Glycemic status in exclusively breast fed low birth weight babies In first 72 hours of life in a teriary care hospital

Background: Neonatal hypoglycaemia, a common metabolic problem, often goes unnoticed owing to lack of specific symptoms. It can lead to considerable mortality and morbidity with long term neurological sequelae. Adequate breast feeding play an important role in maintaining normal glucose levels. So, this study is done to assess the incidence of hypoglycaemia in exclusively breast fed low birth weight babies, both term and preterm neonates and evaluate the impact of early breast feeding on glycaemic status upto 72 hours of life.Methods: This study was conducted over 12 month period involving 236 AGA (Appropriate for gestational age), SGA (Small for gestational age) babies with birth weight between 1.6-2.49 kg. Blood glucose values were measured at birth, 3h, 6h, 12h, 24h, 48h and 72h of life after delivery which was independent of feeding time. Hypoglycaemia was assessed against age of onset, gestational age, sex of baby, mode of delivery and time of initiation of breast feeding.Results: Total 56 episodes of hypoglycaemia were recorded in 52 babies of which 46 (27%) were term SGA babies and 6(8%) were preterm AGA babies (p=0.00148). The incidence of hypoglycaemia was found to be 22%, highest during the first 24 hours of life (93%) and delayed breast feeding is the most commonly noted risk factor (p=0.00024).Conclusions: Low birth babies are more prone to develop hypoglycaemia especially in first 24 hours of life with delayed introduction of breast feeding being one of the common risk factors and asymptomatic hypoglycaemia can be managed with frequent breast feeding without any formula feeds.

The first golden hour of breastfeeding: where do we stand?

Background: Breastfeeding is the corner stone of child survival, nutrition and development and maternal health. The World Health Organization recommends that all neonates be breastfed within one hour of birth. Early initiation of breast feeding (EIBF) is a sentinel indicator for successful breastfeeding. The aim of this study is to assess the practice of early initiation of breastfeeding among babies delivered in our tertiary care teaching unit and to list out the reasons for delay in implementation.Methods: This study is done on 409 postnatal mothers who delivered in our hospital. All the mother-baby dyads enrolled were interviewed within 12 hours of delivery. Data was collected through clinical records and interview of mothers.Results: EIBF is seen only in 19.8% of babies. Median time of initiation of breast feed is 110 minutes. Primiparous mothers had a delay in initiation of feed (p<0.01). The mothers who received practical support from health care providers had successful EIBF(p< 0.01). The main reasons for delay in feeding were lack of early, uninterrupted skin to skin contact between baby and mother and the separation of mother - baby dyads immediately after delivery.Conclusions: EIBF rate in our centre is extremely low compared to the national standards of 44.6%. Several gaps in EIBF need to be addressed and a strict institutional protocol need to be followed. Periodic review of EIBF rates needs to be done by every institute to achieve a global target of > 90%.