Low-birthweight baby: Born too soon or too small

Abstract

This book is a summary of the proceedings of Nestlé Nutrition Institute workshop held in March-April, 2014, in Magaliesburg, South Africa. The authors are leaders and subjects experts in the field of ‘low birth weight’. The book is divided into three sections. Section 1, ‘Global Epidemiology focuses on the global estimates of preterm and term small for gestational age (SGA) prevalence, risk factors for increased morbidity and mortality in this group and possible intervention in reducing the preterm and term SGA burden. India contributes to 12.8 million of the 32.4 million global burden of SGA infants. Nearly 12.5 million infants are born preterm. Maternal short stature, body mass index and weight gain during pregnancy as important predictors of SGA highlight the need to care for the girl child in middle and low-income countries. A generational change is needed to address this issue of ‘low-birthweight – born too small’. A special focus on the girl child nutrition, education and upbringing would have added more value to this section. Although preterm (preterm SGA at highest risk) infants are at higher risk for mortality compared with term SGA, the sustained morbidity and mortality of term SGA through the first year of infancy is an important message. Antimicrobials for infections of the reproductive tract, malaria, parasitic diseases, skin infections and periondonitis to improve foetal growth and reduce incidence of prerterm birth are more contextual and may work only in situations where infections are the major contributing factors for SGA and pretrerm births. Section 2, ‘Catch-Up Growth’ focuses on the catch-up growth in preterm, term SGA and late preterm infants. The effects of early and aggressive catch-up growth on the metabolic diseases and cardiovascular health with benefits of cognitive dividents restricted to preterm infants is well described. Promoting breastfeeding for term SGA and late preterm infants with emphasis on ‘no additional supplementation’ is noteworthy. In section 3, ‘Feeding Practices-Current and Improved?’, sepical emphasis is given to human milk fortifier and probiotics. Promoting catch-up growth with special emphasis on protein supplementation to ensure lean body mass in preterm infants is understood from the chapters in this section. However, early colostrum, aggressive enteral nutrition, universal milk fortification, ad libitum paladia feeding, early and aggressive kangaroo mother care as interventions to improve nutritional outcomes of preterm infants especially in the context of preterm SGA in low and middle income countries, are underfocussed. In conclusion, this book is a good read for core neonatologists, researchers with special focus on low birth weight infants, policy and decision making health specialists.