Nutrition practices of neonatal intensive care units in the African Neonatal Network

Authors

  • Mahlet Abayneh
  • Kullehe Haddis Yeshanew
  • Samuel Lulseged Yidengitu
  • Redeat Workneh Tadasse
  • Afolayan Ayomide
  • Erika M. Edwards
  • Danielle E. Y. Ehret
  • Pamela Henderson
  • Loveness Nya Kwima
  • Benenia Muzuva
  • John Baptist Nkuranga
  • Helina Selam
  • Elizabeth Siraha
  • Alexander G. Stevenson
  • Misrak Tadesse
  • Gregory C. Valentine

Keywords:

Infant, Premature; Infant, Newborn; Nutritional Support; Neonatal Intensive Care Units; Lactation Support; Diet, Infant; Milk, Human; Human Milk Banking; Africa South of the Sahara; Global Health

Abstract

Background: Optimal and adequate nutrition provision and standard nutritional practice is mandatory for critically ill infants in the neonatal intensive care unit. Poor nutrition in early life is associated with problems that increase risk of mortality and morbidity in preterm newborns. Preterm infants are at high risk of having inadequate nutrition in low-resource settings due to lack of resources 
and trained health workers.
Methods: Fourteen hospitals in the African Neonatal Network responded to an annual facility survey and a health facility survey co-developed by faculty in the African Neonatal Network and Vermont Oxford Network. All analyses use descriptive statistics.
Results: Almost all the units (94%) had guidelines for initiation and advancement of feeding. Ten hospitals (71%) reported complying with Baby-Friendly Hospital initiatives. Among the 14 hospitals, only one (7%) had access to pasteurized donor milk. There was
significant variation in use of breast milk fortifiers; only three (21%) hospitals reported using it consistently for more than 90% of 
their preterm newborns. There was also variation in human resources related to neonatal NICU nutrition with only four (29%) of the hospitals having a dedicated dietitian and one with 24/7 access to a lactation consultant. 
Conclusion: Dedicated dietitian or lactation support team were limited in the network hospitals. There was only one hospital with access to pasteurized donor milk, and use of breast milk fortifiers was not optimal. Optimising nutrition should be prioritised to improve opportunities for infants to go home meeting growth standards.

Author Biographies

  • Mahlet Abayneh

    St Paul's Hospital Millennium
    Medical College, Addis Ababa,
    Ethiopia

  • Kullehe Haddis Yeshanew

    Tikur Anbessa Specialized Hospital,
    Addis Ababa, Ethiopia

  • Samuel Lulseged Yidengitu

    St Paul's Hospital Millennium
    Medical College, Addis Ababa,
    Ethiopia

  • Redeat Workneh Tadasse

    St Paul's Hospital Millennium
    Medical College, Addis Ababa,
    Ethiopia

  • Afolayan Ayomide

    Federal Teaching Hospital,
    Ido-Ekiti, Nigeria

  • Erika M. Edwards

    Vermont Oxford Network and
    University of Vermont,
    Burlington, Vermont, USA

  • Danielle E. Y. Ehret

    Vermont Oxford Network and
    University of Vermont,
    Burlington, Vermont, USA

  • Pamela Henderson

    African Neonatal Network, Kigali,
    Rwanda and Harare, Zimbabwe

  • Loveness Nya Kwima

    Mbuya Nehanda Maternity Hospital,
    Harare, Zimbabwe

  • Benenia Muzuva

    Mbuya Nehanda Maternity Hospital,
    Harare, Zimbabwe

  • John Baptist Nkuranga

    University of Rwanda/African
    Health Sciences University, Kigali,
    Rwanda

  • Helina Selam

    Vermont Oxford Network,
    Burlington, Vermont, USA

  • Elizabeth Siraha

    Great Zimbabwe University,
    Masvingo, Zimbabwe

  • Alexander G. Stevenson

    African Neonatal Network, Kigali,
    Rwanda and Harare, Zimbabwe

  • Misrak Tadesse

    Vermont Oxford Network and Johns
    Hopkins University School of
    Medicine, Baltimore, MD, USA

  • Gregory C. Valentine

    University of Washington,
    Seattle, Washington, USA

References

Pollack MM, Ruttimann UE, Wiley JS. Nutritional Depletions in Critically Ill Children: Associations with Physiologic Instability and Increased Quantity of Care. J Parenter Enteral Nutr. 1985;9(3):309–13.

Maas C, Poets CF, Franz AR. Avoiding postnatal undernutrition of VLBW infants during neonatal intensive care: evidence and personal view in the absence of evidence. Arch Dis Child Fetal Neonatal Ed.

;100(1):F76–81.

Meier PP, Patel AL, Bigger HR, Chen Y, Johnson TJ, Rossman B, et al. Human milk feedings in the neonatal intensive care unit. In: Rajendram R, Preedy VR, Patel VB, editors. Diet and Nutrition in Critical Care. Springer New York; 2015. p. 807–22.

McCallie KR, Lee HC, Mayer O, Cohen RS, Hintz SR, Rhine WD. Improved outcomes with a standardized feeding protocol for very low birth weight infants. J Perinatol. 2011;31(S1):S61–7.

