Guidelines on Optimal Feeding of Low Birth Weight Infants in Low- and Middle-income Countries

Countries can substantially reduce their infant mortality rates by improving the care of LBW infants. Experience from developed and low- and middle-income countries has clearly shown that appropriate care of LBW infants, including feeding, temperature maintenance, hygienic cord and skin care, and early detection and treatment of complications, can substantially reduce mortality in this highly vulnerable group. Interventions to improve feeding are likely to improve the immediate and longerterm health and well-being of the individual infant and have a significant impact on neonatal and infant mortality levels in the population. Better feeding was one of the first interventions for preterm babies in the 1960s in the United Kingdom and was associated with reduced case fatality in hospitals before the advent of intensive care.

The objective of these guidelines is to improve the quality of care received by LBW infants in developing countries through improved capacity of health workers. These guidelines focus on the feeding of clinically stable LBW infants in low-and middle income countries. They do not specifically address the feeding of infants with a birth weight less than 1.0 kg (known as extremely LBW, ELBW), who are often clinically unstable and may require parenteral nutrition. Guidance on the management of clinically unstable infants is addressed in other WHO documents.

The guideline development group identified 18 research questions to be of the highest priority for development of recommendations. Most of the questions are relevant to all LBW infants (birth weight less than 2.5 kg) but some are specific to very LBW (VLBW) infants (birth weight less than 1.5 kg). The questions do not specifically address ELBW infants. For each question, the following four outcomes were considered to be critical: mortality, severe morbidity, neurodevelopment and anthropometric status. Benefits and harms in critical outcomes formed the basis of the recommendations for each question.