Globally, more than 20 million infants each year are born low birthweight (<2500g); these newborns are at higher risk of mortality, morbidity, and poor growth. Current World Health Organization (WHO) guidelines for feeding low birthweight infants (LBWs) prioritize, in this order, the mother’s own breast milk (MOM), donor human milk (DHM), and then breast milk substitute/formula (BMS). Macro or micronutrient supplementation is not currently recommended, and the guidelines offer limited insight into the implementation of these policies. Moreover, 70% of the guidelines are based on “low or very low” quality of evidence (WHO Infant Feeding Guidelines 2011).

 Recently, a call to action for investigation of infant feeding practices for vulnerable newborns highlighted the deep lack of knowledge around the current care provision for vulnerable newborns, as well as what the optimal infant feeding “ecosystem” is that supports breastfeeding and offers appropriate alternatives when infants are nutritionally at risk (Greenslade et al 2017).

 Infant feeding is a very sensitive subject with deeply held beliefs, globally. At the end of the investment, we will have answered key questions around current infant feeding practices of low birthweight children who are at heightened risk of morbidity, mortality and poor development. Additionally, we will identify key systems gaps to understand how and why breastfeeding is unsuccessful. This work will provide new evidence to guide improved nutritional support for the 20 million low birthweight infants born each year and fill a massive data gap which currently results in suboptimal programs and systems. In particular, this work will provide guidance for the needed efficacy and effectiveness trials for infant in LMICs, where 90% of LBW occurs, and where causes of morbidity and mortality are significantly different than those in High Income Countries (HIC), where most evidence is generated around infant feeding (Blencowe 2013).

Study goal is to understand feeding options for LBW infants in LMIC settings, including current feeding practices, health outcomes, and potential interventions.

 Objectives:

1.    Understand the current practices and standard of care (SOC) for feeding LBW infants

2.    Define and document the key outcomes (including growth, morbidity, and lack of success on MOM) for LBW infants under current practices

3.    Assess the acceptability and feasibility of a system-level IYCF intervention and the proposed infant feeding options for LBW infants