding options for LBW infants
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 16 Years 至 59 Years（Child, Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Infant birthweight between 1500 and <2500g (according to chart and then verified by study staff).
- •Residence within catchment area of facility.
- •Mother's consent obtained for herself and infant.
- •Newborns must be enrolled within 72 hours of birth.
- •Women (mothers) who are of age of majority in their respective countries.
排除标准
- •Mother does not meet the local age of majority.
- •Infant very low birthweight <1500g.
- •Infant has congenital abnormality that interferes with feeding, which includes: Cleft lip or palate; Hydrocephalus; Gastrointestinal tract anomalies including gastroschisis, omphalocele, or anal atresia; Neural tube defects; Congenital cardiac defects; Suspected Trisomy 21; Suspected TORCH infection such as congenital rubella, cytomegalovirus (CMV), toxoplasmosis, or syphilis.
- •Critical or severe illness jeopardizing early survival, specifically, investigators will exclude infants with severe encephalopathy as determined by modified Sarnat criteria.
- •If the Infant dies before enrollment can occur.
- •Infant has a twin or triplet that has died.
- •Plans to leave the study area before end of data collection.
- •Infants must be enrolled in the prospective study within 72 hours of birth. If the infant is older than 72 hours at the time of screening, s/he will be ineligible for the study.
- •Maternal death: The study will exclude cases of maternal death that occur during labor and delivery (or at any time before the consenting process would begin for this study).
- •Maternal deaths will count as an exclusion criterion for the prospective cohort if they occur before enrollment. In the event that a mother dies at any time after enrollment the infant will still be retained in the cohort.
- •6-Month Extension Study Criteria:
- •Inclusion criteria for the mother/infant pair are:
- •Currently enrolled in the LIFE study and fulfills all original inclusion criteria.
- •Mother's or surrogate consent obtained for herself and infant for another 6 months of follow up.
- •Exclusion criteria for the mother/infant pair are:
- •Not previously enrolled in the LIFE study in addition to all original exclusion criteria.
结局指标
主要结局
Length-for-Age Z-score
时间窗: At 12 month of age
A Child's length-for-age z-score at 12 months of age. A Child's length-for-age z-score at 12 months of age. Length-for-age (LAZ) z-scores were based on World Health Organization (WHO) growth standards for term infants and preterm infants; we corrected for gestational age (GA) for preterm infants. A LAZ z-score of 0 represents the population mean and scores below 0 represent a worse outcome. Further, Z-scores less than -2.0 indicates an infant who is underweight.
次要结局
- Incidence of Diarrheal Disease(6 month postpartum)
研究者
Katherine Semrau
Director of BetterBirth Program at Ariadne Labs; Assistant Professor
Harvard School of Public Health (HSPH)