Feeding the Larger Low-Birthweight Infant in a Resource-Poor Environment.

The high low birthweight prevalence in resource-poor countries (16.5%) places a burden on overstretched resources. Labor ward must have written guidelines to triage these infants for optimal nutritional support to the special care nursery (SCN; 1,500-1,800 g and <34 weeks) and postnatal ward (PW; >1,800 g and ≥ 34 weeks). Separation of mother and infant should be prevented. Initiating breastfeeding and kangaroo mother care (KMC) in labor ward by skilled nurses in the latter group is a priority and continues in the PW. SCN infants receive an intravenous 10% glucose-electrolyte solution and, if stable, commence with expressed colostrum and breast milk (EBM) feeding and intermittent KMC which progresses to continuous KMC and breastfeeding. Enteral feeding is advanced more slowly in unstable infants. Parenteral nutrition is only administered to infants with bowel obstruction or feeding intolerance. EBM of HIV+ mothers in the SCN is pasteurized. The decision to discharge a mother-infant dyad should be individualized. Infants in the SCN are discharged at 34 weeks, a weight of 1,600-1,800 g and are gaining adequate weight. Discharge from the PW usually takes place after 48 h, often before the infant has regained his birthweight but breastfeeding must be established. Multivitamin- and iron-containing syrup is continued for at least 12 months. The clinics in the community must provide postdischarge nutritional support.