Influence of Kangaroo Mother Care on breastfeeding, the introduction of complementary feeding and diet quality in the first year of life
Keywords:
Eating behavior, Kangaroo mother care, Neonatal intensive care, Newborn, PrematureAbstract
Objective
To assess the influence of Kangaroo Mother Care on breastfeeding rates in preterm neonates, both at hospital discharge and throughout the first year of life, as well as its relation with the time of introduction of early complementary feeding and diet quality.
Methods
Observational, prospective and analytical longitudinal study conducted in a public hospital in southern Brazil. The study included 46 preterm neonates, who were admitted to a Kangaroo Neonatal Intermediate Care Unit or Conventional Neonatal Intermediate Care Unit.
Results
The frequency of exclusive breastfeeding at hospital discharge was higher in preterm neonates of Kangaroo Neonatal Intermediate Care Unit (p<0.001), and at four months of corrected age, 35% of them continued on exclusive breastfeeding (p=0.029), as compared to infants in Conventional Neonatal Intermediate Care Unit. However, at six and 12 months, no difference was found in breastfeeding rates between the participating groups. At four months of corrected age, approximately 45% of the breastfeeding infants in both groups were already on complementary feeding. At 12 months of corrected age, consumption of ultra-processed foods was 38.9% in infants from the Kangaroo Neonatal Intermediate Care Unit and 70% in infants from the Conventional Neonatal Intermediate Care Unit (p=0.054), and no significant differences were found.
Conclusion
The Kangaroo Mother Care fostered exclusive breastfeeding at hospital discharge and at 4 months of corrected age. On the other hand, with regard to the early introduction of complementary feeding, Kangaroo Mother Care was not protective, and a high rate of consumption of processed foods by infants was found.
References
World Health Organization. The optimal duration of exclusive breastfeeding: report of an expert consultation. Geneva: Organization; 2001 [cited 2021 Nov 22]. Available from: https://apps.who.int/nutrition/publications/ infantfeeding/WHO_NHD_01.09/en/index.html
Sociedade Brasileira de Pediatria. Manual de Alimentação: orientações para alimentação do lactente ao adolescente, na escola, na gestante, na prevenção de doenças e segurança alimentar. 4th ed. São Paulo: Sociedade; 2018 [cited 2021 June 14]. Available from: https://www.sbp.com.br/fileadmin/user_upload/_21089kManNutro_Alimentacao_para_site.pdf
Lyons KE, Ryan CA, Dempsey EM, Ross RP, Stanton C. Breast Milk, a Source of Beneficial Microbes and Associated Benefits for Infant Health. Nutrients. 2020;12(4):1039. https://doi.org/10.3390/nu12041039
Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475-90. https://doi.org/10.1016/S0140-6736(15)01024-7
Dereddy N, Talati A, Smith A, Kudumula R, Dhanireddy R. A multipronged approach is associated with improved breast milk feeding rates in very low birth weight infants of an inner-city hospital. J Hum Lact. 2015;31(1):43-6. https://doi.org/10.1177/0890334414554619
Freitas BAC, Lima LM, Carlos CFLV, Priore SE, Franceschini SCC. Duração do aleitamento materno em prematuros acompanhados em serviço de referência secundário. Rev Paul Pediatr. 2016;34(2):189-96. https://doi.org/10.1016/j. rpped.2015.10.005
Luz LS, Minamisava R, Scochi CGS, Salge AKM, Ribeiro LM, Castral TC. Predictive factors of the interruption of exclusive breastfeeding in premature infants: a prospective cohort. Rev Bras Enferm. 2018;71(6):2876-82. http:// dx.doi.org/10.1590/0034-7167-2017-0762
World Health Organization. WHO recommendations on interventions to improve preterm birth outcomes. Geneva: Organization; 2015 [cited 2021 Nov 20]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK321160/pdf/ Bookshelf_NBK321160.pdf
Rey E, Martinez H. Gestão racional do prematuro infante: curso de Medicina Fetal e Neonatal. Bogotá: Universidad Nacional; 1983.
