Hrev_master Healthcare in Low-resource Settings 2024; volume 12:13012 Various interventions during follow-up care of low birth weight infants: a scoping review Riri Novayelinda,1,2 Yeni Rustina,1 Rr. Tutik Sri Haryanti,1 Fajar Tri Waluyanti1 1Faculty of Nursing, Universitas Indonesia, Depok, West Java; 2Faculty of Nursing, Universitas Riau, Pekan Baru, Riau, Indonesia Abstract Low Birth Weight (LBW) infants require special attention due to the higher risk of death and disease compare to normal weight infants. Follow-up care is a strategy to monitor the growth and development of LBW infants after discharge from hospital. The aim of this literature review is to identify various interventions that are often performed dur- ing follow-up care to help the growth and development of LBW. This scoping review conducted through search using five databases namely PubMed, Proquest, EMBASE, Medline and SAGE, from 2018 to 2023 were search. The review followed the PRISMA using PICOs guideline and restricted from 2018-2023., In total 1071 articles were retrieved and total six articles were meet inclusion criteria and reviewed.The review identified the most common interventions as: education and interventions related to breastfeeding, education related to infant growth and development and infant growth monitoring. While the type of intervention was mostly carried out through home visits and carried out by nurses. This study suggests that it is necessary to conduct research related to follow-up care carried out by nurses in many countries. Introduction Low Birth Weight (LBW) infant refers to a baby born weigh- ing less than 2500 grams. LBW can result from premature deliv- ery, restricted fetal growth, or a combination of both factors.1,2 Globally, the prevalence of LBW is approximately 15%, with Southeast Asia and Oceania reporting rates of around 12.2%.3 Based on the Indonesian Nutritional Status Survey in 2021, Indonesia’s LBW incidence rate is 6.6%.4,5 Although this rate is lower than the LBW prevalence in Southeast Asia, LBW con- tributes the most to neonatal mortality. Indonesia’s health profile shows that about 35% of neonate deaths are caused by LBW.5 LBW conditions cause infants to have a risk of experiencing health problems such as temperature imbalances,6,7 hypoglycemia, dehydration, sepsis, apnea.6,8 LBW are also at risk for recurrent care,8 and failure in breastfeeding.8–10 The development of the cur- rent health economy and technology can increase the life expectancy of LBW infants.11 However, the condition of LBW can increase the risk of future health problems such as diabetes melli- tus,12 cardiovascular disease,12,13 kidney problems,13 motor devel- opment problems.14 LBW also has a risk of stunting in toddler- hood.1,15–17 Medical advancements have enhanced outcomes for low birth weight infants, but continuous support and monitoring remain essential to address both immediate and long-term chal- lenges. Various interventions have been developed to prevent the problem of LBW infants in the future, including nutritional inter- ventions,18 breastfeeding support,19 developmental stimulation,8 and parental support.20,21 Interventions for LBW infants and fami- lies are provided in various forms such as home visits22 and com- munity support.23 Follow-up care is strategy to monitor the growth and develop- ment of LBW after discharge from hospital.24 This activity involves various professions including pediatricians, doctors, nurses, physiotherapy, speech therapy, occupational therapy, psy- chologists, social workers and other related professions who work together to assess, identify and refer as needed.25 Some countries have incorporated follow-up care services into their health care system such as Canada,24 Iran,26 and South Korea.27. Although follow-up care for LBW has been widely prac- ticed in developed countries, in Indonesia this program continues to pose significant challenges.As a developing country, Indonesia still has a high incidence of LBW.Therefore, there needs to be more attention to the follow-up care program for LBW in Indonesia. A scoping review on follow-up care for LBW can pro- vide useful information in designing appropriate and effective fol- low-up care programs for LBW infants. This scoping review aims to identify interventions performed during follow-up care and Correspondence: Riri Novayelinda, Pediatric Nursing Department, Faculty of Nursing, Universitas Riau, Pekan Baru, Riau, Indonesia E-mail: riri.novayelinda@lecturer.unri.ac.id Key word: follow-up care, low birth weight, intervention. Contribution: RN, conceptualization, data collection, data analysis, writ- ing – original draft, review, and editing; YR, RTSH, FTW work concept, supervision, validation, and review the article. Availability of data and material: all data generated or analyzed during this study are included in this published article. Conflict of interest: the authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding: this study did not receive any specific grant from funding agen- cies in the public, commercial, or not-for-profit sector. Conference presentation: this work was presented at the 3rd International Nursing Scholar Congress 2023, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia. Acknowledgements: we thank all those who participated in this research. Received: 4 September 2024. Accepted: 4 September 2024. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2024 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2024; 12:13012 doi:10.4081/hls.2024.13012 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organi- zations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. [Healthcare in Low-resource Settings 2024;12:13012] [page 724] Non -co mmerc ial us e o nly their benefits for the growth and development of LBWs infant and their parents. Materials and Methods This scoping review used the PRISMA Extension for Scoping Review (PRISMA-ScR) and Joana Briggs Institute for scoping reviews. The protocol of the reviews was not registered anywhere. Article selection criteria Articles were selected using the PICOs method: Population (P) Low birth weight infants with birth weight less than or equal to 2500mg who were recruited into the study sample while in the neonate care unit; Intervention (I) getting follow-up care after the hospital; Compare (C) comparingwith other interventions;Outcome (O): the study reports at least one of the following effects: breast- feeding practices, child growth,child development, child morbidity, stress in people; Study (S) the research used is Randomized Controlled Trial (RCT), Cohort and Experiment. The exclusion criteria of this review are studies that do not involve health workers in conducting interventions, studies that involve medical interventions such as drugs, intravenous therapy and micronutrient administration such as fortified milk, additional fat and others, studies published not inEnglish, studies published in the form of research protocols and non-human research subjects. Search strategy The search process was conducted in five electronic databases namely PubMed, Proquest, EMBASE, Medline (viaEBSCOhost) and SAGE from 2018 to 2023. We used “follow-up”, “post dis- charge”, “following discharge”, “discharge”, “aftercare”, “post hospital care”, “after care”, “aftercare”, “interventions or strategies or best practices”, “low birth weight infant”, “low birth weight”/exp. The search was conducted using Boolean using a combination of keywords. All of the article must be written in English. Data extraction and synthesis The search results from the five databases were transferred to Endnote for storage and identification of initial data duplication. From EndNote, it was then transferred to the Rayyan.ai web-based application to identify duplicates and screen titles and abstracts.28 The initial screening process was carried out by identifying titles and abstracts with the criteria of containing the LBW population and is a type of RCT, Clinical trial, Cohort and experimental research with one of the outcomes of growth, child development, breastfeeding practices, stress on parents will be included in the research to be screened. Data analysis This review aims to identify various interventions used in fol- low-up care for LBW infants. Data analysis using narrative review by displaying information from articles related to the year, purpose and method of the intervention used and the results obtained. Results In total, 1070 articles were identified, 59 articles were discard- ed due to duplication with other articles and two articles were dis- carded automatically by the application. The flow of article selec- tionis displayed in the form of a PRISMA flowchart (Figure 1). At the final stage, six articles were eligible to proceed to the review stage. Article characteristics The six articles that entered the review stage consisted of arti- cles with RCT methods (4 articles), quasi-experiments (1 article) and retrospective cohortmethods (1 article). The number of samples in each article ranged from 42 to 355 LBW infants, which were divided into two groups: experimental/special care group and stan- dard care group. The total sample of all articles was 614 infants divided into 279 infants in the intervention/specialized care group and 335 infants in the standard care group. Only the cohort articles had samples above 100 infants in each group. Three articles had a sample of infants weighing less than orequal to 1500 grams (534 infants in total). Four studies were from the Asian continent and two studies were from the Americas. All samples were recruited during hospitalization.All studies described the typeof intervention applied to the infants in detail, but only three studies described the type of measures used in the control or standard care group. An overview of the selected articles can be seen in Supplementary Table 1. The identification of interventions in the reviewed articles identified two interventions that were most commonly provided, namely: education and interventions related to breastfeeding, edu- cation related to infant growth and development and infant growth monitoring. While the type of intervention was mostly carried out through home visits and carried out by nurses. An overview of the follow-up care interventions carried out can be seen in Supplementary Table 2. Lactation education Five studies provided lactation education as part of follow-up care.22,24,26,29,30 All three studies received lactation education mate- rials at the hospital and continued after discharge.22,26,29 Two stud- ies conducted the activity during home visits and two studies con- Article Figure 1. Prisma flowchart. [page 725] [Healthcare in Low-resource Settings 2024;12:13012] Non -co mmerc ial us e o nly ducted lactation education with the help of compact disk, and booklets and when mothers visited the follow-up clinic or during home visits.22,24,26,29 Two studies the control group continued to receive routine services from the follow-up clinic.22,24 Three stud- ies found that there was a significant association between the fol- low-up program and breastfeeding practices.24,26,29 Retrospective cohort study conducted by nurses on breastfeeding practices after discharge from hospital. In this study, home visiting activities were carried out within the first 48 hours after the baby was discharged from the hospital and the results were measured at the time of the first visit, while in a study conducted in Iran both groups received the same lactation intervention, but the intervention group received longer education time and received educationalmedia in the form of booklets and CDs than the control group. Interestingly, interven- tion during follow-up care activities is carried out by nurses from the health clinic as the main follow-up intervention provider. Growth and development education All articles in this review provide education on infant growth and development. Topics provided include early intervention pro- grams based on developmental stages to anticipate motor skills that must be mastered by LBW according to age,22 education about ideal weight gain for LBW infant growth and development support tailored to the needs of the mother and stimulation activities to stimulate gross motor and sensory stimulation.24,26,27 Of the four studies, only the study conducted by Youn, et al was conducted when the babywas 3-6 months old and was conducted by physio- therapy.27 Two studies did not find a significant relationship between follow-up care interventions with either growth or infant development.22,24,27 Only the study identified the effect of interven- tion on LBW infants.26 Growth monitoring Growth monitoring activities were carried out in follow-up care activities in all four studies. The timing of growth monitoring varied from day 14/15 and day 60 and according to the needs of the baby according to the schedule of visits in the first 4 months.24,26 Other articles did not provide information on the timing of growth monitoring.Growthmonitoring activitiesweremostlyperformed