Determinants de la tolerance digestive des nouveau-nes a terme avec retard de croissance intra-uterin ou hypotrophie a L’Hopital Gyneco –Obstetrique et Pediatrique de Douala Cameroun
Keywords:
Intrauterine growth restriction Hypotrophy Nutrition- Digestive tolerance-CameroonAbstract
Background: Adequate nutrition is essential during childhood for proper growth, immunity development and optimal cognitive and neurological development. Digestive tolerance determines feeding behaviour. It is particularly important in newborns with intrauterine growth restriction (IUGR) as it is the main factor in neonatal morbidity and mortality. The overall objective was to identify the determinants of digestive tolerance in full-term newborns with intrauterine growth restriction.
Methodology: This was a case control study conducted in the neonatal units of the Gynaecology, Obstetrics and Paediatrics Hospital in Douala over a four-year period. The target population was full-term newborns weighing <2500g or <10th percentile for gestational age. Cases were matched to controls at a 1:3 ratio based on gestational age (±1 SA), sex and, where relevant, neonatal pathology. Data were recorded using a questionnaire and Kobocollect software. Analyses were performed using Epi Info 7.2.5.0, SPSS 20.0 and Excel 2016 software. Mac Nemar's chi² test and the t-test or Wilcoxon test were used to evaluate associations, while multivariate logistic regression was used to identify independent factors associated with digestive intolerance
(ORa, 95% CI).
Results: IUGR accounted for 6.6% of births, 25% of which had digestive intolerance, with males dominating with a male-to-female sex ratio of 1.5. Twin birth [odds ratio (OR) = 28.7; 95% confidence interval (CI) (3.2–245.4)] and follow-up by a general practitioner [odds ratio (OR) = 1.2; confidence interval 95% CI(1.1–4.2)] are significantly associated with digestive disorders. Breast milk feeding appears to be protective [odds ratio (OR) = 0.2; 95% confidence interval (0.0–1.8)] but not significantly so.
Conclusion: Digestive tolerance in full-term newborns with IUGR is compromised in multiple pregnancies. Early initiation of enteral feeding with breast milk appears to be an essential protective factor in improving their digestive prognosis.
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