Is Neonatal Growth Possible in Low to Middle Resourced Neonatal Intensive Care Units?

Background: The Neonatal unit at University Teaching Hospital in Lusaka, Zambia is the country’s only tertiary Neonatal unit. It is a busy unit with regularly 100 inpatients, accepting patients with weights of 700g or more. There is no total parental nutrition (TPN) or breast milk fortifier available. The only supplements used are multivitamin and oral iron. The unit has feeding guidelines in place with two streams one for infants greater than 1.5kg and the other for infants less than 1.5kg or less than 32 weeks. Generally it is expected a preterm neonate would gain 15g/kg/day and term 20g/kg/day. With limited resources, we wanted to review growth is still possible in this low income resourced setting.

Methods: Collected data on all preterm and term infants admitted to the unit 14 days or longer from March to April 2019. Recorded birth and current weight, time to first feed, full feeds, maximum feed volume.

Results: There were 59 infants. 19% only had birth weights documented. 12% lost weight, and 3% had static weights. 50% had weight gains below expected 15g/kg/day. 8% had weight gain within recommended range of 15-20g/kg/day and 8% had weight gain above this. No infants had head circumferences documented.

Average length of stay was 23 days. Average birth weight was 1.6kg, lowest being 700g and maximum 4.2kg. Time to first feeds on average 1.5 days, average time to full feeds was 5 days. All received expressed breast milk, those deemed preterm received maximum 200mls/kg/day and term infants 150mls/kg/day.

Conclusion: Despite the challenges the unit faces, infants do grow with just breast milk. A daily review sheet has been created including documenting weights, feed volumes, multivitamins and iron supplements and head circumference. This will be re audited to see if this can be a low cost way to improve growth.