Effects of early feeds with mothers’ milk among neonates with very low birth weight and hypoxic Ischaemic encephalopathy admitted at regional Refferral hospitals in Dar Es Salaam, Tanzania

Abstract

BSTRACT Background: Early enteral feeding is usually delayed in neonates with very low birth weight and hypoxic ischaemic encephalopathy due to unstable haemodynamics and the risk of necrotizing enterocolitis. This prevents these neonates from receiving beneficial effects of colostrum hence predisposing them to an increased risk of infections, poor growth and development, and even mortality. Minimal enteral feeding and oral mucosa colostrum administration are feeding options available that can be used safely among unstable neonates, but these methods are not utilized in most of neonatal intensive care units. Aim: To determine effects of early feeding using mother’s milk on the early neonatal outcomes compared to nil orally standard feeding practices amongst neonates with very low birth weight and hypoxic ischaemic encephalopathy admitted at regional referral hospitals in Dar es Salaam. Methodology: A quasi-experimental study was used to evaluate the effects of early infant feeding amongst neonates with very low birth weight and hypoxic ischaemic encephalopathy in Dar es Salaam between October 2018 and April 2019. The intervention consisted of early fed neonates either by minimal enteral nutrition or oral mucosal colostrum within 24 hours and controls received routine care - nil per oral until when considered haemodynamically stable. The primary outcome was the occurrence of necrotizing enterocolitis while the secondary outcomes were neonatal mortality, time to regain birth weight and duration of hospital stay. Data analysis was done by using SPSS version 20. Categorical variables including occurrence of necrotizing enterocolitis and mortality were presented as proportion. Continuous variables were summarized by using mean (standard deviation) or median (inter quartile range) depending on whether they were normally distributed or not, respectively. Chi-square test (or when appropriate Fishers exact test) was used to compare statistical significance in outcomes that were measured as proportions. Odds ratio (OR) was used to determine the association between feeding and dependent variables. The results were considered of statistical significance when P-value was≤0.05. vi Results: A total of 292 neonates were enrolled in this study, 55.8% (163) were controls and 44.2% (129) were in the intervention group. Study participants comprised of 44.5% (130) neonates with Very low birth weight (VLBW) and 55.5% (162) with hypoxic ischaemic encephalopathy (HIE). The mean age of initiating feeding was 45.34 ± 21.58SD hours in the control group and 8.43 ± 3.02SD hours in the intervention group (p-value = 0.000). Overall, 1.4% (4cases) of neonates enrolled in the study had necrotizing enterocolitis, 1.8% (3cases) from the control group and 0.8 %( 1case) from the intervention group (P=0.4, 95%CI: 0.25- 23.3). The overall mortality was 40.8% (119), with no significant difference in mortality between the control group and intervention group, 41.7% vs.39.5 % respectively (p= 0.071, 95%CI: 0.57-1.46). The mean duration of regaining birth weight was 11.26 ± 4.34SD days in control group and 8.25 ± 2.96SD days in intervention group (p=0.000,95%CI: 1.61 - 4.41). The mean duration of hospital stay was 9.02±7.83SD days in the control group and 8.85± 7.12 SD days among the intervention group (p=0.85). Predictors of mortality were birth weight of ≤ 1200g (AOR=2.6; 95%CI: 1.18-5.85) and HIE score of ≥ 15 (AOR=18.12; 95% CI: 4.0 -82.29) among neonates with VLBW and HIE respectively. Conclusion: Early feeding using mother’s milk by oral mucosal colostrum or minimal enteral nutrition was not associated with increased NEC and mortality in neonates with VLBW and HIE, but this study was underpowered to measure these safety outcomes. Neonates who received early feeding significantly regained birth weight earlier than those with delayed feeding. Early feeding did not shorten duration of hospital stay. Birth weight ≤ 1200g and HIE score of ≥ 15 were independent predictors of mortality among neonates with VLBW and HIE respectively. Recommendation: A randomized study with large sample size and higher power is recommended to further confirm the safety early feeding among neonates with VLBW and HIE in our settings. However, early provision of breast milk among neonates with VLBW and HIE promotes early weight gain, hence health workers should encourage mothers on breast feeding to promote growth and