Growth and Malnutrition Assessment of Neonates Admitted to a Government Hospital in Nakuru, Kenya

Melissa  Thoene; Nora  Switchenko; Anya  Morozov; Elizabeth  Kibaru; Matthew Van  Ormer; Corrine  Hanson; Ann  Anderson-Berry

doi:10.6000/1929-4247.2021.10.02.2

Authors

Melissa Thoene Department of Pediatrics, University of Nebraska Medical Center; 981205 Nebraska Medical Center, Omaha, NE 68198-1205, USA
Nora Switchenko Department of Pediatrics, University of Utah, 201 President’s Circle, Salt Lake City, UT 84112, USA
Anya Morozov Department of Pediatrics, University of Nebraska Medical Center; 981205 Nebraska Medical Center, Omaha, NE 68198-1205, USA
Elizabeth Kibaru Paediatrics and Child Health, Egerton University; P.O. Box 536-20115, Egerton, Kenya
Matthew Van Ormer Department of Pediatrics, University of Nebraska Medical Center; 981205 Nebraska Medical Center, Omaha, NE 68198-1205, USA
Corrine Hanson College of Allied Health Professions, University of Nebraska Medical Center; 984045 Nebraska Medical Center, Omaha, NE 68198-4045, USA
Ann Anderson-Berry Department of Pediatrics, University of Nebraska Medical Center; 981205 Nebraska Medical Center, Omaha, NE 68198-1205, USA

DOI:

https://doi.org/10.6000/1929-4247.2021.10.02.2

Keywords:

Malnutrition, growth, infant, newborn, neonatal, Kenya

Abstract

Background and Aims: Inadequate nutrient provision causes neonatal growth failure and malnutrition. Therefore, this study aimed to 1) quantify infant growth velocity from birth to hospital discharge, 2) determine the incidence of neonatal malnutrition at the time of discharge from a government hospital newborn unit in Nakuru, Kenya.

Methods: After ethical approval, data was collected for infants (n=104) hospitalized >14 days (June 2016 - December 2018) including: birth gestational age (GA), birth and discharge weight (grams, g) with z-scores (2013 Fenton Preterm or 2006 World Health Organization 0-2 Year growth chart), hospital length of stay (LOS) days. Growth during hospitalization was calculated in g/day [(discharge weight – birth weight)/LOS] and g/kilogram(kg)/day [1000xln(birth weight/discharge weight)/LOS). Malnutrition was diagnosed by birth to discharge weight z-score change (decline): mild = 0.8-1.2 standard deviations (SD), moderate = >1.2-2.0 SD, severe = >2.0 SD. P-value <0.05 was significant.

Results: 94/104 (90.4%) infants were preterm with median birth GA 32 weeks, weight 1500 g (z-score -0.33), LOS 21 days and discharge weight 1735 g (z-score -1.95). Median weight gain was 8.2 g/day or 5.2 g/kg/day with weight z-score change -1.34 SD. Linear regression predicted each hospital day decreased z-score by -0.031 (p<0.001). At discharge, 81.7% of infants met malnutrition criteria—27.1% mild, 49.4% moderate, 23.5% severe.

Conclusions: Infants with LOS >14 days in a government hospital newborn unit in Nakuru, Kenya, experience growth rates below recommended velocities by the World Health Organization (23-34 grams/day from 0-4 months). Nutrition intervention is necessary to support appropriate growth.

References

World Health Organization. Children: Reducing Mortality. 2019; Available at: https://www.who.int/news-room/factsheets/ detail/children-reducing-mortality. Accessed November 5, 2019.

UNICEF. Malnutrition. 2019; Available at: https://data.unicef. org/topic/nutrition/malnutrition/. Accessed November 4, 2019.

Belfort MB, Rifas-Shiman SL, Sullivan T, Collins CT, McPhee AJ, Ryan P, et al. Infant growth before and after term: effects on neurodevelopment in preterm infants. Pediatrics 2011; 128(4): e899-906. https://doi.org/10.1542/peds.2011-0282 DOI: https://doi.org/10.1542/peds.2011-0282

Ehrenkranz R, Dusick A, Vohr B, Wright L, Wrage L, Poole W. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Journal of Pediatrics 2006; 117(4): 1253-61. https://doi.org/10.1542/peds.2005-1368 DOI: https://doi.org/10.1542/peds.2005-1368

Curtis LJ, Bernier P, Jeejeebhoy K, Allard J, Duerksen D, Gramlich L, et al. Costs of hospital malnutrition. Clin Nutr 2017; 36(5): 1391-1396. https://doi.org/10.1016/j.clnu.2016.09.009 DOI: https://doi.org/10.1016/j.clnu.2016.09.009

Kittisakmontri K, Sukhosa O. The financial burden of malnutrition in hospitalized pediatric patients under five years of age. Clin Nutr ESPEN 2016; 15: 38-43. https://doi.org/10.1016/j.clnesp.2016.06.010 DOI: https://doi.org/10.1016/j.clnesp.2016.06.010

Lew CCH, Yandell R, Fraser RJL, Chua AP, Chong MFF, Miller M. Association Between Malnutrition and Clinical Outcomes in the Intensive Care Unit: A Systematic Review [Formula: see text. JPEN J Parenter Enteral Nutr 2017; 41(5): 744-758. https://doi.org/10.1177/0148607115625638 DOI: https://doi.org/10.1177/0148607115625638

Schroeder DG, Brown KH. Nutritional status as a predictor of child survival: summarizing the association and quantifying its global impact. Bull World Health Organ 1994; 72(4): 569-579.

