Guideline

Guidelines on optimal feeding of low birth-weight infants in low- and middle-income countries

Year of Publication

2011

Issuing Institution

World Health Organization

Links

WHO IRIS

Recommendations

18 included recommendations

Low-birth-weight (LBW) infants, including those with very low birth weight (VLBW), should be fed mother’s own milk

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Moderate

Low-birth-weight infants, including those with very low birth weight , who cannot be fed mother's own milk should be fed donor human milk (recommendation relevant for settings where safe and affordable milk-banking facilities are available or can be set up).

Status

Retired

Recommended in favor

Strong

Certainty of evidence

High

Low-birth-weight infants, including those with very low birth weight , who cannot be fed mother's own milk or donor human milk should be fed standard infant formula (recommendation relevant for resource-limited settings). very low birth weight infants who cannot be fed mother's own milk or donor human milk should be given preterm infant formula if they fail to gain weight despite adequate feeding with standard infant formula

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Low

Low-birth-weight infants, including those with very low birth weight , who cannot be fed mother's own milk or donor human milk should be fed standard infant formula from the time of discharge until 6 months of age (recommendation relevant for resource-limited settings)

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Low

very low birth weight infants who are fed mother’s own milk or donor human milk should not routinely be given bovine milk-based humanmilk fortifier (recommendation relevant for resource-limited settings). very low birth weight infants who fail to gain weight despite adequate breastmilk feeding should be given human-milk fortifiers, preferably those that are human milk based

Status

Retired

Recommended against

Conditional

Certainty of evidence

Low

very low birth weight infants should be given vitamin D supplements at a dose ranging from400 i.u to 1000 i.u. per day until 6 months of age

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Very low

very low birth weight infants fed mother’s own milk or donor human milk should be given 2-4 mg/kg per day iron supplementation starting at 2 weeks until 6 months of age

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Low

Daily oral vitamin A supplementation for Low-birth-weight infants who are fed mother's own milk or donor human milk is not recommended at the present time, because there is not enough evidence of benefits to support such a recommendation.

Status

Retired

Recommended against

Conditional

Certainty of evidence

Low

Routine zinc supplementation for Low-birth-weight infants who are fed mother's own milk or donor human milk is not recommended at the present time, because there is not enough evidence of benefits to support such a recommendation.

Status

Retired

Recommended against

Conditional

Certainty of evidence

Moderate

Low-birth-weight infants who are able to breastfeed should be put to the breast as soon as possible after birth when they are clinically stable

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Low

very low birth weight infants should be given 10 ml/kg per day of enteral feeds, preferably expressed breast milk, starting from the first day of life, with the remaining fluid requirement met by intravenous fluids (recommendation relevant for resource-limited settings).

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Low

Low-birth-weight infants should be exclusively breastfed until 6 months of age.

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Low

Low-birth-weight infants who need to be fed by an alternative oral feeding method should be fed by cup (or palladai, which is a cup with a beak) or spoon

Status

New

Recommended in favor

Strong

Certainty of evidence

Moderate

very low birth weight infants requiring intragastric tube feeding should be given bolus intermittent feeds

Status

New

Recommended in favor

Conditional

Certainty of evidence

Low

In very low birth weight infants who need to be given intragastric tube feeding, the intragastric tube may be placed either by oral or nasal route, depending upon the preferences of health-care providers.

Status

New

Recommended in favor

Conditional

Certainty of evidence

Low

Low-birth-weight infants who are fully or mostly fed by an alternative oral feeding method should be fed based on infants’ hunger cues, except when the infant remains asleep beyond 3 hours since the last feed (recommendation relevant to settings with an adequate number of health-care providers).

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Moderate

In very low birth weight infants who need to be fed by an alternative oral feeding method or given intragastric tube feeds, feed volumes can be increased by up to 30 ml/kg per day with careful monitoring for feed intolerance

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Moderate

Very low birth weight infants who are fed mother’s own milk or donor human milk should be given daily calcium (120-140 mg/kg per day) and phosphorus (60-90 mg/kg per day) supplementation during the first months of life

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Low