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Genna CW, Notarangelo M. Differentiating Normal Newborn Weight Loss From Breastfeeding Failure. CLINICAL LACTATION 2018. [DOI: 10.1891/2158-0782.9.4.183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There is increasing concern for the risk of hypernatremic dehydration in infants breastfeeding poorly. It is important to differentiate normal weight changes as infants adapt to extrauterine life from excessive weight loss from breastfeeding failure or mismanagement. We review recent data on normal weight changes in exclusively breastfeeding infants and those at risk for hypernatremic dehydration to help health professionals determine when infants require further scrutiny and supplementation. The data suggest that perinatal practices influence infant weight changes. Protecting normal birth and early initiation of breastfeeding should reduce the incidence of excessive weight loss and risk of hypernatremic dehydration
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Smith ER, Hurt L, Chowdhury R, Sinha B, Fawzi W, Edmond KM. Delayed breastfeeding initiation and infant survival: A systematic review and meta-analysis. PLoS One 2017; 12:e0180722. [PMID: 28746353 PMCID: PMC5528898 DOI: 10.1371/journal.pone.0180722] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/20/2017] [Indexed: 11/22/2022] Open
Abstract
Objective To assess the existing evidence regarding breastfeeding initiation time and infant morbidity and mortality. Study design We conducted a systematic review and meta-analysis. We searched Pubmed, Embase, Web of Science, CINAHL, Popline, LILACS, AIM, and Index Medicus to identify existing evidence. We included observational studies and randomized control trials that examined the association between breastfeeding initiation time and mortality, morbidity, or nutrition outcomes from birth through 12 months of age in a population of infants who all initiated breastfeeding. Two reviewers independently extracted data from eligible studies using a standardized form. We pooled effect estimates using fixed-effects meta-analysis. Results We pooled five studies, including 136,047 infants, which examined the association between very early breastfeeding initiation and neonatal mortality. Compared to infants who initiated breastfeeding ≤1 hour after birth, infants who initiated breastfeeding 2–23 hours after birth had a 33% greater risk of neonatal mortality (95% CI: 13–56%, I2 = 0%), and infants who initiated breastfeeding ≥24 hours after birth had a 2.19-fold greater risk of neonatal mortality (95% CI: 1.73–2.77, I2 = 33%). Among the subgroup of infants exclusively breastfed in the neonatal period, those who initiated breastfeeding ≥24 hours after birth had an 85% greater risk of neonatal mortality compared to infants who initiated <24 hours after birth (95% CI: 29–167%, I2 = 33%). Conclusions Policy frameworks and models to estimate newborn and infant survival, as well as health facility policies, should consider the potential independent effect of early breastfeeding initiation.
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Affiliation(s)
- Emily R. Smith
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
- * E-mail:
| | - Lisa Hurt
- Division of Population Medicine, Cardiff University School of Medicine, Wales, United Kingdom
| | - Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Bireshwar Sinha
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Wafaie Fawzi
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
| | - Karen M. Edmond
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
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Debes AK, Kohli A, Walker N, Edmond K, Mullany LC. Time to initiation of breastfeeding and neonatal mortality and morbidity: a systematic review. BMC Public Health 2013; 13 Suppl 3:S19. [PMID: 24564770 PMCID: PMC3847227 DOI: 10.1186/1471-2458-13-s3-s19] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Early breastfeeding is defined as the initiation of breastfeeding within twenty four hours of birth. While the benefits of breastfeeding have been known for decades, only recently has the role of time to initiation of breastfeeding in neonatal mortality and morbidity been assessed. OBJECTIVE To review the evidence for early breastfeeding initiation practices and to estimate the association between timing and neonatal outcomes. METHODS We systematically reviewed multiple databases from 1963 to 2011. Standardized abstraction tables were used and quality was assessed for each study utilizing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Three meta-analyses were conducted for mortality among babies surviving to 48 hours. RESULTS We identified 18 studies reporting a direct association between early breastfeeding initiation and neonatal mortality and morbidity outcomes. The results of random effects analyses of data from 3 studies (from 5 publications) demonstrated lower risks of all-cause neonatal mortality among all live births (RR = 0.56 [95% CI: 0.40 - 0.79]) and among low birth weight babies (RR=0.58 [95% CI: 0.43 - 0.78]), and infection-related neonatal mortality (RR = 0.55 [95% CI: 0.36 - 0.84]). Among exclusively breastfed infants, all-cause mortality risk did not differ between early and late initiators (RR = 0.69 [95% CI: 0.27 - 1.75]). CONCLUSIONS This review demonstrates that early breastfeeding initiation is a simple intervention that has the potential to significantly improve neonatal outcomes and should be universally recommended. Significant gaps in knowledge are highlighted, revealing a need to prioritize additional high quality studies that further clarify the specific cause of death, as well as providing improved understanding of the independent or combined effects of early initiation and breastfeeding patterns.
