Newborn Nutrition and Breastfeeding
Breastfeeding is the ordinary and unequaled strategy for feeding newborn babies and a critical aspect of caring for infants and young children. Breastmilk promotes sensory and cognitive development and protects infants against infectious and chronic diseases. In 2001 the 54th World Health Assembly urged member states to promote ‘EXCLUSIVE BREASTFEEDING’ for six months as a global public health recommendation which was concluded by WHO systematic review of the evidence (Kramer and Kakuwa, 2002) and finalized that exclusive breastfeeding for six months confers several benefits on infant and mother.
Colostrum is a highly concentrated form of breastmilk constituting an immune-boosting package of fat, carbohydrates, protein, immunoglobins (IgA, IgG, IgM), lactose, ashes, magnesium, and antimicrobial peptide lactoferrin on the first 3days of pregnancy. This nutrient is complete nutrition for a newborn which promotes protection from infections, first immunization, acts as laxatives, promotes sleep and digestion, effective for brain growth, and even promotes growth and development. According to a national study on ‘Determinant of infant breastfeeding practices in Nepal’, “Most infants in Nepal receive colostrum but less than half initiate breastfeeding within an hour of birth and one-third are fed prelacteal feeds, which may negatively affect breastfeeding and health throughout early infancy” published on International Breastfeeding Journal, article 14(2019).
Exclusive breastfeeding reduces infant mortality due to common childhood illnesses such as diarrhea or pneumonia and helps for a quicker recovery during illness. Breastfeeding contributes to the health and wellbeing of mothers too by birth spacing, even reduces the risk of breast and ovarian cancer. Breastmilk contains 0.8% to 0.9% protein, 4.5% fat, 7.1% carbohydrates, ash 0.2%, vitamins, and 86-88% water which is alone adequate till 6months of age. Babies which are born early (before 37 weeks) or at a low birth weight (1.5kg/ 5pounds 8ounces) need special nutrition to help them catch up on growth. Breast-fed babies may get a fortifier added to the milk, which contains extra calories, fat, protein, vitamins, and minerals. Babies who can’t breastfeed will need a special formula higher on calories. Newborns requires normally 30-60ml for 0-2 days every 2-3 hourly, 60- 90ml for 3rdday-4 weeks every 3-4 hourly, 120-150ml for 4weeks-12weeks every 4-5 hourly, 180-240ml for 12weeks-24weeks every 5-6hourly.
Breastfeeding practice depends on attitudes, knowledge, exposures, beliefs, intended behavior, demographic factors, workplace/employment, and family support. Nepal as a developing country lacks adequate resources to monitor assess awareness on remote site which leads them to follow the traditional pattern of newborn feeding. A health facility-based cross-sectional study conducted for breastfeeding practices on 574 infants within the first 6months of age in mid-western and eastern regions of Nepal concludes only 23.2% of infants were exclusively breastfed until 6months, with 28.2% are predominantly breastfed and 48.6% partially breastfed. Malnutrition and undernutrition are serious factors contributing to child health status. Nepal is one of the thirty-four countries that constitute 90% of the global burden of malnutrition in children. NDHS (Nepal demographic health survey) in 2016 reported that 36% of children are stunted (defined as height-for-age<-2z score), 10% are wasted (defined as weight-for-height<-2z score) and 27% are underweight (defines as weight-for-age<- 2z score); based on WHO growth chart.
Breastmilk is the ideal food for infants. Appropriate feeding practices stimulate bonding with the caregiver and psycho-social development which leads to improved nutrition, psycho-social development and even contributes to maternal health and well-being. Exclusive breastfeeding for six months and continue frequent, on-demand breastfeeding until 2ys of age are vital nutritional contributors for the child.
RN Binita Khatiwada Itahari-9, Sunsari,