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Ginsburg AS, Jehan F, Ariff S, Nisar MI, Schaefer E, Flaherman V, Shrestha A, Dongol S, Laleau V, de Sa AB, Co R, Nankabirwa V. Newborn weight nomograms in selected low and middle-income countries. Sci Rep 2023; 13:14128. [PMID: 37644038 PMCID: PMC10465556 DOI: 10.1038/s41598-023-39773-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
Growth impairment is common in low- and middle-income countries (LMIC) and may begin during early infancy, increasing morbidity and mortality. To ensure healthy infant growth, healthcare providers in high-income countries (HIC) track newborn weight change using tools developed and validated in HIC. To understand the utility of these tools for LMIC, we conducted a secondary analysis to compare weight trajectories in the first 5 days of life among newborns born in our LMIC cohort to an existing HIC newborn weight tool designed to track early weight change. Between April 2019 and March 2020, a convenience sample of 741 singleton healthy breastfeeding newborns who weighed ≥ 2000 g at birth were enrolled at selected health facilities in Guinea-Bissau, Nepal, Pakistan, and Uganda. Using a standardized protocol, newborn weights were obtained within 6 h of birth and at 1, 2, 3, 4, and 5 days, and nomograms depicting newborn weight change were generated. The trajectories of early newborn weight change in our cohort were largely similar to published norms derived from HIC infants, with the exceptions that initial newborn weight loss in Guinea-Bissau was more pronounced than HIC norms and newborn weight gain following weight nadir was more pronounced in Guinea-Bissau, Pakistan, and Uganda than HIC norms. These data demonstrate that HIC newborn weight change tools may have utility in LMIC settings.
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Affiliation(s)
| | | | | | | | | | - Valerie Flaherman
- University of California, San Francisco, 3333 California St., Box 0503, San Francisco, CA, 94118, USA.
| | - Akina Shrestha
- Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Srijana Dongol
- Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Victoria Laleau
- University of California, San Francisco, 3333 California St., Box 0503, San Francisco, CA, 94118, USA
| | | | - Raimundo Co
- International Partnership for Human Development, Bissau, Guinea-Bissau
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Smith AP, Ward LP, Heinig MJ, Dewey KG, Nommsen-Rivers LA. First-Day Use of the Newborn Weight Loss Tool to Predict Excess Weight Loss in Breastfeeding Newborns. Breastfeed Med 2021; 16:230-237. [PMID: 33337275 PMCID: PMC8418441 DOI: 10.1089/bfm.2020.0280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background and Objectives: Exclusive breastfeeding is recommended for most newborns. However, exclusively breastfed newborns sometimes experience excess weight loss (EWL, loss ≥10% of birth weight) while lactation is being established. Our primary objective was to evaluate the sensitivity and specificity of the Newborn Weight Loss Tool (NEWT) in early identification of exclusively breastfed newborns who develop EWL; and secondarily, identify breastfeeding variables associated with an at-risk NEWT trajectory. Materials and Methods: We conducted a secondary analysis of prospective data from mother-infant dyads screened for inclusion in the U.S. site of the WHO Growth Reference Study. We excluded records if: NEWT-specific criteria not met, missing key data, or >60 mL formula consumed. We defined NEWT "test-positive" based on an in-hospital weight at about 24 hours falling within the NEWT trajectory consistent with eventual EWL. We defined cases as true EWL based on weight measured at home on day of life 4 (DoL4). Results: Of 280 original records, 60 were excluded (n = 27, NEWT-specific exclusion; n = 15, missing data; n = 18, >60 mL formula), resulting in 220 paired newborn weights measured in-hospital (17 ± 8 hours), and at DoL4 (84 ± 8 hours). NEWT status correctly identified 6/28 EWL cases (21% sensitivity [95% confidence interval, CI, 8-34%]), and 158/192 noncases (82% specificity [95% CI, 75-89%]). NEWT test-positive status was associated with greater weight loss, lower perceived breastfeeding support, and infant less often showing feeding cues on DoL4 (p < 0.05). Conclusion: Sensitivity in predicting EWL is low when applying NEWT at about 24 hours of life; however, early test-positive status is associated with indicators of breastfeeding difficulties on DoL4.
