Prevalence on the complement in offering food to newborns

across-sectional study nested to a cohort study that assessed newborn care in four public maternity hospitals in Natal/Brazil. Sample was composed by 415 mothers and full-term newborns, with appropriate weight for gestational age and Apgar scores in 1st and 5th minutes ≥ 7. In order to analyze the determining factors, we used Poisson’s regression.

Results:

from 415 newborns, 51.3% received feeding complements (57.6% in the first hour of life), of which 92% was infant formula. Only 50.7% of those complement in offering food were prescribed by physicians. Colostrum deficiency was the main reason to be indicated (33.8%). Maternal age ≤ 20 years old (PR=0.64; CI95%=0.47-0.86) and between 2030 years old (PR=0.70; CI95%=0.57-0.87)comparing to women older than 30 were shown as protective factors, while being primiparous (PR=1.37; CI95%=1.11-1.60) and had cesarean section (PR=1.2; CI95%=1.00-1.45) as risk factors.

Conclusion:

maternal characteristics are associated with the complement in offering food to the newborn in the first hours of life. The high prevalence shows the need for interventions that minimize the inadequate offer of infant formula and promote exclusive breastfeeding before hospital discharge.

Key words
Infant nutrition; Infant formula; Breastfeeding; Weaning; Complementary feeding

Variables	Total (N=415)			Complement in offering food (N=213)
	Total (N=415)			Not adjusted			Adjusted
		n	%	p ^*	PR	CI95%	PR	CI95%	p ^**
Maternal characteristics
Maternal age (years)				0.019
≤ 20	79	37	46.8		0.77	0.59-1.01	0.64	0.47-0.86	0.003
20 - 29	193	89	46.1		0.76	0.62-0.92	0.70	0.57-0.87	0.001
>30	143	87	60.8		1	-	1	-	-
Schooling				0.154
High school to higher Education	271	146	53.9		0.86	0.70-1.06	-	-	-
Elementary School	144	67	46.5		1	-	-	-	-
Marital status				0.294
Married or stable union	328	164	50.0		1.06	0.95-1.99	-	-	-
Single/divorced/widowed	87	49	56.3		1	-	-	-	-
Income^a a Minimum wage (2018)= R$998.00;				0.350
>1	147	80	54.4		0.95	0.86-1.05	-	-	-
≤ 1	268	133	49.6		1	-	-	-	-
Gestational diabetes				0.107
Yes	50	31	49.9		1.24	0.98-1.58	-	-	-
No	365	182	62.0		1	-	-	-	-
Parity				0.106
Multiparous	261	126	48.3		1	-	1	-	-
Primiparous	154	87	56.5		1.17	0.97-1.41	1.37	1.11-1.60	0.004
Type of delivery				0.018
Vaginal	224	103	48.4		1	-	1	-	-
Cesarean section	191	110	51.6		1.25	1.04-1.51	1.20	1.00-1.45	0.050
Intention to breastfeed^b b Variable collected in 3 maternity hospitals;				0.945
Up to 6 months	83	43	50.0		0.99	0.86-1.13	-	-	-
7 to 12 months	70	35	50.0		0.99	0.85-1.14	-	-	-
For more than 12 months	123	64	52.0		1	-	-	-	-
Characteristics of NB Child’s sex				0.182
Male	218	117	53.7		1.05	0.95-1.16	-	-	-
Female	197	96	48.7		-	-	-	-	-
Birth weight (g)^c c Sample with 407 weight records;				0.098
2,500-4,000	375	189	50.4		1	-	-	-	-
>4,000	32	21	65.6		1.32	0.99-1.71	-	-	-
Pre-supplemental glycemia^d d Variable collected in 3 maternity hospitals(n= 296/415 (23.4%), and not included in the Regression model;Variables included in the adjusted model: variables with p value <0.20.				0.005
< 40 mg/dL	29	28	96.6		1,36	1,14-1,63	-	-	-
40-50 mg/dL	36	31	86.1		1.23	1.00-1.50	-	-	-
> 50 mg/dL Health care characteristics	32	21	65.6		1	-	-	-	-
Companion during delivery				0.087
Yes	307	151	49.2		1	-	-	-	-
No	108	62	57.4		1.17	0.96-1.42	-	-	-
Skin-to-skin contact				0.651
Yes	246	124	50.4		1	-	-	-	-
No	169	89	52.7		1,02	0.93-1.13	-	-	-
Breastfeeding in the first hour of life				0.036
Yes	242	114	47.1		1	-	-	-	-
No	172	99	57.6		1.22	1.01-1.47	-	-	-

Variables	Total (N=415)	Complement in offering food (N=213)				p
		Yes		No
		n	%	n	%
Administrative nature of the maternity ward						0.346^a a Linear Trend;
City	190	91	47.9	99	52.1
State	96	54	56.2	42	43.8
Federal	129	68	52.7	61	47.3
Level of complexity						0.199^b b Pearson’s Chi-square;
Low risk	190	91	47.9	99	52.1
High risk	225	122	54.2	103	45.8
IHAC Title						0.936^b b Pearson’s Chi-square;
Yes	313	161	51.4	152	48.6
No	102	52	51.0	50	49.0
Ratio number of professionals per bed ( $\bar{X}$ ± SD)	1.25 ± 0.04					0.971^c c Student’s Ttest.
Ratio number of pediatricians per bed ( $\bar{X}$ ± SD)	0.13 ± 0.02					0.875^c c Student’s Ttest.

Variables	N	%	CI95%
Reason to offer complements to NB
Colostrum deficiency	72	33.8	27.5-40.2
Difficulty in grabbing /sucking	50	23.5	17.8-29.2
LGA	7	3.3	0.9-5.7
Other problems related to the NB	18	8.5	4.7-12.2
Other maternal problems	15	7.0	3.6-10.5
Without prescribed reasons Medical prescription of the complement	51	23.9	18.2-29.7
Yes	108	50.7	44.0-57.4
No	105	49.3	42.6-56.0
Time of the complement offered to NB (n=148)^a a Registration of Time was only of bi148 newborns who received complements; NB= newborn; SD= standard deviation; LGA= large for gestational age.
Morning (6:00 a.m. to 6:00 p.m.)	76	35.7	29.0-42.0
Night (6:00 p.m. to 6:00 a.m.) Type of complement	72	37.8	27.0-40.0
Pasteurized breast milk	17	8.0	43.3-59.4
Infant formula Complement volume offered	196	92.0	40.6-56.7
≤ 10 mL	174	81.7	76.5-86.9
> 10 mL	39	18.3	13.1-23.5
Beginning of the supplement offer after the birth of the NB (hours) $\bar{X}$ (SD)	5.61 (7.2)

Instituto de Medicina Integral Prof. Fernando Figueira Rua dos Coelhos, 300. Boa Vista, 50070-550 Recife PE Brasil, Tel./Fax: +55 81 2122-4141 - Recife - PR - Brazil
E-mail: revista@imip.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Authors’ contribution

Pinheiro JMF, MenêzesFlor TB, Braga da Mata AM, Andrade FB: made substantial contributions to the conception, design, analysis and interpretation of the data as well as the writing of the article. Pires VCC, Oliveira LIC, Barbosa WPM made substantial contributions to data acquisition and writing of the article. All authors approved the final version of the manuscript.