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Affiliation(s)
- Amanda K Debes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anjalee Kohli
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Neff Walker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karen Edmond
- School of Pediatrics and Child Health, University of Western Australia, Crawley, WA, Australia
| | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Rijken MJ, Rijken JA, Papageorghiou AT, Kennedy SH, Visser GHA, Nosten F, McGready R. Malaria in pregnancy: the difficulties in measuring birthweight. BJOG 2011; 118:671-8. [PMID: 21332632 PMCID: PMC3118281 DOI: 10.1111/j.1471-0528.2010.02880.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recommendations for interventions to control malaria in pregnancy are often based on studies using birthweight as the primary endpoint. Differences in birthweight may be attributable partly to methodological difficulties. We performed a structured search of the literature using ‘malaria’, ‘pregnancy’ and ‘birth weight’ as search terms. Of the clinical trials reporting birthweight, only 33% (14/43) gave information about the timing of the measurement and details on the scales used. Seventy seven per cent explained how gestational age was estimated. We propose a standardised method for the measurement and reporting of birthweight in future studies.
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Affiliation(s)
- M J Rijken
- Shoklo Malaria Research Unit, Mae Sot, Tak, Thailand.
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Okumus N, Atalay Y, Onal EE, Turkyilmaz C, Senel S, Gunaydin B, Pasaoglu H, Koc E, Ergenekon E, Unal S. The effects of delivery route and anesthesia type on early postnatal weight loss in newborns: the role of vasoactive hormones. J Pediatr Endocrinol Metab 2011; 24:45-50. [PMID: 21528814 DOI: 10.1515/jpem.2011.109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the effects of delivery route and maternal anesthesia type and the roles of vasoactive hormones on early postnatal weight loss in term newborns. METHODS Ninety-four term infants delivered vaginally (group 1, n=31), cesarean section (C/S) with general anesthesia (GA) (group 2, n=29), and C/S with epidural anesthesia (EA) (group 3, n=34) were included in this study. All infants were weighed at birth and on the second day of life and intravenous (IV) fluid infused to the mothers for the last 6 h prior to delivery was recorded. Serum electrolytes, osmolality, N-terminal proANP (NT-proANP), brain natriuretic peptide (BNP), aldosterone and plasma antidiuretic hormone (ADH) concentrations were measured at cord blood and on the second day of life. RESULTS Our research showed that postnatal weight loss of infants was higher in C/S than vaginal deliveries (5.7% vs. 1.3%) (p < 0.0001) and in EA group than GA group (6.8% vs. 4.3%) (p < 0.0001). Postnatal weight losses were correlated with IV fluid volume infused to the mothers for the last 6 h prior to delivery (R = 0.814, p = 0.000) and with serum NT-proANP (R = 0.418, p = 0.000), BNP (R = 0.454, p = 0.000), and ADH (R = 0.509, p = 0.000) but not with aldosterone concentrations (p > 0.05). CONCLUSION Large amounts of IV fluid given to the mothers who were applied EA prior to the delivery affect their offsprings' postnatal weight loss via certain vasoactive hormones.