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Affiliation(s)
- Anna P Smith
- Department of Rehabilitation, Exercise, and Nutritional Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Laura P Ward
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Meredith Jane Heinig
- Department of Nutrition, University of California, Davis, Davis, California, USA
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, California, USA
| | - Laurie A Nommsen-Rivers
- Department of Rehabilitation, Exercise, and Nutritional Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
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Wilbaux M, Kasser S, Wellmann S, Lapaire O, van den Anker JN, Pfister M. Characterizing and Forecasting Individual Weight Changes in Term Neonates. J Pediatr 2016; 173:101-107.e10. [PMID: 27039231 DOI: 10.1016/j.jpeds.2016.02.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/22/2015] [Accepted: 02/17/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To develop a mathematical, semimechanistic model characterizing physiological weight changes in term neonates, identify and quantify key maternal and neonatal factors influencing weight changes, and provide an online tool to forecast individual weight changes during the first week of life. STUDY DESIGN Longitudinal weight data from 1335 healthy term neonates exclusively breastfed up to 1 week of life were available. A semimechanistic model was developed to characterize weight changes applying nonlinear mixed-effects modeling. Covariate testing was performed by applying a standard stepwise forward selection-backward deletion approach. The developed model was externally evaluated on 300 additional neonates collected in the same center. RESULTS Weight changes during first week of life were described as a function of a changing net balance between time-dependent rates of weight gain and weight loss. Males had higher birth weights (WT0) than females. Gestational age had a positive effect on WT0 and weight gain rate, whereas mother's age had a positive effect on WT0 and a negative effect on weight gain rate. The developed model showed good predictive performance when externally validated (bias = 0.011%, precision = 0.52%) and was able to accurately forecast individual weight changes up to 1 week with only 3 initial weight measurements (bias = -0.74%, precision = 1.54%). CONCLUSIONS This semimechanistic model characterizes weight changes in healthy breastfed neonates during first week of life. We provide a user-friendly online tool allowing caregivers to forecast and monitor individual weight changes. We plan to validate this model with data from other centers and expand it with data from preterm neonates.
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Affiliation(s)
- Mélanie Wilbaux
- Division of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Severin Kasser
- Division of Neonatology, University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Sven Wellmann
- Division of Neonatology, University of Basel Children's Hospital (UKBB), Basel, Switzerland.
| | - Olav Lapaire
- Division of Obstetrics and Gynecology, University Hospital Basel, Basel, Switzerland
| | - Johannes N van den Anker
- Division of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital (UKBB), Basel, Switzerland; Division of Pediatric Clinical Pharmacology, Children's National Health System, Washington, DC
| | - Marc Pfister
- Division of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital (UKBB), Basel, Switzerland
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Thulier D. Weighing the Facts: A Systematic Review of Expected Patterns of Weight Loss in Full-Term, Breastfed Infants. J Hum Lact 2016; 32:28-34. [PMID: 26253288 DOI: 10.1177/0890334415597681] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 07/04/2015] [Indexed: 11/17/2022]
Abstract
All breastfeeding infants lose some weight in the early days of life. Conventionally, 5% to 7% loss of birth weight has been accepted as the normal and expected amount of weight loss before infants begin to gain weight steadily. When infants lose more than 7% of their birth weight, breastfeeding adequacy is sometimes questioned and formula supplementation is often given. Despite the fact that 5% to 7% is well known and commonly cited, little reliable evidence exists that supports use of this figure as a guide to practice. A systematic review of studies that focused on infant weight loss was conducted. The main objective was to determine the mean amount of weight loss for healthy, full-term exclusively breastfed infants after birth. One previous review and 9 primary studies published since 2008 were examined. The reported mean infant weight loss ranged widely among studies from 3.79% to 8.6%. The point at which most infants have lost the most amount of weight occurs 2 to 4 days after birth. Close examination of the studies, however, revealed significant methodological flaws in the research. Study limitations commonly included gaps in data collection, lack of documented feeding type, sample groups that lacked adequate numbers of exclusively breastfed infants, and the exclusion of breastfed infants who lost the most weight. Well-designed clinical studies that address these limitations are needed.
