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Author Notes:

Dr Linda Vesel, lvesel@ariadnelabs.org

Study conceptualisation and design was completed by ACCL, BAC, CD, CRS, DET, IH, KEAS, KB, KLM, KMa, KMi, KN, LA, LS, LV, MY, RMB, SD, SSG, SLM and TM. Protocol development and tool design was carried out by ACCL, BAC, CRS, CD, DET, EF, IH, KEAS, KF, K-IB, KLM, KMa, KMi, KN, LA, LD, LS, LV, MY, NS, RMB, RK, SD, SSG, SLM, SM, SP, SS, SSV and TM. Tool pilot testing/ modification were conducted by DET, EF, FS, KF, MBK, LD, LGS, LS, LV, MP, MS, NS, RK, SM, SS, SSV, VH, YM. Data collection, cleaning and management was carried out by AP, EV, FN, MBK, KMs, LD, LS, LV, MB, KL, SP, YK. Analysis and interpretation were conducted by CRS, DET, EF, EV, GB, KEAS, KMi, LA, LV, RRM and SL. Writing of the manuscript was done by LV. All authors reviewed the study results and multiple drafts of the manuscript and approved the final version. LV acted as the guarantor of the manuscript.

All authors completed the ICMJE conflict of interest form and were funded by the Bill & Melinda Gates Foundation for this work as part of the LIFE study. ACCL, BAC, CD, CRS, DET, KEAS, K-IB, KLM, KM, MY have received funding from the Bill & Melinda Gates Foundation for maternal and newborn health and nutrition work at large. CD reports other funding from American Society for Nutrition, UpToDate and People’s Medical Publishing House. ACCL reports grants from the WHO and National Institute of Health/ NICHD. BAC reports funding from UNICEF and the US National Health Institutes of Health. MY reports grants from NIH, Emory University, and the Centers for Disease Control. K-IB and KM report grants from the Philips Foundation, the WHO and USAID. SLM has received funding from the International Society for Research on Human Milk and Lactation. All other authors have declared no conflicts of interest.


Research Funding:

This publication is based on research funded in part by the Bill & Melinda Gates Foundation. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation (INV-007326).


  • Science & Technology
  • Life Sciences & Biomedicine
  • Medicine, General & Internal
  • General & Internal Medicine
  • epidemiology
  • neonatology
  • nutrition & dietetics
  • community child health
  • public health
  • GAIN

Feeding practices and growth patterns of moderately low birthweight infants in resource-limited settings: results from a multisite, longitudinal observational study

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Journal Title:



Volume 13, Number 2


, Pages e067316-e067316

Type of Work:

Article | Final Publisher PDF


Objectives To describe the feeding profile of low birthweight (LBW) infants in the first half of infancy; and to examine growth patterns and early risk factors of poor 6-month growth outcomes. Design Prospective observational cohort study. Setting and participants Stable, moderately LBW (1.50 to <2.50 kg) infants were enrolled at birth from 12 secondary/tertiary facilities in India, Malawi and Tanzania and visited nine times over 6 months. Variables of interest Key variables of interest included birth weight, LBW type (combination of preterm/term status and size-for-gestational age at birth), lactation practices and support, feeding profile, birthweight regain by 2 weeks of age and poor 6-month growth outcomes. Results Between 13 September 2019 and 27 January 2021, 1114 infants were enrolled, comprising 4 LBW types. 363 (37.3%) infants initiated early breast feeding and 425 (43.8%) were exclusively breastfed to 6 months. 231 (22.3%) did not regain birthweight by 2 weeks; at 6 months, 280 (32.6%) were stunted, 222 (25.8%) underweight and 88 (10.2%) wasted. Preterm-small-for-gestational age (SGA) infants had 1.89 (95% CI 1.37 to 2.62) and 2.32 (95% CI 1.48 to 3.62) times greater risks of being stunted and underweight at 6 months compared with preterm-appropriate-for-gestational age (AGA) infants. Term-SGA infants had 2.33 (95% CI 1.77 to 3.08), 2.89 (95% CI 1.97 to 4.24) and 1.99 (95% CI 1.13 to 3.51) times higher risks of being stunted, underweight and wasted compared with preterm-AGA infants. Those not regaining their birthweight by 2 weeks had 1.51 (95% CI 1.23 to 1.85) and 1.55 (95% CI 1.21 to 1.99) times greater risks of being stunted and underweight compared with infants regaining. Conclusion LBW type, particularly SGA regardless of preterm or term status, and lack of birthweight regain by 2 weeks are important risk identification parameters. Early interventions are needed that include optimal feeding support, action-oriented growth monitoring and understanding of the needs and growth patterns of SGA infants to enable appropriate weight gain and proactive management of vulnerable infants. Trial registration number NCT04002908.

Copyright information:

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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