TABLE 1 Nutrition in Preterm and Low Birthweight Infants in Africa: the course developers.

Global risks of poor nutrition in LBW and premature infants

Globally more than 20 million babies (one in seven) are born low birth weight (LBW) or premature in whom the risks of death or serious disability are higher than infants born at full term. Many of these infants suffer from under-nutrition while in hospital, which increases the risk of death, resource use (including antibiotics), laboratory tests and duration of hospital stays. Under-nutrition also worsens short-term morbidities, such as sepsis, and results in poorer longer-term outcomes such as poor cognitive development or disability. Research has shown that there is a lack of high-quality education on neonatal nutrition; a precursor to further research studies.

NeoNuNet aims to improve outcomes for preterm and LBW infants by improving their nutritional care in early life. To achieve this, NeoNuNet works with health, nutrition, other allied professionals and parents to co-create new knowledge and promote best practice in neonatal nutrition in Africa and other similar contexts.

Course development and partnerships

The development of Nutrition in Preterm and Low Birthweight Infants in Africa was supported by an award from the UK Research and Innovation (UKRI) Global Challenges Research Fund (GCRF) and Newton Fund Consolidation Accounts (GNCA). A website was created to host the course (africanneonatalnutrition.net) along with other learning materials, webinars and an interactive forum (FIGURE 1). The course is a partnership between Newcastle University and Aga Khan University, Nairobi, Kenya, with input from clinicians in five other African countries. It has wide stakeholder and community involvement by partnering with professional organisations and parent-led advocacy organisations.

FIGURE 1 The interactive forum.

Membership of the African NeoNuNet is free and open to all healthcare professionals, students, and academics, although it excludes anyone working for the formula milk industry.

The course was developed by paediatricians, neonatologists and nurses who are clinical leaders in Kenya, Nigeria, The Gambia, Uganda, Zambia and Malawi. The content includes downloadable resources, references, and links to relevant national and international websites.

It is fully aligned with World Health Organization (WHO) and UNICEF policies and recommendations and includes quizzes to assess and test baseline knowledge and skills. Course production and website creation was led by Page Medical (pagemedical.co.uk).

Learning topics

The course provides evidence-based recommendations for neonatal nutrition with a focus on clinical practice in Africa. The nutritional needs of preterm and LBW infants in a hospital setting are considered alongside advice on preparation for discharge and ongoing nutritional needs. Emphasis is placed on the critical role of mother’s own breast milk to reduce mortality and improve outcomes, and the importance of kangaroo mother care. The course is broken down into five modules that each take around 40-60 minutes to complete. Each module consists of a series of steps which are made of short text summaries, graphics, interactive case studies, quizzes, etc. A brief overview of the modules and topics is provided in TABLE 2.

TABLE 2 The course modules and topics.*Nutritional assessment for use on the neonatal unit summarised as ABCDE: A=anthropometry, B=biochemistry, C=clinical, D=dietary intakes, E=environment and evaluation.

FIGURE 2 Module 1: Kangaroo mother care (KMC).

FIGURE 3 Module 3: Feeding methods – gastric residuals.

FIGURE 4 Module 4: Growth and nutrients – probiotics.

Summary

Poor nutrition in preterm and LBW infants increases the risk of death and sepsis and worsens long-term growth, metabolic and cognitive outcomes. Support for kangaroo mother care and mother’s own milk is vital, but this requires a good understanding of the principles of nutritional needs and how to provide this in clinical practice. While resources vary widely across the world, the basic principles upon which this course is founded are the same. With four hours of online learning eligible for continuing professional development (CPD), continuing medical education (CME), or continuing nurse education (CNE), the course is relevant to everyone working on neonatal units across the UK and further afield. What’s more, it is completely free…come and join us!

To find out more about the African Neonatal Nutrition Network (NeoNuNet) and take the online eLearning course, visit:

www.africanneonatalnutrition.net