Comparison of Growth Pattern in Neonates on Breast Feed Versus Formula Feed REsEaRCH

Methods: This study was done in the Department of Pediatrics, King Edward Medical University, Mayo Hospital, Lahore from 2015 July to 2016 July as cross sectional study. The Non Probability purposive sampling technique was used. Information on type of feeding was obtained from mothers. Subsequently neonates were divided in two groups on the basis of type of feeding (i.e. breast feeding or formula feeding).


iNtRoDUCtioN
Breast milk and colostrums are the first feeding sources of infant, providing nutrients, growth factors and immunological components, which are crucial for the newborn's optimum development and health.Duration of exclusive breast feeding & time of introduction of solid foods is a key factor that may influence allergy development. 1east feeding is one of most effective ways to ensure child health & survival.Failure to breast feed during the 1st 6-months of life contributes to MED PHoEnix : An Official Journal of NMC, Birgunj, Nepal, Volume (2), Issue (1) July 2017, 18-23 over a million preventable child death each year.There are well established benefits to the mother and to the child's growth, mental development and immunological system. 2 The WHO recommends that an infant should be exclusively breast fed for the six months and then continued breast feeding for two years with supplemental foods.Globally less than 40% of infants less than six months of age are exclusively breast fed.Increasing this rate can be achieved by improving breast feeding support for mothers and families. 2e incidence of breast feeding has recently been found to be 81% in the London UK (an increase from 76% in 2005).The incidence of breast feeding was only 62% in 1990. 3The incidence of Exclusive breast feeding in Pakistan was reported by about 54% of the mothers. 4eastfeeding, also known as nursing, is the feeding of babies or young children with milk from the female breast. 7Breastfeeding should be started during the hour after birth and allowed as the baby wishes. 8During the first few weeks of life babies may nurse eight to twelve times a day.The duration of a feeding is usually ten to fifteen minutes on each breast.The frequency of feeding decreases as the child gets older. 9Some mothers pump milk so that it can be used later when their child is being cared for by others.Breastfeeding benefits both mother and baby.Infant formula does not have many of the benefits. 10 is estimated that greater than a million babies could be saved globally per year through greater breastfeeding.Breastfeeding decreases the risk of respiratory tract infections and diarrhea.This is true both in developing and developed countries.Other benefits include a lower risk of asthma, food allergies, celiac disease, type-1 diabetes and leukemia.Breastfeeding may also decrease the risk of obesity in adulthood and improved cognitive development. 7nefits of breastfeeding for the mother include less blood loss following delivery, better uterus shrinkage, weight loss and less postpartum depression.It also increases the time before menstruation and fertility returns, known as lactational amenorrhea.Long term benefits may include a decreased risk of breast cancer, cardiovascular disease and rheumatoid arthritis.Breastfeeding is less expensive for the family than infant formula. 11alth groups, such as World Health Organization (WHO), support six months of exclusive breastfeeding.12 This means that no other foods (other than vitamin) D are typically given.Continued partial breastfeeding until at least a year of age is recommended.Globally about 38% of infants are just breastfed during their first six months of life In the United States about 75% of women begin breastfeeding and about 43% breastfed until six months. Meical conditions that do not allow breastfeeding are uncommon.During breastfeeding drugs and certain medications are not recommended.12 But a study found that there is no significant difference (p>0.05) between infants either on breast feed or formula feed in their length and weight (breast feed: Weight = 6835.5±782gramsand Length = 63.85±2.35cms vs. formula feed: Weight = 6922±703grams and Length = 63.9±1.6cms).The growth was slightly better in formula feeding during first 6 months of life.5 But another study also found that there are infants on breast feed have better weight gain (6712±626.5grams)as compared to infants on formula feeding (6356±667grams), moreover, the length was also greater with breast feeding (i.e.63.15±2.14cms of breast feed infants vs. 62.45±2.33 cms of formula feed infants, p<0.05).6 The rationale of my study is to determine the frequency of exclusive breast feeding and growth pattern of neonates presenting in Department of Pediatrics, King Edward Medical University, Mayo Hospital, Lahore of a tertiary care hospital.Infant formula is the only alternative to breast milk. It available in cartons or as powder to be made up as directed.But mother feed is better in all means.So we conducted this study to assess the growth pattern of infants in local population who are on either formula feed or breast feed.

