Failure to thrive amongst neonates, prevalence, causes and early outcome,at Muhimbili National Hospital.

Abstract

In troduction: Failure to thrive in the neonate is the common pathway or outcome for several different underlying conditions. It IS defined as failure to regain birth weight by three weeks of age; weight loss of more than 10% of birth weight at 2 weeks of age or more; weight gain below 3rd centile by age 2 weeks or more and a weight gain of less than 5 grams per kilogram per day. Results from other studies, and case reports at this center , suggested an increase in the incidence of FTT, partly fueled by maternal HIV and tuberculosis co-infection. Nutritional deficiencies, were not expected to be a cause of FTT in the neonate, ideally since breast feeding suffices an infants nutritional requirement. Could an improper breast feeding technique be a cause? A pilot study done before the beginning of the study showed that infections were a leading cause. FTT was not comprehensively studied nor rigorously sought at the neonatal unit, its magnitude was not known. The multifactorial causes of FTT could not be ignored. Objective: This study intended to systematically determine the pattern of FTT amongst infants up to six weeks of age; and identify probable underlying causes and early outcome.

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Study Design: This was a cross-sectional prospective hospital based study, from April 2001 to January 2002, with a sample size of 88 patients. Results: A total of 94 infants were recruited up to September 2001, and a three months period of follow up which ended in January 2002. There was no loss to follow up. Total admissions during the recruitment period were 3914. The prevalence to FTT was found to be 2.4%, with a male to female ratio of 1.23: 1, fifty one preterm and 43 term babies. Sixty eight percent of the total recruited babies had a birth weight of 2.5kg and below. The leading cause of FTT was infect~ followed by anaemia. Perinatal tuberculosis contributed to 2.1%. There was a high percentage of maternal HIV and tuberculosis in the studied group. Majority of the mothers who breastfed had incorrect positioning, and hence incorrect attachment. Mixed feeding was part of the feeding problems found. Most mothers were primipara; adolescent motherhood was not much represented. Mortality was 25.5%; amongst the 74.5% who survived, 43.6% presented with significant problems during followed up, necessitating rehospitalization, or further work of and management. Anaemia, pneumonia, failure to improve weight, and developmental delay were amongst the presenting problems.

x Conclusion: FTf is a common problem in the young infant; multiple factors underlying it. The most important were low birth weight, infections, anaemia and mixed feeding. Maternal health was a significant contributing factor. The high mortality rate demonstrated' indicate that FTf in the young infant is an ominous sign. Larger community based studies are needed to establish causal relationship between FTf and non organic/ psychosocial factors outlined by this study.