Conde-Agudelo A, Díaz-Rossello JL. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev. 2016;16(8):CD002771. https://doi.org/10.1002/14651858.CD002771
Charpak N, Montealegre-Pomar A, Bohorquez A. Systematic review and meta-analysis suggest that the duration of Kangaroo mother care has a direct impact on neonatal growth. Acta Paediatr. 2021;110(1):45-59. https://doi. org/10.1111/apa.15489
Alves FN, Azevedo VMGO, Moura MRS, Ferreira DMLM, Araújo CGA, Mendes-Rodrigues C, et al. Impacto do método canguru sobre o aleitamento materno de recém-nascidos pré-termo no Brasil: uma revisão integrativa. Cien Saude Colet. 2020;25:4509-20. https://doi.org/10.1590/1413-812320202511.29942018
Boundy EO, Dastjerdi R, Spiegelman D, Fawzi WW, Missmer AS, Lieberman E, et al. Kangaroo mother care and neonatal outcomes: a meta-analysis. Pediatrics. 2016;137(1):e20152238. https://doi.org/10.1542/peds.2015-2238
Zhang B, Duan Z, Zhao Y, Williams S, Wall S, Huang L, et al. Intermittent kangaroo mother care and the practice of breastfeeding late preterm infants: results from four hospitals in different provinces of China. Int Breastfeed J. 2020;15(1):64. https://doi.org/10.1186/s13006-020-00309-5
Ministério da Saúde (Brasil). Guia alimentar pata crianças brasileiras menores de 2 anos. Brasília: Ministério; 2019.
Ministério da Saúde (Brasil). Manual do Método Canguru: seguimento compartilhado entre a Atenção Hospitalar e a Atenção Básica. Brasília: Ministério; 2015.
Villar J, Cheikh Ismail L, Victora CG, Ohuma EO, Bertino E, Altman DG, et al. International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st). International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. Lancet. 2014;384(9946):857-68. https://doi.org/10.1016/S0140-6736(14)60932-6
Villar J, Giuliani F, Fenton TR, Ohuma EO, Ismail LC, Kennedy SH, et al. INTERGROWTH-21st very preterm size at birth reference charts. Lancet. 2016;387(10021):844-5. https://doi.org/10.1016/S0140-6736(16)00384-6
World Health Organization. Indicators for assessing infant and young child feeding practices Definitions and measurement methods. Geneva: Organization; 2021 [cited 2021 Sep 25]. Available from: https://www.who.int/ publications/i/item/9789240018389
Ministério da Saúde (Brasil). Orientações para avaliação de marcadores de consumo alimentar na atenção básica. Brasília: Ministério; 2015.
Lussier MM, Tosi L, Brownell EA. Predictors of Mother’s Own Milk Feeding at Discharge in Preterm Infants. Adv Neonatal Care. 2019;19(6):468-73. https://doi.org/10.1097/ANC.0000000000000679
Almeida H, Venancio SI, Sanches MTC, Onuk D. Impacto do método canguru nas taxas de aleitamento materno exclusivo em recém-nascidos de baixo peso. J Pediatr. 2010;86(3):250-3. https://doi.org/10.1590/S0021-75572010000300015
Menezes MADS, Garcia D, Melo EV, Cipolotti R. Recém-nascidos prematuros assistidos pelo Método Canguru: avaliação de uma coorte do nascimento aos seis meses. Rev Paul Pediatr. 2014;32(2):171-7. https://doi.org/10.1590/0103- 0582201432213113
Charpak N, Ruiz-Pelaez JG, Figueroa de C Z, Charpak Y. A randomized, controlled trial of kangaroo mother care: results of follow-up at 1 year of corrected age. Pediatrics. 2001;108(5):1072-9. https://doi.org/10.1542/ peds.108.5.1072
Gavhane S, Eklare D, Mohammad H. Long Term Outcomes of Kangaroo Mother Care in Very Low Birth Weight Infants. J Clin Diagn Res. 2016;10(12):SC13-SC15. https://doi.org/10.7860/JCDR/2016/23855.9006
Rollins NC, Lutter CK, Bhandari N, Hajeebhoy N, Horton S, Martines JC. et al. Why invest, and what it will take to improve breastfeeding practices? Lancet. 2016;387(10017):491-504. https://doi.org/10.1016/S0140-6736(15)01044-2
