Indian clinical trial puts forth recommendations for improving growth in preterm infants

WHO recommends that infants must be exclusively breast fed for 6 months after which they should be given complementary diet to ensure good health and appropriate growth. However, no such guidelines exist for infants who are born preterm, that is, before 34 weeks of gestation period, as opposed to 37 weeks, which is the normal term of pregnancy. Complementary diet consists of semisolid, soft, or solid foods other than breast or animal milk.

Clinicians at AIIMS, Kasturba Gandhi hospital, and Vardhman Mahavir Medical College and associated Safdarjung hospital, New Delhi conducted a clinical trial to address this concern regarding preterm infants. They published their results in a recent issue of The Lancet Global Health. The research team included Shuchita Gupta, Ramesh Agarwal, Kailash Chandra Aggarwal, Harish Chellani, Anil Duggal, Sugandha Arya, Sunita Bhatia, Mari Jeeva Sankar, Vishnubhatla Sreenivas, Vandana Jain, Arun Kumar Gupta, Ashok K Deorari, Vinod K Paul, and Investigators of the CF trial. The study was done with 403 infants between March 2013 and April 2015, and was largely funded by Indian Council of Medical Research.

There are more than 15 million preterm births worldwide every year, which is the leading cause of death in children below 5 years of age. Most preterm infants have poor growth and development. In this study also, 34% infants died before hospital discharge and 10% died before 4 months of age, emphasizing the risk of death due to preterm birth. Scientists examined if feeding preterm infants with a complementary diet early in life improves their growth at 12 months of age. “Preterm infants have higher energy requirements, and feeding them with complementary diet at 4 months of age could be a good measure to accelerate growth, and this needed to be tested”, said Dr. Ramesh Agarwal at the Department of Pediatrics, AIIMS in New Delhi. Scientists found that starting an early complementary diet in preterm infants did not improve their growth, but did increase the number of hospital admissions indicating higher chances of infection in these children. 

Hence, they concluded that complementary feeding must be started at 6 months of age for preterm children, just like normal infants. This age however indicates corrected age, which means that if an infant is born 2 weeks before the expected date of delivery, he must be put on complementary diet at 6 months plus 2 weeks of age. “Our study will fill the big vacuum in understanding the diet for preterm infants, and help design evidence-based policies in India and other developing countries”, says Dr. Agarwal.

Another concern that this study brings out is that most preterm infants were iron-deficient despite supplementation. “This could be a result of more vegetarian food rich in fibers. This is in line with another study in Haryana, where most women are iron-deficient despite iron and folic acid supplementation. In India, this is seen even in women from higher socio-economic status, which could be a result of eating less and losing blood every month to menstrual cycles” according to Dr. Agarwal. 

Published by Down to Earth, Outlook, and India Science Wire.