Operational Definition
Breast Fed: It was defined as neonate on exclusively mother feed / breast feeding.Formula Fed: It was defined as neonate on bottle feed or formula feed.

Exclusion Criteria
Children having congenital heart diseases, tracheoesophageal fistula, cleft lip, cleft palate or with visible congenital deformity assessed through general physical examination, twin birth (on history),LBW (birth weight<2500grams) on birth card, Sick babies (on clinical examination), Infants on exclusive breast feeding at start of study converted on bottle/formula feeding due to environmental circumstances like mother's health is not fit or she has conceived again and change in breast feeding practice (exclusive breast feeding/ formula feeding) during the follow-up period.
Data CollECtioN PRoCEDURE 400 neonates fulfilling inclusion criteria were enrolled from Department of Pediatrics, King Edward Medical University, Mayo Hospital, Lahore.A verbal consent was obtained from their parents & ensuring confidentiality.Demographic variables (name, age, gestational age at birth, contact number) were also obtained.Feeding information was obtained from mothers.Then neonates were divided in two groups on the basis of type of feeding (i.e.breast feeding or formula feeding).Weight of neonate was measured by digital weighing scale.Neonate's length was measured (cms) using an infantometer.The mothers were advised to visit Department of Pediatrics, King Edward Medical University, Mayo Hospital, Lahore, regularly till 4 months.Then again Weight and Length of infant was measured.

Data aNalysis PRoCEDURE
The data collected was analyzed by statistical program SPSS Version 18. Quantitative variables like age, gestational age, weight and length at time of first presentation and after 4 months was presented as mean and standard deviation.Qualitative variables like gender were presented as frequency and percentage.Both groups were compared by using t-test.p<0.05 was taken as significant.Chi-square test was applied.P-value <0.05 was considered as significant.

REsUlts
In present study, total 400 cases were enrolled.The mean age of the cases was 16.56±6.26days with age range 7 to 27 days.57% patients were males and 43% patients were females (M:F ratio 1.3:1).

Figure 1 : Sex distribution of Study cases
The results showed that the mean weight of the study cases at 28 th day was 3244.75±445.75 grams; at 6 th week the mean weight was 4745.00±853.99 grams and at 10 th week the mean weight was 6428.75±1329.93grams, the mean weight at 14 th week was 6428.75±1329.93grams and at 4 th month the mean weight was 7372.50±1274.38grams.groups at follow up at 28 th day, 6 th , 10 th , 14 th week and 4 th months (p-value=0.81,0.41, 0.41, 0.12, 0.12 respectively).