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Affiliation(s)
- Diane Thulier
- College of Nursing, University of Rhode Island, Wakefield, RI, USA
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Miller JR, Flaherman VJ, Schaefer EW, Kuzniewicz MW, Li SX, Walsh EM, Paul IM. Early weight loss nomograms for formula fed newborns. Hosp Pediatr 2015; 5:263-8. [PMID: 25934810 DOI: 10.1542/hpeds.2014-0143] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To develop nomograms depicting percentiles of weight loss by hour of age for both vaginal and cesarean-delivered newborns who are exclusively formula fed. METHODS Data regarding delivery mode, race/ethnicity, feeding type, and weights were extracted from electronic medical records of the birth hospitalization at 14 Kaiser Permanente Northern California hospitals between 2009 and 2013. Newborns whose first feeding was formula from a cohort of 161 471 healthy, term, singleton neonates born at ≥36 weeks' gestation between 2009 and 2013 were identified. Quantile regression was used to create nomograms stratified according to delivery mode; percentiles of weight loss were estimated as a function of time among formula-fed neonates. Weights measured subsequent to any breast milk feeding were excluded. Percentiles were determined through 48 and 72 hours of age for those born vaginally and via cesarean delivery, respectively. RESULTS A total of 7075 formula-fed newborns had weights recorded; 4525 were delivered vaginally, and 2550 were born via cesarean delivery. The median weight loss was 2.9% at 48 hours after vaginal delivery; weight loss>7% was rare. For cesarean-delivered neonates, median weight losses at 48 and 72 hours were 3.7% and 3.5%, respectively; weight loss>8% was rare. CONCLUSIONS For newborns who are formula fed, these results provide nomograms depicting percentiles of weight loss according to mode of delivery. These plots can be used to classify early weight loss according to percentile and may enable early identification of feeding difficulties or other neonatal morbidities.
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Affiliation(s)
| | - Valerie J Flaherman
- Departments of Pediatrics, and Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California; and
| | - Eric W Schaefer
- Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Michael W Kuzniewicz
- Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California; and Division of Research, Kaiser Permanente, Oakland, California
| | - Sherian X Li
- Division of Research, Kaiser Permanente, Oakland, California
| | - Eileen M Walsh
- Division of Research, Kaiser Permanente, Oakland, California
| | - Ian M Paul
- Departments of Pediatrics, and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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Flaherman VJ, Schaefer EW, Kuzniewicz MW, Li SX, Walsh EM, Paul IM. Early weight loss nomograms for exclusively breastfed newborns. Pediatrics 2015; 135:e16-23. [PMID: 25554815 PMCID: PMC4279066 DOI: 10.1542/peds.2014-1532] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The majority of newborns are exclusively breastfed during the birth hospitalization, and weight loss is nearly universal for these neonates. The amount of weight lost varies substantially among newborns with higher amounts of weight loss increasing risk for morbidity. No hour-by-hour newborn weight loss nomogram exists to assist in early identification of those on a trajectory for adverse outcomes. METHODS For 161 471 term, singleton neonates born at ≥36 weeks' gestation at Northern California Kaiser Permanente hospitals in 2009-2013, data were extracted from the birth hospitalization regarding delivery mode, race/ethnicity, feeding type, and weights from electronic records. Quantile regression was used to create nomograms stratified by delivery mode that estimated percentiles of weight loss as a function of time among exclusively breastfed neonates. Weights measured subsequent to any nonbreastmilk feeding were excluded. RESULTS Among this sample, 108 907 newborns had weights recorded while exclusively breastfeeding with 83 433 delivered vaginally and 25 474 delivered by cesarean. Differential weight loss by delivery mode was evident 6 hours after delivery and persisted over time. Almost 5% of vaginally delivered newborns and >10% of those delivered by cesarean had lost ≥10% of their birth weight 48 hours after delivery. By 72 hours, >25% of newborns delivered by cesarean had lost ≥10% of their birth weight. CONCLUSIONS These newborn weight loss nomograms demonstrate percentiles for weight loss by delivery mode for those who are exclusively breastfed. The nomograms can be used for early identification of neonates on a trajectory for greater weight loss and related morbidities.
