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Dietary Patterns and Health: A Global Perspective (Oral Session 12)

(OR12-03-25) Introduction of a Feeding Support Package for Low Birthweight and Preterm Infants to Improve Nutritional and Health Outcomes: A Pilot Study in Tanzania, Malawi, and India

Monday, June 2, 2025
8:56 AM – 9:06 AM ET
Location: S220 E-G
Objectives: To compare key feeding and health outcomes from baseline (BL) and after piloting the Feeding Support Package Plus (FSP+), a facility based feeding support curriculum and package developed for mothers and their infants who are low birthweight (LBW, < 2500g) and/or preterm ( < 37 weeks gestational age) in low- and middle-income countries (LMICs).

Methods: A pre-post pilot study was conducted in six public hospitals across Tanzania, Malawi, and India. NICU-admitted, LBW and/or preterm infants were enrolled within 24 hours of birth and followed daily until discharge or 14 days of life. Baseline data were collected prior to facility-level FSP+ implementation; pilot (PL) data were collected during FSP+ implementation.  Mothers received at least three counseling sessions by trained research healthcare providers around 12 key milestones. Outcomes included breastfeeding initiation within 1 hour postpartum, early and continuous KMC, exclusive breastfeeding (EBF), frequency of milk expression, and maternal breastfeeding confidence.

Results: Overall, 168 infants were enrolled (BL 85; PL 83); 20 (11.9%) died by day 14 (BL 9; PL 11). The mean length of stay was short with significant site variation (mean (SD): BL: 5.5 (12.7) days; PL: 3.9 (8.1) days). After FSP+ implementation, key feeding and care practices improved; uptake varied by sites. Breastfeeding initiation within one hour increased from 12.9% to 36.1% (RR: 3.2, p=0.0003); mean time to first breastfeeding reduced from 6.0 (60.0) hours to 2.0 (3.2) hours. EBF rose from 35.8% to 52.4%; milk expression increased from 52.6% to 77.7%; expression frequency rose from 2.3 to 3.6 sessions per day (p=0.07). 

Maternal breastfeeding confidence improved significantly (p < 0.01). Lactation support also improved, with more mothers receiving help (BL 33%; PL 75%) and resolution of their breastfeeding problems (BL 63%; PL 100%). Infants ever receiving skin-to-skin care increased from 33.0% to 63.7%, and skin-to- skin care provision within one hour postpartum also rose (33.3% to 75.0%); however, no infants had KMC for a full 8 hours per day.

Conclusions: FSP+ improved early breastfeeding initiation, maternal breastfeeding confidence, and KMC. Adaptations were made before scaling to the first implementation phase. 

Funding Sources: Bill & Melinda Gates Foundation