Abstract
Objective
To determine the burden of early growth faltering and understand the care practices for small and sick babies discharged from newborn units in the district.
Study design
Observational and follow-up study.
Participants
512 babies discharged from two Special Newborn Care Units (SNCUs) and four Newborn Stabilization Units (NBSUs) in two districts of Himachal Pradesh.
Methods
Anthropometric assessments, interview of mothers and Accredited Social Health Activists (ASHAs) conducted between August, 2018 and March, 2019. Change in weight-for-age z-score (ΔWAZ) of <−0.67SD between birth and assessment was used to define growth faltering.
Outcomes
Proportion of growth faltering (or catch-down growth) in small and sick babies discharged from SNCUs and NBSUs, and infant care practices.
Results
Growth faltering was observed in a significant proportion of both term (30%) and preterm (52.6%) babies between 1 to 4 months of age. Among babies with growth faltering (n=180), 73.9% received a home visit by ASHA, and only 36.7% received a follow-up visit at a facility. There were 71.3% mothers counselled at discharge (mostly informed about breast feeding). Most (96.7%) mothers did not perceive inadequate weight gain in their babies post-discharge. During home visits, ASHAs weighed 61.6% of the infants with growth faltering. Amongst infants who had growth faltering, only 49.6% of mothers had been provided information about their infant’s growth and 57.1% mothers had received breastfeeding counselling.
Conclusion
Small and sick newborn infants (both term and preterm babies) discharged from special care newborn units are at increased risk of early growth faltering. Follow-up care provided to these infants is inadequate. There is a need to strengthen both facility-based and home-based follow up of small and sick newborn infants discharged from newborn care facilities.
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Acknowledgement
We extend our sincerest gratitude to Late Dr M K Bhan and Dr VK Paul (Department of Pediatrics, AIIMS, Delhi) under whose guidance the study was conceptualized. The hospital management team, field workers, and the entire research team (Ajay Sharma, Anchal Dhiman, Kashika Sharma, Lakshmi Thakur, Medhavi Manish, Nidhi Mudgil, Rajendra P. Ola, Sanjeev Kumar, Sarita Bisht, Priyanka Devi, Priyanka Pundir, Aditi KC) that made this study possible. We would also like to thank Dr Pradeep Debata and Dr Shobhna Gupta (Safdarjung Hospital, New Delhi) who were involved in the training of the research team.
Funding
Funding: Jointly supported by Knowledge Integration and Translational Platform (KnIT) (supported by DBT-BMGF-BIRAC-Wellcome) and Gates Ventures. Project reference numbers: BIRAC/PMU/2016/KnIT/001 (PRIV010) and bgC3 — Research Services 2019 (PRIV025).
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Contributions
Contributors: SR, HC, RDG, RMP, RG, and JJ: involved in the conceptualization of the study; SR, HC, RDG, RMP, RG along with late Dr MK Bhan: provided overall guidance across different steps involved in the study; MS: facilitated the study in the state of HP, JJ, MN, along with the research team were involved in the overall study conduct and data collection process with inputs provided by SR, HC, RDG, JJ and RJ compiled and analyzed the data, drafted the manuscript with technical inputs from SR, HC, RDG, RMP, RG, and MS in analysis and finalizing the manuscript. All the authors have reviewed and approved the final version of the manuscript.
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Ethics approval: Institutional Ethics Committee, Maulana Azad Medical College; No. F1/IEC/MAMC/62/02/2018/268, dated March 30, 2018.
Competing interests: None stated.
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Joseph, J., Jalal, R., Nagrath, M. et al. Growth Faltering Among Discharged Babies from Inpatient Newborn Care Facilities: Learnings from Two Districts of Himachal Pradesh. Indian Pediatr 59, 763–768 (2022). https://doi.org/10.1007/s13312-022-2618-y
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DOI: https://doi.org/10.1007/s13312-022-2618-y