Promoting Early and Exclusive Breastfeeding for Vulnerable Infants with Feeding Difficulties in Neonatal Care Units in Rural Rwanda

• Published in: Pediatrics (Evanston) 2019-08, Vol.144 (2_MeetingAbstract), p.564-546
• Main Authors: Palha De Sousa, Chiquita A., Karambizi, Charlie Angelique, Beck, Kathryn, Kirk, Catherine, Bradford, Jessica, de Silva, Himali, Asir, Maya, Biziyaremye, Francois, Manirakiza, Louise, Saidath, Gato, Wilson, Kim
• Format: Article
• Language: English
• Subjects: Birth weight; Brain damage; Breast feeding; Breast milk; Breastfeeding & lactation; Drinking water; Encephalopathy; Feeding; Hypoxia; Infants; Ischemia; Lactation; Low birth weight; Malnutrition; Medical personnel; Mortality; Neonates; Newborn babies; Nutrient solutions; Pediatrics; Refrigerators; Risk groups; Workers
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.144.2MA6.564

Background: While neonatal mortality has declined globally, neonates born premature, low birth weight (LBW), or with perinatal hypoxic ischemic encephalopathy (HIE) in low-resource settings, continue to face significant challenges including feeding difficulties, malnutrition, poor growth and development, and increased mortality. Among high-risk infants followed in Pediatric Development Clinics (PDCs) in rural Rwanda, 26% and 33% of infants aged 0-3 and 3-6 months respectively had poor interval growth, and at 6 months, 16% had moderate acute malnutrition and 3% had severe acute malnutrition. Promoting early and exclusive breastfeeding for vulnerable infants in neonatal units is critical in helping these infants survive and thrive. Methods: Implementation of an evidence-based package of interventions began in January 2018 in neonatal care units at Rwinkwavu and Kirehe District Hospitals in eastern Rwanda. Baseline data on rates of exclusive breastfeeding, weight gain and length of stay (LOS) was collected from October-December 2017 by neonatal unit chart review. Assessment is ongoing with data aggregated every 3 months. Interventions were anchored around a training for clinical staff led by two UK-based Speech and Language Therapists on specialized breastfeeding support for infants with feeding difficulties in low resouce settings. The training was attended by nurses, midwives, nutritionists, and social workers from neonatology, maternity and PDCs with 3 staff trained as Master Trainers. Other interventions being implemented include expanded patient education with breastfeeding videos and customized posters, early introduction of non-nutritive sucking and transition to exclusive breastfeeding, peer counseling by "expert mothers", providing maternal nutritional supplementation and clean drinking water to support lactation, and providing refrigerators to store expressed breastmilk. Results: 336 newborns were admitted from October-December 2017; 14% died prior to discharge. On day of life (DOL) 0, 8% of infants were feeding from the breast; 89% were on IV fluids. On DOL7, 95% of infants were taking breast milk only, with 61% taking all feeds from the breast. 44% of infants admitted from DOL0-1 until DOL14+ had regained their birth weight at 2 weeks. Average interval growth during admission was 0.6g/day for very LBW (VLBW) infants, 5.0g/day for LBW infants, and 15.4g/day for infants with HIE. Average LOS was 31.5 days for VLBW, 11.8 days for LBW, and 12.3 days f