Prevalence on the complement in offering food to newborns / Prevalência da oferta de complemento alimentar para o recém-nascido

Abstract Objectives: to identify the prevalence and determining factors of the complements in offering food to newborns. Methods: across-sectional study nested to a cohort study that assessed newborn care in four public maternity hospitals in Natal/Brazil. Sample was composed by 415 mothers and full-term newborns, with appropriate weight for gestational age and Apgar scores in 1st and 5th minutes ≥ 7. In order to analyze the determining factors, we used Poisson's regression. Results: from 415 newborns, 51.3% received feeding complements (57.6% in the first hour of life), of which 92% was infant formula. Only 50.7% of those complement in offering food were prescribed by physicians. Colostrum deficiency was the main reason to be indicated (33.8%). Maternal age ≤ 20 years old (PR=0.64; CI95%=0.47-0.86) and between 2030 years old (PR=0.70; CI95%=0.57-0.87)comparing to women older than 30 were shown as protective factors, while being primiparous (PR=1.37; CI95%=1.11-1.60) and had cesarean section (PR=1.2; CI95%=1.00-1.45) as risk factors. Conclusion: maternal characteristics are associated with the complement in offering food to the newborn in the first hours of life. The high prevalence shows the need for interventions that minimize the inadequate offer of infant formula and promote exclusive breastfeeding before hospital discharge.

Resumo Objetivos: identificar a prevalência e os fatores determinantes da oferta do complemento alimentar para o recém-nascido. Métodos: estudo transversal, aninhado a um estudo de coorte que avaliou a assistência ao neonato em quatro maternidades públicas de Natal/Brasil. Amostra composta de 415 mães, e recém-nascidos à termo, com peso adequado para idade gestacional e Apgar no 1º e 5º minuto ≥ 7. Para analisar os fatores determinantes, foi utilizado a regressão de Poisson. Resultados: dos 415 recém-nascidos, 51,3% receberam complemento (57,6% na primeira hora de vida), dos quais 92% com fórmula infantil. Destes, apenas 50,7% foi prescrito pelo médico. A deficiência de colostro foi o principal motivo de indicação (33,8%). A idade materna ≤ 20 anos (RP=0,64; IC95%=0,47-0,86) e entre 20-30 anos (RP=0,70; IC95%=0,57-0,87, em comparação com mulheres acima de 30 anos, mostrou-se como fator de proteção, enquanto ser primípara (RP=1,37; IC95%=1,11-1,60) e o parto cesárea (RP=1,2; IC95%=1,00-1,45) como fatores de risco. Conclusão: as características maternas e assistenciais estão associadas à oferta de complemento alimentar ao recém-nascido nas primeiras horas de vida. A alta prevalência mostra a necessidade de intervenções que minimizem a oferta inadequada de fórmula infantil, e promovam o aleitamento materno exclusivo antes da alta hospitalar.

Feeding practices and early weaning in the neonatal period: a cohort study

ABSTRACT OBJECTIVE To describe feeding practices and the risk factors for the mixed breastfeeding and early weaning in the neonatal period. METHODS Cohort study, which we collected socioeconomic, demographic, health care and feeding data from 415 mother/child binomials born in four public maternity hospitals in Natal/Brazil. They were followed-up at 48 hours, 7 and 28 days after birth. The association was established using Pearson's Chi-square test and Poisson's regression, after adjusting it to other variables. RESULTS The prevalence of mixed breastfeeding in the first 2 days was 47,2% and early weaning in 7 and 28 days was 8,4% and 16,2% in that order. The main reasons for mixed breastfeeding and early weaning were: colostrum deficiency (33.8%), difficulty in latching/sucking (23.5%) and "little milk" (70.0%). The use of formula/milk/porridge remained associated with maternal age ≤ 20 years (RR = 0.64; 95%CI: 0.47-0.86), age 20-29 years (RR = 0,70; 95%CI: 0,57-0,87), primiparity (RR = 1.37; 95%CI: 1.11-1.60) and cesarean delivery (RR = 1.20; 95%CI: 1.00-1.45) at 2 days; absence of paternal support (RR = 4.98; 95%CI: 2.54-9.79) and pacifier use (RR = 3.21; 95%CI: 1.63-6.32) at 7 days; and only pacifier use (RR = 2.48; 95%CI: 1.53-4.02) at 28 days. CONCLUSIONS Early weaning was associated with maternal and health care factors, thus suggesting the need to readjust good practices and educational actions to achieve the exclusive offer to the maternal breast in the neonatal period.