DisCUssioN
This cross sectional survey was done determine the frequency of neonates on exclusively breast feeding and compare the growth in terms of length gain and weight gain between breast fed and formula fed infants.
According to our study results in their growth of weight at 10 th , 14 th week & 4 th month there is significant difference was found between the breast fed and formula fed baby.The greater weight was observed in breast fed infants than in formula fed infants.The mean weight in breast fed patients at 4th month was 7825.36±1251.68gmsand in formula fed infants it was 6876.96±1105.86gms i.e. p-value=0.000.
Our study results showed no difference among length of babies between the breast fed and formula fed infants.On 4 th month in breast fed infants the mean baby length of the patients was 64.46±0.86cmsand in formula fed it was 64.59±0.88cmsi.e. p-value=0.12.
Agostoni, et al. concluded in their study that the growth pattern of breast fed and formula fed Italian infants differs in the first 12 months of life.Growth indices in breast fed groups was high at birth and closer than expected to the reference at 12 months, may reflect differences in genetic factors, intrauterine conditions, or both. 6n contrary a study by Ahmed, et al. showed that no statistical significant differences between the weight, length, head, and chest circumference to breast-fed and artificially fed infants during the second visit as regards to all anthropometric measurements. 14study found that there is no significant difference (p>0.05) between infants either on breast feed or formula feed in their length and weight (breast feed: Weight = 6835.5±782grams and Length = 63.85±2.35cms vs. formula feed: Weight = 6922±703 grams and Length = 63.9±1.6 cms).The growth was slightly better in formula feeding during first 6 months of life .5But another study also found that there is infants on breast feed have better weight gain (6712±626.5grams) as compared to infants on formula feeding (6356±667 grams), moreover, the length was also greater with breast feeding (i.e.63.15±2.14cms of breast feed infants vs. 62.45±2.33 cms of formula feed infants, p<0.05). 6ne study in Menoufia, Egypt reported that the infants who were exclusively breast-fed lost 14 percentiles of weight for age from birth to 6 months while those who were exclusively formula fed lost 18 percentiles. 15wey showed in their study that there is no significant difference in linear growth between feeding groups.Growth in head circumference does not differ by feeding mode.Because of the difference in weight gain, breast-fed infants are generally leaner than formula-fed infants by 12 months of age.Evidence to date suggests that there are no apparent adverse consequences associated with the lower intake and slower weight gain of breast-fed infants: compared to formula-fed infants. 16egler, et al. demonstrated in their study that during the first 6-8 weeks of life there was little difference in growth (gain in weight and length) between breast-and formula-fed infants.
However, from about 2 months of age to the end of the first year of life formula-fed infants gain weight and length more rapidly than breastfed infants.There are no consistent differences in adiposity during the first 4-5 months of life, but during the later part of the first year of life the preponderance of the evidence suggests that breast-fed infants are leaner than formula-fed infants. 17 our study breast fed infants were 52.25% while the formula fed infants were 47.75%.Some of the studies discussed here showing the incidence of breast fed infants.In 2010, HHS released Healthy People 2020, which provides updated national breastfeeding objectives for 2020, The exclusively Breastfed infants at 3 months were 46.2%, and who are exclusively breastfed at 6 months to 25.5% ever breastfed to 81.9%, who are breastfed at 6 months to 60.6%, who are breastfed at 12 months to 34.1%. 18i, et al. showed in their study that trend data suggest the prevalence of exclusive breastfeeding among infants younger than six months in developing countries increased from 33% in 1995 to 39% in 2010.The prevalence increased in almost all regions in the developing world, with the biggest improvement seen in West and Central Africa. 19

CoNClUsioN
The prevalence of exclusively breast fed infants in our study was 52.3%.Our study results showed that the breast fed infants had better weight gain than formula fed infants; however no statistically significant difference was observed in the average length on breast fed and formula fed infants.
Weight: It was measured as increase in weight of baby from baseline till 4 months of age in terms of grams measured by digital weighing scale.

Group a= Breast feed Group B= Formula feed In
group A, the mean length at 28 th day was 51.57±0.86cm compared to group B (51.55±0.86cm).The mean length of study cases on 6 th week in group A was 55.88±1.73cm and in group B 56.02±1.69cm.The mean length of study cases on 10 th week in group A was 59.88±1.73cm and in group B 60.02±1.69cm.The mean length of study cases on 14 th week in group A was 62.46±0.85cms and in group B 62.59±0.89cm.Similarly at 4 th month in group A the mean length was 64.46±0.86cm and in group B 64.59±0.88cm.Statistically there was no significant difference between the mean lengths of study Neonates on Breast Feed MED PHoEnix : An Official Journal of NMC, Birgunj, Nepal, Volume (2), Issue (1) July 2017, 18-23