1 Calcium supplementation during pregnancy for the prevention of pre-eclampsia

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1 1 Calcium supplementation during pregnancy for the prevention of pre-eclampsia 2 Cord clamping for the prevention of iron deficiency anaemia in infants: optimal timing 3 Cup-feeding for low-birth-weight infants unable to fully breastfeed 4 Daily iron and folic acid supplementation during pregnancy 5 Demand feeding for low-birthweight infants Late cord clamping for all births while initiating simultaneous essential newborn care LBW infants who need to be fed by an alternative oral feeding method should be fed by cup or spoon. Daily oral iron and folic acid recommended as part of the antenatal care. In populations where calcium intake is low, calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia among pregnant women, particularly among those at higher risk of hypertension. LBW infants who are fully or mostly fed by an alternative oral feeding method should be fed based on infants hunger cues, except when the infant remains asleep beyond 3 hours since the last feed (recommendation relevant to settings with an adequate number of health-care providers). Early cord clamping is not recommended unless the neonate is asphyxiated and needs to be moved immediately for resuscitation.

2 6 Donor human milk for low-birthweight infants 7 Feeding of low-birth-weight infants Low-birth-weight (LBW) infants, including those with very low birth weight (VLBW), should be fed mother s own milk as soon as possible after birth. LBW infants should be exclusively breastfed until 6 months of age. 8 Increasing potassium intake to control blood pressure in children 9 Increasing potassium intake to reduce blood pressure and risk of cardiovascular diseases in adults WHO suggests an increase in potassium intake from food to control blood pressure in children (conditional recommendation). The recommended potassium intake of at least 90 mmol/day should be adjusted downward for children, based on the energy requirements of children relative to those of adults. WHO recommends an increase in potassium intake from food to reduce blood pressure and risk of cardiovascular disease, stroke and coronary heart disease in adults (strong recommendation). WHO suggests a potassium intake of at least 90 mmol/day (3510 mg/day) for adults (conditional recommendation). LBW infants, including those with VLBW, who cannot be fed mother's own milk should be fed donor human milk (recommendation relevant for settings where safe and affordable milk-banking facilities are available or can be set up).

3 10 Infant feeding for the prevention of mother-to-child transmission of HIV 11 Intermittent iron and folic acid supplementation for menstruating women 12 Intermittent iron and folic acid supplementation in non-anaemic pregnant women Intermittent use of iron and folic acid supplements by non-anaemic pregnant women is recommended to prevent anaemia and improve gestational outcomes. In settings where national or sub-national authorities have decided that maternal, newborn and child health services will principally promote and support breastfeeding and ARV interventions: Mothers known to be HIV-infected (and whose infants are HIV uninfected or of unknown HIV status) should exclusively breastfeed their infants for the first 6 months of life, introducing appropriate complementary foods thereafter, and continue breastfeeding for the first 12 months of life. Breastfeeding should then only stop once a nutritionally adequate and safe diet without breast milk can be provided. Intermittent iron and folic acid recommended as a public health intervention in menstruating women living in settings where anaemia is highly prevalent, to improve their haemoglobin concentrations and iron status and reduce the risk of anaemia.

4 13 Intermittent iron supplementation in preschool and school-age children 14 Iron supplementation for children in malaria-endemic regions 15 Multiple micronutrient powders for home fortification of foods consumed by children 6 23 months of age 16 Multiple micronutrient powders for home fortification of foods consumed by pregnant women Intermittent iron recommended as a public health intervention in preschool and school-age children to improve iron status and reduce the risk of anaemia. Home fortification of foods with multiple micronutrient powders is recommended to improve iron status and reduce anaemia among infants and children 6 23 months of age. In malaria-endemic areas, the provision of iron supplements should be implemented in conjunction with adequate measures to prevent, diagnose and treat malaria. As there is currently no available evidence to directly assess the potential benefits or harms of the use of multiple micronutrient powders in pregnant women for improving maternal and infant health outcomes, routine use of this intervention during gestation is not recommended as an alternative to iron and folic acid supplementation.

5 17 Nutritional care for adults with active tuberculosis 18 Reducing sodium intake to control blood pressure in children 19 Reducing sodium intake to reduce blood pressure and risk of cardiovascular diseases in adults All individuals with active TB should receive nutrition assessment and counselling; severe acute malnutrition should be treated in accordance with the WHO recommendations; Children <5y, PLWs with active TB and patients with active MDR-TB and moderate undernutrition should be provided with locally available nutrient-rich or fortified supplementary foods, as necessary to restore normal nutritional status (strong recommendations only). WHO recommends a reduction in sodium intake to control blood pressure in children (strong recommendation). The recommended maximum level of intake of 2 g/day sodium in adults should be adjusted downward based on the energy requirements of children relative to those of adults. WHO recommends a reduction in sodium intake to reduce blood pressure and risk of cardiovascular disease, stroke and coronary heart disease in adults (strong recommendation1). WHO recommends a reduction to <2 g/day sodium (5 g/day salt) in adults (strong recommendation).

6 20 Reducing the impact of marketing of foods and non-alcoholic beverages on children 21 Standard formula for low-birthweight infants following hospital discharge 22 Treatment of dehydration in children with severe acute malnutrition 23 Treatment of severe acute malnutrition in HIV-infected children 24 Vitamin A supplementation for HIVinfected women during pregnancy 25 Vitamin A supplementation in HIVinfected infants and children 6 59 months of age LBW infants, including those with VLBW, who cannot be fed mother's own milk or donor human milk should be fed standard infant formula from the time of discharge until 6 months of age (recommendation relevant for resource-limited settings). High-dose vitamin A recommended in infants and children 6 59 months of age in settings where vitamin A deficiency is a public health problem. Vitamin A supplementation in HIV-positive pregnant women is not recommended as a public health intervention for reducing the risk of mother-tochild transmission of HIV. No GRCapproved guidelines available No GRCapproved guidelines available No GRCapproved guidelines available

7 26 Vitamin A supplementation in infants 1 5 months of age 27 Vitamin A supplementation in infants and children 6 59 months of age 28 Vitamin A supplementation in neonates 29 Vitamin A supplementation in postpartum women 30 Vitamin A supplementation in pregnant women High-dose vitamin A recommended in infants and children 6 59 months of age in settings where vitamin A deficiency is a public health problem. In areas where there is a severe public health problem related to vitamin A deficiency, vitamin A supplementation during pregnancy is recommended for the prevention of night blindness. Vitamin A supplementation in infants 1 5 months of age is not recommended as a public health intervention for the reduction of morbidity and mortality. At the present time, neonatal vitamin A supplementation (that is, supplementation within the first 28 days after birth) is not recommended as a public health intervention to reduce infant morbidity and mortality Vitamin A supplementation in postpartum women is not recommended for the prevention of maternal and infant morbidity and mortality. Vitamin A not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality.

8 31 Vitamin D supplementation during pregnancy for the prevention of pre-eclampsia 32 Vitamin D supplementation during pregnancy Vitamin D not recommended during in pregnancy to prevent the development of pre-eclampsia and its complications. In addition, due to the limited evidence currently available to directly assess the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes, the use of this intervention during pregnancy as part of routine antenatal care is also not recommended. Compiled by Dr. Oliver Hoffmann, Public Health Advisor, Johanniter International Assistance on March 17th, 2014