by nurses and were done either in the clinic or during home vis- its.22,24,26 Home visit by nurse The home visit method is a method that is widely used in fol- low-up interventions for LBW. Two studies combined the home visit method with a visit to the follow-up clinic.22,24,27 The home visit activities carried out varied from 4 visits since discharge from the hospital until the baby was 2 months old,27 10 home visits,22 and based on family needs until the baby was 4 months old.24 Nurses were the most commonly appointed health workers to con- duct home visits.24,27 Discussion LBW remains at risk after hospital discharge. LBW often fac- ing respiratory issues, feeding difficulties, developmental delays, and may need surgery during their first year.24 Follow-up care is crucial for these vulnerable infants, as it allows healthcare providers to closely monitor their progress, address emerging health issues, and ensure that they receive the necessary interven- tions. Regular check-ups and specialized care can help manage and reduce the risks of complications, supporting the infant’s develop- ment and overall well-being throughout their first year and beyond.24,25 Based on the search results from the five databases, research on the effectiveness of follow-up care interventions for LBW and parents in the last five years is still limited. During the search process the typesof articles found were mostly focused on premature babies, even though low birth weight babies are also at risk for disease and feeding problems compared to normal weight babies.10 Unfortunately, based on the literature search process, the number of studies that discuss this topic is limited, so more research needs to be done on the effects of this intervention. Based on the literature search, only two studies have shown a significant effect of the follow-up care intervention on breastfeed- ing practices and weight gain of LBW infants.24,26 Meanwhile, the effect of follow-up care interventions on the development of LBW and stress in parents has not been successfully established.22,27 This may be due to the small number of samples in the study and because the assessment method was too long. In addition, the com- parison groups in these two studies also received standardized interventions on follow-up care at the clinic, so that this process would certainly affect the results in the comparison group. Both countries in the intervention have made follow-up care as part of the policy in the management of LBW after hospitalization. Indonesia has not yet made follow-up care activities part of the services that LBW will receive after hospitalization. It would be interesting if relatedresearch. Follow-up care is implemented and its effect on the development and health of LBW in the future is identified. This review found that educational materials related to breast- feeding and the growth and development of LBW were the most widely used interventions in follow-up care programs. Lactation interventions benefit not only the breastfeeding practices of LBW but also have a positive effect on neonate weight gain.26 Unfortunately, the sample size of this study was limited, and the long-term effect of this intervention is still questionable. Nurses and home interventions were the most widely used intervention models in the reviewed studies. In the home context, nurses have an important role to play in providing guidance and support to families, especially mothers, for daily living care, and these professionals should ensure individualized and continuous care tailored to the specific needs of the family. Nursing actions in the home context involve evaluation, guidance, demonstration, clarification, referral, and stimulation for follow-up with special- ists.It also includes facilitating family empowerment and gradual autonomy of care.27 Nurses can help parents understand the health care system and connect them with community resources for sup- port. This review has limitations, including that the included stud- ies varied from various countries and with various population set- tings and various types of interventions. The studies included a range of research designs, such as RCTs, cohort studies, and quasi- experimental designs, making it difficult to generalize the results obtained. The diversity of the population and the timing of the assessment of the results also affects the results in the study. It is recommended thatin the future articles should be limited to the last 10 years and the time of outcome assessment should be standard- ized. In Indonesia, follow-up care for Low Birth Weight (LBW) infants is often inadequate, leading to delayed detection of health issues and insufficient support. To address this, a structured fol- low-up program is needed, including regular check-ups, nutritional assessments, and developmental screenings. Nurses play a crucial role in this process, providing essential monitoring, support, and education for families. Strengthening coordination between pri- mary and specialized care, standardizing monitoring protocols, and Article [Healthcare in Low-resource Settings 2024;12:13012] [page 726] Non -co mmerc ial us e o nly enhancing training for healthcare providers, including nurses, are key recommendations to improve outcomes for LBW infants. Conclusions Follow-up care interventions need to be developed to improve the life expectancy and quality of life of LBW. This review found that lactation education, growth and development education and growth and development monitoring were the most commonly provided services. Health workers who play a role in follow-up care interventions are nurses using the home visit method. 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Syst Article [page 727] [Healthcare in Low-resource Settings 2024;12:13012] Non -co mmerc ial us e o nly Rev 2016;5:210. 29. Sinha B, Taneja S, Chowdhury R, Mazumder S, et al. Low-birthweight infants born to short-stature mothers are at additional risk of stunting and poor growth velocity: evidence from secondary data analyses. Matern Child Nutr 2017;14:e12504. 30. Asadian S, Talakub S, Sadeghnia A, Golchin M. Effect of development-based care programs by mothers on growth indices of infants with low birth weight. Iranian J Neonatology 2019;10:81–7. Article [Healthcare in Low-resource Settings 2024;12:13012] [page 728] Online Supplementary Materials Table 1. Characteristics and description of articles included in the review. Table 2. Overview follow-up care activities. Non -co mmerc ial us e o nly