Lima APE, Castral TC, Leal LP, Javorski M, Sette GCS, Scochi CGS, et al. Aleitamento materno exclusivo de prematuros e motivos para sua interrupção no primeiro mês pós-alta hospitalar. Rev Gaucha Enferm. 2019;40:e20180406. https://doi.org/10.1590/1983-1447.2019.20180406
Mendes SC, Lobo IKV, Sousa SQ, Vianna RPT. Factors associated with a shorter duration of breastfeeding. Cien Saude Colet. 2019;24(5):1821-29. https://doi.org/10.1590/1413-81232018245.13772017
Cleary J, Dalton SM, Harman A, Wright IM. Current practice in the introduction of solid foods for preterm infants. Public Health Nutr. 2020;23(1):94-101. https://doi.org/10.1017/S1368980019002337
Liotto N, Cresi F, Beghetti I, Roggero P, Menis C, Corvaglia L, et al. Complementary Feeding in Preterm Infants: a systematic review. Nutrients. 2020;20;12(6):1843. https://doi.org/10.3390/nu12061843
World Health Organization. Complementary Feeding: Report of the Global Consultation, and Summary of Guiding Principles for Complementary Feeding of the Breastfed Child. Geneva: Organization; 2002 [cited 2020 Sep 5]. Available from: https://apps.who.int/iris/bitstream/handle/10665/42739/924154614X.pdf?sequence=1&isAllowed=y
Fewtrell M, Bronsky J, Campoy C, Domellöf M, Embleton N, Fidler Mis N, et al. Complementary Feeding: a position paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2017;64(1):119-32. https://doi.org/10.1097/MPG.0000000000001454
Alvisi P, Brusa S, Alboresi S, Amarri S, Bottau P, Cavagni G, et al. Recommendations on complementary feeding for healthy, full-term infants. Ital J Pediatr. 2015;28;41:36. https://doi.org/10.1186/s13052-015-0143-5
Department of Agriculture (United States of América). Dietary Guidelines for Americans, 2020-2025. 9th ed. Washington: Department; 2020 [cited 2021 May 15]. Available from: https://www.dietaryguidelines.gov/sites/ default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf
Sociedade Brasileira de Pediatria. Manual de seguimento ambulatorial do prematuro de risco. Porto Alegre: Sociedade; 2012 [cited 2021 Jun 14]. Available from: https://www.sbp.com.br/fileadmin/user_upload/pdfs/seguimento_ prematuro_ok.pdf
Pagliaro CL, Bühler KE, Ibidi SM, Limongi SC. Dietary transition difficulties in preterm infants: critical literature review. J Pediatr. 2016;92(1):7-14. https://doi.org/10.1016/j.jped.2015.05.004
Gupta S, Agarwal R, Aggarwal KC, Chellani H, Duggal A, Arya S, et al. Complementary feeding at 4 versus 6 months of age for preterm infants born at less than 34 weeks of gestation: a randomised, open-label, multicentre trial. Lancet Glob Health. 2017;5(5):e501-e511. https://doi.org/10.1016/S2214-109X(17)30074-8
Figueroa Pedraza D, Santos EES. Marcadores de consumo alimentar e contexto social de crianças menores de 5 anos de idade. Cad Saude Colet. 2021;29(2):163-78. https://doi.org/10.1590/1414-462X202129020072
Bortolini GA, Vitolo MR, Gubert MB, Santos LMP. Iniquidades sociais influenciam a qualidade e a diversidade da dieta de crianças brasileiras de 6 a 36 meses. Cad Saude Publica. 2015;31(11):2413-24. https://doi.org/10.1590/0102- 311X00153414
Karnopp EV, Vaz JS, Schafer AA, Muniz LC, Souza RL, Santos I, et al. Food consumption of children younger than 6 years according to the degree of food processing. J Pediatr. 2017;93(1):70-8. https://doi.org/10.1016/j. jped.2016.04.007
Ministério da Saúde (Brasil). Método Canguru: manual da terceira etapa do Método Canguru na Atenção Básica. Brasília: Ministério; 2018.