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Affiliation(s)
- Nurullah Okumus
- Division of Neonatology, Department of Pediatrics, Ankara, Turkey
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Sloan NL, Ahmed S, Mitra SN, Choudhury N, Chowdhury M, Rob U, Winikoff B. Community-based kangaroo mother care to prevent neonatal and infant mortality: a randomized, controlled cluster trial. Pediatrics 2008; 121:e1047-59. [PMID: 18450847 DOI: 10.1542/peds.2007-0076] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We adapted kangaroo mother care for immediate postnatal community-based application in rural Bangladesh, where the incidence of home delivery, low birth weight, and neonatal and infant mortality is high and neonatal intensive care is unavailable. This trial tested whether community-based kangaroo mother care reduces the overall neonatal mortality rate by 27.5%, infant mortality rate by 25%, and low birth weight neonatal mortality rate by 30%. METHODS Half of 42 unions in 2 Bangladesh divisions with the highest infant mortality rates were randomly assigned to community-based kangaroo mother care, and half were not. One village per union was randomly selected proportionate to union population size. A baseline survey of 39,888 eligible consenting women collected sociodemographic information. Community-based workers were taught to teach community-based kangaroo mother care to all expectant and postpartum women in the intervention villages. A total of 4165 live births were identified and enrolled. Newborns were followed for 30 to 45 days and infants were followed quarterly through their first birthday to record infant care, feeding, growth, health, and vital status. RESULTS Forty percent overall and approximately 65% of newborns who died were not weighed at birth, and missing birth weight was differential by study group. There was no difference in overall neonatal mortality rate or infant mortality rate. Except for care seeking, community-based kangaroo mother care behaviors were more common in the intervention than control group, but implementation was weak compared with the pilot study. CONCLUSIONS The extensive missing birth weight and its potential bias render the evidence insufficient to justify implementing community-based kangaroo mother care. Additional experimental research ensuring baseline comparability of mortality, adequate kangaroo mother care implementation, and birth weight assessment is necessary to clarify the effect of community-based kangaroo mother care on survival.
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Affiliation(s)
- Nancy L Sloan
- Department of Epidemiology, Columbia University, Mailman School of Public Health, 722 West 168th St, New York, NY 10032, USA.
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Abstract
BACKGROUND Midwives once used serial weighing to highlight lactation problems, but this is now discouraged for the fear of undermining maternal confidence. AIM To explore weight changes in healthy newborn term babies, to gain information to aid interpretation of such measurements and to construct a centile chart for those exclusively breastfed during the first 2 weeks. METHOD Two hundred ninety-nine mothers weighed their baby daily using the same electronic scales. In 46 cases, three or more consecutive measurements were omitted leaving 253 series to evaluate, of which 111 were exclusively breastfed. RESULTS Breastfed babies lost a mean 6.4% of birthweight (95% CI: 5.5-7.3%) before starting to gain, and 54% took more than 8 days to regain birthweight. Artificially fed babies lost less (3.7%, 95% CI: 2.7-4.7%), but 39% had not regained their birthweight by 8 days. Once birthweight was regained, average gain was about 1% of birthweight per day in both breast- and artificially-fed babies. Measurements less than 5 days apart predicted average weight gain poorly. CONCLUSIONS Feeding problems should be considered if weight is not increasing by 6 days, but some healthy babies take 17 days to regain their birthweight.
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Affiliation(s)
- D S Crossland
- Maternity Department, Sunderland Royal Hospital, Kayll Road, Sunderland, SR4 7TP UK
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Mullany LC, Darmstadt GL, Katz J, Khatry SK, Tielsch JM. Effect of instrument precision on estimation of low birth weight prevalence. J Perinatol 2005; 25:11-3. [PMID: 15496868 PMCID: PMC1317297 DOI: 10.1038/sj.jp.7211209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Reductions in prevalence of low birth weight (LBW) are likely to be achieved only through small increments, amplifying the importance of precision of measurement. This study compared two instruments for measuring birth weight to investigate the effect of instrument precision on estimates of LBW prevalence. STUDY DESIGN Analysis was based on 497 infants born to mothers enrolled in an ongoing community-based trial of the effect of umbilical cord and skin antisepsis on neonatal mortality in Nepal. For each child, two birth weight measurements were recorded within 72 hours after delivery using weighing scales of differing precisions (100 vs 2 g). RESULTS While continuous measures between the two instruments were similar, the prevalence of LBW among lower precision measurements (30%) was 11.3% lower than for higher precision measurements (34%). The difference in precision between the instruments accounted for 96% of the difference in LBW prevalence estimates. CONCLUSIONS Differences in estimated LBW rates may be entirely due to differences in instrument precision. Conclusions concerning programmatic or research intervention impact, or comparisons of rates across populations should consider the effect of instrument precision on estimates of LBW.
