Complementary Feeding: Beyond Nutrition.

In this article, we will summarize the key non-nutritional aspects of the introduction of complementary feeding. Intestinal maturation related to starch digestion is relatively complete by the time complementary feeding is recommended to be initiated. A much more complex maturation is needed, however, from the neurodevelopmental standpoint as the infants need to be able to hold their head and trunk and be able to coordinate tongue movement followed by swallowing. Issues can arise in infants with a history of medical problems as well as when caretakers cannot handle the initial difficulties or want to impose certain rigidity to the learning process. The introduction of complementary feedings is also part of the early steps in introduction to human socialization. In that regard, it sets up the infant to internalize and accept the diversity of food textures and food choices. Early refusal of some food items is common and should not be interpreted as being disliked. Multiple attempts should be made to incorporate new food items. To accomplish these dynamics, caregivers need comprehensive education and relevant information.

Hypoglycaemia and hypocalcaemia as determinants of admission birth weight criteria for term stable low risk macrosomic neonates.

BACKGROUND: Large for gestational age (LGA) accounts for about 6.3% of admissions in kenyatta national hospital, newborn unit. As a policy all IGA's, defined by birth weight of 4000 g and above are admitted for 24 hours to monitor blood glucose levels. The rational for this policy is questionable and contributes to unnecessary burden on resources needed for new born care. OBJECTIVE: To study birth weight related incidence of hypoglycemia and hypocalcaemia in stable low risk lgas in knh and use it to establish a new admission weight based criteria. PATIENTS AND METHODS: prospective cohort study done in new born-unit, post natal and labour wards of knh. Term lga neonates (birth weight = 4000 g) were recruited as subjects and controlled against term appropriate weight (aga) neonates. RESULTS: the incidence of hypoglycemia and hypocalcaemia in lgas was 21% and 9% respectively. Hypoglycemia was rarely encountered after 12 hours of life in lgas. Hypoglycemia and hypocalcaemia showed a direct upward relationship with weight beyond 4250 g. No significant difference in incidence of hypoglycemia and hypocalcaemia between controls and 4000-4249 g category to justify their routine admission to newborn unit. CONCLUSION: the study identified 4275 g as new admission birth weight criteria for stable term low risk IGA's admission.

Neonatal nutrition and later outcomes of very low birth weight infants at Kenyatta National Hospital.

BACKGROUND: Extensive research in developed countries has established that very low birth weight (VLBW) infants are particularly vulnerable to the effects of early nutritional deficiencies. There is, however, little information from poor countries on the long-term effects of these deficiencies in such infants. OBJECTIVE: Determine the association between neonatal feeding regimens and post-discharge morbidity/ mortality and neurological abnormalities at the age of two years for a cohort of VLBW infants. DESIGN: Prospective Cohort. METHODS: One hundred and seventy five VLBW infants were recruited over a consecutive period of one year and followed up to the age of two years corrected for gestation. With neonatal feeding regimes as the exposure variable, post-discharge re-hospitalization, mortality and Saigal and Rosenbaum's functional disability assessment scores were compared as the outcome variables. RESULTS: The 175 infants recruited into the study had median birth weight of 1400 +/- 103 grams and gestation 32 +/- 2.3 weeks. The male:female ratio was 2:3 while 64 (36.6%) had been born intrauterine growth retarded. During the newborn period, 83(47.4%), 35 (20.0%) and 57 (32.6%) of the infants fed on exclusive breast milk, pre-term formula and mixed preparations respectively. The median neonatal weight gain was 17 +/- 2.5, 15 +/- 2.0 and 13 +/- 3.9 grams/kilo/day for preterm formula, combined and exclusive breast milk fed infants respectively. More of the infants fed on breast milk alone were re-hospitalized compared to those on pre-term formula, RR 2.3; 95%CI 1.4-3.6 or mixed milk preparations, RR 1.9; 95% CI 1.4-2.7. Infants exclusively fed on breast milk had more neurological disabilities than those on pre-term formula alone, RR 3.2; 95% CI 1.2-8.1. Though only 22.9% of pre-term milk fed infants died compared to 36.1% of those on breast milk alone the difference was not statistically significant, P>0.05. CONCLUSION: Nutritionally enhanced enteral feeds during the first month of life appear to have reduced post-discharge morbidity and improved neurological outcomes at two years in VLBW infants.