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Vesel, Linda; Bellad, Roopa M.; Manji, Karim; Saidi, Friday; Velasquez, Esther; Sudfeld, Christopher R.; Miller, Katharine; Bakari, Mohamed; Lugangira, Kristina; & Kisenge, Rodrick, et al. (2023). Feeding Practices and Growth Patterns of Moderately Low Birthweight Infants in Resource-Limited Settings: Results from a Multisite, Longitudinal Observational Study. BMJ Open, 13(2), e067316. PMCID: PMC9933750


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.


Reference Type

Journal Article

Year Published


Journal Title

BMJ Open


Vesel, Linda
Bellad, Roopa M.
Manji, Karim
Saidi, Friday
Velasquez, Esther
Sudfeld, Christopher R.
Miller, Katharine
Bakari, Mohamed
Lugangira, Kristina
Kisenge, Rodrick
Salim, Nahya
Somji, Sarah
Hoffman, Irving F.
Msimuko, Kingsly
Mvalo, Tisungane
Nyirenda, Fadire
Phiri, Melda
Das, Leena
Dhaded, Sangappa
Goudar, Shivaprasad S.
Herekar, Veena
Kumar, Yogesh
Koujalagi, M. B.
Guruprasad, Gowdar
Panda, Sanghamitra
Shamanur, Latha G.
Somannavar, Manjunath
Vernekar, Sunil S.
Misra, Sujata
Adair, Linda S.
Bell, Griffith
Caruso, Bethany A.
Duggan, Christopher P.
Fleming, Katelyn
Israel-Ballard, Kiersten
Fishman, Eliza
Lee, Anne C. C.
Lipsitz, Stuart R.
Mansen, Kimberly L.
Martin, Stephanie L.
Mokhtar, Rana R.
North, Krysten
Pote, Arthur
Spigel, Lauren
Tuller, Danielle E.
Young, Melissa
Semrau, Katherine E. A.

Article Type




Data Set/Study

Low Birthweight Infant Feeding Exploration (LIFE) Study




Martin, S. - 0000-0002-0378-802X
Adair - 0000-0002-3670-8073