Kleinman RE, Greer FR.Pediatric Nutrition. 8th ed. American Academy of PediatricsItasca, IL; 2020.

Ofek Shlomai N, Reichman B, Lerner-Geva L, Boyko V, Bar- Oz B. Population-based study shows improved postnatal growth in preterm very-lowbirthweight infants between 1995 and 2010. Acta Paediatr. 2014;103(5):498-503. doi: 10.1111/apa.12569.

Gidi NW, Goldenberg RL, Nigussie AK, et al. Incidence and associated factors of extrauterine growth restriction (EUGR) in preterm infants, a cross-sectional study in selected NICUs in Ethiopia. BMJ Paediatr Open 2020;4:e000765.

Mosidi, LND, van Niekerk A, Coetzee M. 2024. Change in the prevalence of extra-uterine growth restriction in very low birthweight infants, following the introduction of a written nutrition protocol, in a tertiary neonatal unit. South Afr J Clin Nutr. 2024;37(3):140–47.

WHO/UNICEF. Global strategy on infant and young child feeding. Geneva: World Health Organization; 2003.

WHO. Recommendations for care of the preterm or low birth weight infant. 1st ed. Geneva: World Health Organization; 2022.

Gephart SM, Hanson C, Wetzel CM, Fleiner M, Umberger E, Martin L, et al. NEC-zero recommendations from scoping review of evidence to prevent and foster timely recognition of necrotizing enterocolitis. Matern Health Neonato Perinatol. 2017 Dec 18;3:23.

American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors. Clinical guidelines for the use of parenteral and enteral nutrition in adult and pediatricpatients, 2009. J Parenter Enteral Nutr. 2009;33 (3):255.

Sneve J, Kattelmann K, Ren C, Stevens DC. Implementation of a multidisciplinary team that includes a registered dietitian in a neonatal intensive care unit improved nutrition outcomes. Nutr Clin Pract. 2008-2009;23(6):630- 4.

Bernaix LW, Schmidt CA, Arrizola M, Iovinelli D, Medina- Poelinez C. Success of a lactation education program on NICU nurses' knowledge and attitudes. J Obstet Gynecol Neonatal Nurs. 2008;37 (4):436-45.

Maastrup R, Rom AL, Walloee S, Sandfeld HB, Kronborg H. Improved exclusive breastfeeding rates in preterm infants after a neonatal nurse training program focusing on six breastfeeding-supportive clinical practices. PLoS One. 2021;16(2):e0245273.

Olsen SL, Park ND, Tracy K, Younger D, Anderson B. Implementing standardized feeding guidelines, challenges, and results. Neonatal Netw. 2018;37(4):218-223.

Wittwer A, Hascoët JM. Impact of introducing a standardized nutrition protocol on very premature infants' growth and morbidity. PLoS One. 2020 May 21;15(5):e0232659.

Sehhatie FS, Mirghafourvand M, Havizari S. Effect of prenatal counseling on exclusive breastfeeding frequency and infant weight gain in mothers with previous unsuccessful breastfeeding: a randomized controlled clinical trial. J Matern Fetal Neonatal Med. 2020 Nov;33(21):3571-3578.

Koli H, Nair M, Shah M. (2021). Impact of structured pre-natal counselling on early initiation of breastfeeding and adherence to exclusive breastfeeding: a comparative interventional study. Int J Reprod Contracept Obstet Gynecol. 2021;10:2699.

Nakibuuka V, Kainza J, Nasiima R, Nalunga S, Nazziwa R, Mponye H, et al. Setting up the first human milk bank in Uganda: a success story from Nsambya hospital. Front Nutr. 2024;10:1275877.

Moreira DH, Gregory SB, Younge NE. Human milk fortification and use of infant formulas to support growth in the neonatal intensive care unit. Nutr in Clin Prac. 2023;38(S2).

Stevenson AG, Abayneh M, Bolaji O, et al. Characteristics, interventions, and status of infants discharged from 14 hospitals in the African Neonatal Network in 2023. J African Neonatology.

Areprekumor T ebi, Ezeh BU, Madjemu RP, Okocha EL. Prevalence and determinants of exclusive breastfeeding among infants after discharge from a neonatal unit in South- South Nigeria. Int J Trop Dis Health. 2024;45(12):85–101.

Belfort MB, Edwards EM, Greenberg LT, Parker MG, Horbar JD. Diet, weight gain, and head growth in hospitalized U.S. very preterm infants: a 10-year observational study. Am J Clin Nutr. 2019;109(5):1373-1379.

Fang L, Wu L, Han S, Chen X, Yu Z. Quality Improvement to Increase Breastfeeding in Preterm Infants: Systematic Review and Meta-

Analysis. Front Pediatr. 2021 Jun 10;9:681341.

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Published

2025-08-05

How to Cite

Nutrition practices of neonatal intensive care units in the African Neonatal Network. (2025). JOURNAL OF AFRICAN NEONATOLOGY, 3(3), 92-97. https://janeonatology.org/index.php/jan/article/view/179

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