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Paediatrics
Research
Risk of postneonatal mortality, hospitalisation and suboptimal breast feeding practices in low birthweight infants from rural Haryana, India: findings from a secondary data analysis
  1. Ravi Prakash Upadhyay1,
  2. Jose Carlos Martines2,
  3. Sunita Taneja1,
  4. Sarmila Mazumder1,
  5. Rajiv Bahl3,
  6. Nita Bhandari1,
  7. Suresh Dalpath4,
  8. Maharaj Kishan Bhan5,6
  1. 1 Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
  2. 2 Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Bergen, Norway
  3. 3 Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
  4. 4 Department of Health, National Health Mission, Haryana, India
  5. 5 Department of Science and Technology, Indian Institute of Technology (IIT), New Delhi, India
  6. 6 Knowledge Integration and Translational Platform (KnIT), Biotechnology Industry Research Assistance Council (BIRAC), New Delhi, India
  1. Correspondence to Dr Ravi Prakash Upadhyay; ravi.upadhyay{at}sas.org.in

Abstract

Objectives Low birth weight (LBW) is a risk factor for neonatal mortality and morbidity. It is important to examine whether this risk persists beyond neonatal period. The current secondary data analysis aimed to examine association of birth weight with mortality, hospitalisation and breast feeding practices during infancy.

Design Data from a large randomised controlled trial of neonatal vitamin A supplementation (Neovita) trial were used. Log binomial model was applied to assess association between birth weight and mortality, hospitalisation and breast feeding practices.

Setting Rural Haryana, North India.

Participants Newborns recruited in the primary intervention trial that aimed to evaluate the effect of single-dose oral vitamin A supplementation on mortality in the first 6 months of life.

Results We recruited a total of 44 984 infants, of which 10 658 (23.7%) were born LBW, that is, birth weight less than 2500 g. In the neonatal period, LBW babies had four times higher risk of mortality (relative risk (RR) 3.92; 95% CI 3.33 to 4.66) compared with normal birthweight babies. In the postneonatal period, the risk was two times higher (RR 1.92; 95% CI 1.71 to 2.15); even higher in those with birth weight <2000 g (RR 3.38; 95% CI 2.71 to 4.12). The risk of hospitalisation in the neonatal period and postneonatal period was (RR 1.86; 95% CI 1.64 to 2.11) and (RR 1.13; 95% CI 1.05 to 1.21), respectively. LBWs were at increased risk of breast feeding initiation 24 hours after birth (RR 1.64; 95% CI 1.45 to 1.81), no breast feeding at 6 months (RR 1.34; 95% CI 1.23 to 1.46) and at 12 months of age (RR 1.24; 95% CI 1.18 to 1.30).

Conclusions LBW babies, especially those with birth weight of <2000 g, were at increased risk of mortality, hospitalisation and suboptimal breast feeding practices during entire infancy and therefore require additional care beyond the first 28 days of life.

Trial registration number NCT01138449.

  • low birth weight
  • infant mortality
  • postneonatal mortality
  • hospitalisation risk
  • breast feeding practices
  • extended home visitation
  • care and support
  • India

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-020384

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    Footnotes

    • Contributors RPU conceptualsed the study, did the formal analysis and drafted the manuscript. JM conceptualised the study, and helped in analysis and preparation of the manuscript. RB conceptualised the study, helped in the formal analysis and reviewed and revised the manuscript. ST, SM, NB and SD provided overall coordination and supervised data procurement; provided inputs in the analysis, manuscript writing and critically reviewed the manuscript. MKB conceptualised the study, helped in framing the plan of analysis and provided critical feedback throughout the analysis and manuscript preparation. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

    • Funding This secondary data analysis was funded by Knowledge Integration and Technology Platform (KnIT), a Grand Challenges Initiative of the Department of Biotechnology and Biotechnology Industry Research Assistance Council (BIRAC) of Government of India and Bill and Melinda Gates Foundation (USA).

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The trial was approved by the ethics review committes of WHO and Society for Applied Studies, New Delhi. Permission and approvals were taken from the state government of Haryana.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data available. Request for data used in the current analysis can be directed to the corresponding author.