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Affiliation(s)
- Luke C Mullany
- Department of International Health, Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Wright CM, Parkinson KN. Postnatal weight loss in term infants: what is normal and do growth charts allow for it? Arch Dis Child Fetal Neonatal Ed 2004; 89:F254-7. [PMID: 15102731 PMCID: PMC1721692 DOI: 10.1136/adc.2003.026906] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Although it is a well known phenomenon, limited normative data on neonatal weight loss and subsequent gain are available, making it hard to assess individual children with prolonged weight loss. OBJECTIVE To establish, using data from a large prospective population based cohort study, norms and limits for postnatal weight loss and its impact on current growth reference charts. METHOD A cohort of 961 term infants were recruited at birth and followed using parental questionnaires and community nursing returns. Routine weights were collected for half the cohort at 5 days and for all at 12 days and 6 weeks. RESULTS Less weight loss was seen than the 3-6% suggested by previous studies, but one in five infants had not regained their birth weight by 12 days. Those lightest at birth showed least weight loss. Twenty six (3%) children had more than 10% weight loss, but none showed evidence of major organic disease. Actual weights in the first fortnight are half to one centile space lower than growth charts suggest, while birthweight centiles for children born at 37 weeks were two centile spaces lower. CONCLUSIONS Neonatal weight loss is brief, with few children remaining more than 10% below birth weight after 5 days. Growth charts are misleading in the first 2 weeks, because they make no allowance for neonatal weight loss.
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Affiliation(s)
- C M Wright
- Department of Child Health, University of Newcastle upon Tyne, Newcastle upon Tyne, UK.
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Jolly PE, Humphrey M, Irons BY, Campbell-Forrester S, Weiss HL. Breast-feeding and weight change in newborns in Jamaica. Child Care Health Dev 2000; 26:17-27. [PMID: 10696515 DOI: 10.1046/j.1365-2214.2000.00103.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study was conducted to examine weight change of exclusively breast-fed infants during the first week and through the first 24 days of life, and to evaluate the effect of breast-feeding factors and maternal characteristics on early weight change in the infants. The weights of 21 infants were recorded on day 1 (day of birth), and on days 3, 7, 10, 17, and 24, and the data analysed to evaluate weight change over the period. Multiple regression analysis was used to assess whether birth weight as well as maternal and breast-feeding factors were significant predictors of weight on day 24. Nineteen of the 21 infants gained weight between days 1 and 3, and 20 infants gained weight between days 3 and 7. All infants gained weight over the 24-day period and their weights at day 7 and day 24 were significantly different (P < 0.05 and P < 0.01, respectively) from their birth weights. Multiple linear regression analysis showed that significant (P < 0.01) predictors of weight gain by day 24 included birth weight, mother's educational level, whether the baby cried before feeding, and length of feeding time periods. This is the first study of weight change in the early days and weeks of life of exclusively breast-fed newborn infants in Jamaica. The infants showed significant weight gain during the study period and weight gain was affected by certain maternal and breast-feeding factors.
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Affiliation(s)
- P E Jolly
- Department of International Health, School of Public Health, University of Alabama at Birmingham 35294-0022, USA
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Abstract
The degree of neonatal weight loss and the time required for a newborn to regain birth-weight vary between different populations. It has been suggested that co-sleeping, the sharing of a single bed by mother and baby, might be an important factor in determining the neonatal weight change. In a rural setting in central Africa, 203 mother-baby pairs were studied. For 101 babies cared for in cribs and for 102 babies who shared their mothers' beds, sleeping location was associated with no significant difference either in the weight loss (6.3% for each group) or the time taken to regain birthweight (5.3 days for crib-cared babies and 5.4 days for co-sleepers). It is concluded that co-sleeping does not play a major role in determining the neonatal weight change.
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Affiliation(s)
- P R Fischer
- Evangelical Medical Centre, Nyankunde, Zaire
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