Exclusive breastfeeding and growth velocity in preterm and low birth weight newborns in the Kangaroo Method

Salviano, Andressa Freire; Azevedo, Lídia Helena Bezerra; Maneschy, Ivie Reis; Almeida, Paulo César de; Azevedo, Daniela Vasconcelos de

doi:10.1590/1806-9304202500000205-en

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 25 • 2025 • https://doi.org/10.1590/1806-9304202500000205-en linkcopy

Exclusive breastfeeding and growth velocity in preterm and low birth weight newborns in the Kangaroo Method

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives: to analyze growth velocity trajectories according to exclusive breastfeeding practices among preterm and low-birth-weight infants followed within the Kangaroo Mother Care.

Methods: a longitudinal study was conducted with 152 newborns cared for in two public maternity hospitals in Fortaleza, Ceará, Brazil, between October 2016 and October 2017. The exposure variable was exclusive breastfeeding at Kangaroo Mother Care discharge. Weight gain (g/kg/day), length (cm/day), and head circumference (cm/day) velocities were estimated from repeated anthropometric measurements using linear mixed-effects models with restricted cubic splines, adjusted for neonatal and maternal characteristics.

Results: overall, 51.3% of the infants were female, with a mean birth weight of 1,743 g (±43.8) and a mean gestational age of 32.7 weeks (±2.1). At 37 weeks of age, exclusively breastfed infants showed higher weight gain velocity (11.8 g/kg/day; 95%CI= 10.7-12.9) compared with those not exclusively breastfed (8.4 g/kg/day; 95%CI= 6.4-10.5; p<0.05). No statistically significant differences were observed in length or head circumference trajectories between feeding groups.

Conclusions: exclusive breastfeeding at Kangaroo Mother Care discharge was associated with higher weight gain velocity at 37 weeks of life, underscoring the importance of breastfeeding in promoting healthy growth among preterm and low-birth-weight infants.

Key words
Exclusive breastfeeding; Growth; Preterm infant; Low birth weight infant; Kangaroo-mother care

Variáveis	Exclusive breastfeeding				p*
	Yes		No
	n	%	n	%
Sex					0.275
Male	47	45.6	27	55.1
Female	56	54.4	22	44.9
Birth weight (g)					0.156
<1.500	30	29.1	9	18.4
>1.500	73	70.9	40	81.6
Prematurity (gw)					0.068
<32	36	34.9	10	20.4
>32	67	65.1	39	79.6
Maternal age (years)					0.632
<19	23	22.3	8	16.3
19-34	68	66.0	36	73.5
>35	12	11.7	5	10.2
Maternal education (years)					0.645
<9	44	42.7	19	38.8
>9	59	57.3	30	61.2
Family Income (MW)					0.139
<2	79	76.7	32	65.3
>2	24	23.3	17	34.7
Presence of a partner					0.092
Yes	55	53.4	19	38.8
No	48	46.6	30	61.2
Area of Residence					0.57
Capital/MRF	74	71.8	33	67.4
Rural area	29	28.2	16	32.6
Pre-gestational weight excess					0.747
Yes	47	51.1	19	54.3
No	45	48.9	16	45.7

Mean growth velocity (95% CI) based on exclusive breastfeeding practice
	Unadjusted model^*		Adjusted model**
	Exclusive breastfeeding		Exclusive breastfeeding
	Yes	No	Yes	No
Weight (g/kg/day)
31 gw	-15.01 (-20.36; -9.66)	-8.06 (-17.77; 1.65)	-14.81 (-19.95; -9.67)	-8.72 (-19.26; 1.83)
33 gw	-4.15 (-6.70; -1.59)	-2.65 (-7.36; 2.06)	-3.98 (-6.43; -1.53)	-2.41 (-7.32; 2.49)
35 gw	5.48 (4.17; 6.78)	2.71 (0.56; 4.86)	5.64 (4.39; 6.89)	3.52 (1.26; 5.79)
37 gw	11.63 (10.44; 12.83)	7.89 (6.09; 9.69)	11.83 (10.67; 12.99)	8.42 (6.38; 10.45)
39 gw	13.90 (12.21; 15.60)	12.00 (9.94; 14.06)	14.09 (12.33; 15.84)	11.99 (9.46; 14.51)
41 gw	13.74 (11.43; 16.05)	13.43 (11.04; 15.83)	13.61 (11.27; 15.95	14.34 (11.36; 17.33)
43 gw	12.33 (8.03; 16.62)	12.24 (6.84; 17.65)	11.57 (7.56; 15.58)	15.83 (8.66; 23.00)
45 gw	10.48 (2.54; 18.43)	10.11 (-0.99; 21.22)	8.99 (1.64; 16.33)	17.01 (2.40; 31.63)

Length (cm/day)
31 gw	0.13 (0.04; 0.22)	0.09 (-0.09; 0.28)	0.14 (0.05; 0.24)	0.02 (-0.21; 0.26)
33 gw	0.11 (0.07; 0.15)	0.09 (0.00; 0.18)	0.12 (0.08; 0.17)	0.07 (-0.05; 0.18)
35 gw	0.10 (0.08; 0.12)	0.09 (0.05; 0.13)	0.11 (0.09; 0.13)	0.10 (0.06; 0.15)
37 gw	0.13 (0.11; 0.15)	0.11 (0.07; 0.14)	0.13 (0.11; 0.15)	0.11 (0.07; 0.15)
39 gw	0.17 (0.15; 0.20)	0.13 (0.09; 0.16)	0.17 (0.14; 0.20)	0.10 (0.06; 0.15)
41 gw	0.19 (0.15; 0.22)	0.15 (0.11; 0.19)	0.18 (0.14; 0.22)	0.12 (0.07; 0.17)
43 gw	0.16 (0.09; 0.22)	0.16 (0.07; 0.26)	0.16 (0.09; 0.22)	0.16 (0.04; 0.28)
45 gw	0.12 (0.00; 0.23)	0.17 (-0.02; 0.37)	0.12 (0.01; 0.24)	0.22 (-0.03; 0.47)

Head circumference (cm/day)
31 gw	0.05 (-0.02; 0.13)	0.04 (-0.08; 0.16)	0.02 (-0.06; 0.10)	0.01 (-0.15; 0.17)
33 gw	0.07 (0.04; 0.11)	0.06 (0.00; 0.12)	0.05 (0.02; 0.09)	0.05 (-0.03; 0.12)
35 gw	0.09 (0.08; 0.11)	0.08 (0.05; 0.11)	0.09 (0.07; 0.10)	0.08 (0.05; 0.12)
37 gw	0.11 (0.10; 0.13)	0.10 (0.07; 0.13)	0.12 (0.10; 0.13)	0.10 (0.07; 0.13)
39 gw	0.13 (0.11; 0.15)	0.11 (0.08; 0.14)	0.14 (0.11; 0.16)	0.11 (0.07; 0.15)
41 gw	0.13 (0.10; 0.16)	0.10 (0.07; 0.14)	0.13 (0.10; 0.16)	0.11 (0.06; 0.15)
43 gw	0.11 (0.06; 0.15)	0.08 (0.00; 0.15)	0.10 (0.04; 0.15)	0.10 (0.00; 0.20)
45 gw	0.07 (-0.02; 0.17)	0.04 (-0.11; 0.19)	0.05 (-0.04; 0.15)	0.09 (-0.11; 0.29)

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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
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[1] gw= gestational weeks; MW= minimum wages (value of minimum wage in 2017: R$ 937.00); MRF= Metropolitan Region of Fortaleza.

[TFN1] ^*
Pearson’s chi-square test or Fisher’s exact test for categorical variables.