White JV, Guenter P, Jensen G, Malone A, Schofield M, Academy of Nutrition and Dietetics Malnutrition Work Group, et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). J Acad Nutr Diet 2012; 112(5): 730-738. https://doi.org/10.1016/j.jand.2012.03.012 DOI: https://doi.org/10.1016/j.jand.2012.03.012

Becker P, Carney LN, Corkins MR, Monczka J, Smith E, Smith SE, et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition). Nutr Clin Pract 2015; 30(1): 147-161. https://doi.org/10.1177/0884533614557642 DOI: https://doi.org/10.1177/0884533614557642

Goldberg DL, Becker PJ, Brigham K, Carlson S, Fleck L, Gollins L, et al. Identifying Malnutrition in Preterm and Neonatal Populations: Recommended Indicators. J Acad Nutr Diet 2018; 118(9): 1571-1582. https://doi.org/10.1016/j.jand.2017.10.006 DOI: https://doi.org/10.1016/j.jand.2017.10.006

Fenton TR, Cormack B, Goldberg D, Nasser R, Alshaikh B, Eliasziw M, et al. "Extrauterine Growth Restriction" and "Postnatal Growth Failure" are Misnomers for Preterm Infants. J Perinatology 2020; 40(5): 704-14. https://doi.org/10.1038/s41372-020-0658-5 DOI: https://doi.org/10.1038/s41372-020-0658-5

World Health Organization Department of Nutrition for Health and Development. WHO Child Growth Standards. 2009; Available at: https://www.who.int/childgrowth/standards/ velocity/tr3_velocity_report.pdf?ua=1. Accessed November 5, 2019.

American Academy of Nutrition & Dietetics. Preterm and High-Risk Infants: Anthropometric Measurements. 2019; Available at: https://www.nutritioncaremanual.org/topic.cfm? ncm_category_id=32&lv1=255531&lv2=274287&ncm_toc_id =274287&ncm_heading=Preterm%20and%20High%2DRisk %20Infants. Accessed November 5, 2019.

PediTools. Growth Parameters. Available at: http://peditools.org/fenton2013/. Accessed July 16, 2017.

Chou JH, Roumiantsev S, Singh R. PediTools Electronic Growth Chart Calculators: Applications in Clinical Care, Research, and Quality Improvement. J Med Internet Res 2020; 22(1): e16204. https://doi.org/10.2196/16204 DOI: https://doi.org/10.2196/16204

Republic of Kenya Ministry of Health. Basic Paediatric Protocols for children up to 5 years of age. 2016; Available at: https://www.psk.or.ke/public/uploads/file/ c0d3675787d651dedbf4a0edfc9a2898.pdf. Accessed November 5, 2019.

Patel AL, Engstrom JL, Meier PP, Kimura RE. Accuracy of methods for calculating postnatal growth velocity for extremely low birth weight infants. Pediatrics 2005; 116(6): 1466-1473. https://doi.org/10.1542/peds.2004-1699 DOI: https://doi.org/10.1542/peds.2004-1699

Tappan J. The Riddle of Malnutrition: The Long Arc of Biomedical and Public Health Interventions in Uganda. Athens, Ohio: Ohio University Press 2017. DOI: https://doi.org/10.2307/j.ctv21ptt5h

Oddie SJ, Young L, McGuire W. Slow advancement of enteral feed volumes to prevent necrotizing enterocolitis in very low birth weight infants. Cochrane Database Syst Rev 2017; 8: CD001241. https://doi.org/10.1002/14651858.CD001241.pub7 DOI: https://doi.org/10.1002/14651858.CD001241.pub7

Morgan J, Bombell S, McGuire W. Early trophic feeding versus enteral fasting for very preterm or very low birth weight infants. Cochrane Database Syst Rev 2013; 3: CD000504. https://doi.org/10.1002/14651858.CD000504.pub4 DOI: https://doi.org/10.1002/14651858.CD000504.pub4

World Health Organization. Micronutrient supplementation in low-birth-weight and very-low-birth-weight infants. 2019; Available at: https://www.who.int/elena/titles/supplementation _lbw_infants/en/. Accessed July 22, 2020.

Koletzko B, Poindexter B, Uauy R. Nutritional Care of Preterm Infants: Scientific Basis and Practical Guidelines 2014. https://doi.org/10.1159/isbn.978-3-318-02641-2 DOI: https://doi.org/10.1159/isbn.978-3-318-02641-2

Bronsky J, Campoy C, Braegger C, ESPGHAN/ESPEN/ ESPR/CSPEN working group on pediatric parenteral nutrition. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Vitamins. Clin Nutr 2018; 37(6 Pt B): 2366-2378. https://doi.org/10.1016/j.clnu.2018.06.951 DOI: https://doi.org/10.1016/j.clnu.2018.06.951

Taylor CJ. Health Professionals Letter on Enterobacter sakazakii Infections Associated With Use of Powdered (Dry) Infant Formulas in Neonatal Intensive Care Units. 2002; Available at: http://www.fda.gov/Food/RecallsOutbreaks Emergencies/SafetyAlertsAdvisories/ucm111299.html. Accessed May 24, 2016.

Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13: 59-2431-13-59. https://doi.org/10.1186/1471-2431-13-59 DOI: https://doi.org/10.1186/1471-2431-13-59

Olsen IE, Groveman SA, Lawson ML, Clark RH, Zemel BS. New intrauterine growth curves based on United States data. Pediatrics 2010; 125(2): e214-24. https://doi.org/10.1542/peds.2009-0913 DOI: https://doi.org/10.1542/peds.2009-0913

The Global Health Network. Postnatal Growth of Preterm Infants. Available at: https://intergrowth21.tghn.org/ postnatalgrowth-preterm-infants/#c5. Accessed June 8, 2020.