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Affiliation(s)
- Valerie J Flaherman
- Departments of Pediatrics, and Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California;
| | | | - Michael W Kuzniewicz
- Departments of Pediatrics, and Division of Research, Kaiser Permanente, Oakland, California
| | - Sherian X Li
- Division of Research, Kaiser Permanente, Oakland, California
| | - Eileen M Walsh
- Division of Research, Kaiser Permanente, Oakland, California
| | - Ian M Paul
- Departments of Public Health Sciences, and Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania; and
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Affiliation(s)
- Ola Didrik Saugstad
- Department of Paediatric Research, Division of Women and Child Health, Oslo University Hospital, University of Oslo, 0027 Oslo, Norway.
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Flaherman VJ, Kuzniewicz MW, Li S, Walsh E, McCulloch CE, Newman TB. First-day weight loss predicts eventual weight nadir for breastfeeding newborns. Arch Dis Child Fetal Neonatal Ed 2013; 98:F488-92. [PMID: 23864443 DOI: 10.1136/archdischild-2012-303076] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the relationship between high (≥5%) weight loss during the first 24 h after birth and eventual excess weight loss (EWL) of ≥10% of birth weight. DESIGN Retrospective cohort study. SETTING Kaiser Permanente Northern California hospitals. PATIENTS 63 096 infants born at ≥36 weeks in 2009-2010, of whom 59 761 (94.5%) had a weight subsequent to birth weight measured at <24 h. MAIN PREDICTOR MEASURE Per cent of birth weight lost by 24 h of age. MAIN OUTCOME MEASURE Weight nadir, defined as the lowest recorded inpatient or outpatient weight in the first 30 days after birth, expressed as a percentage of birth weight. RESULTS Among infants who breastfed at least once, mean (±SD) weight nadir was 6.3±3.5% below birth weight, and 9.6% of the newborns lost ≥10% of birth weight. Among 2670 infants who lost ≥5% of their birth weight in the first 24 h, 782 (29%) eventually developed EWL, compared with 4840 (8%) of 57 109 infants who lost <5% (p<0.0005). In multivariate analysis, ≥5% first-day weight loss predicted eventual EWL (≥10%) with an OR of 4.06 (95% CI 3.69 to 4.46) after adjusting for gestational age, method of delivery, maternal race/ethnicity and hospital of birth. CONCLUSIONS High first-day weight loss predicts eventual weight nadir and can be used to identify infants who might benefit from targeted interventions to support breastfeeding and prevent EWL.
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Affiliation(s)
- Valerie J Flaherman
- Department of Pediatrics, School of Medicine, University of California, , San Francisco, California, USA
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Affiliation(s)
- Lydia Furman
- Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
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10
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Flaherman VJ, Aby J, Burgos AE, Lee KA, Cabana MD, Newman TB. Effect of early limited formula on duration and exclusivity of breastfeeding in at-risk infants: an RCT. Pediatrics 2013; 131:1059-65. [PMID: 23669513 PMCID: PMC3666109 DOI: 10.1542/peds.2012-2809] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Recent public health efforts focus on reducing formula use for breastfed infants during the birth hospitalization. No previous randomized trials report the effects of brief early formula use. The objective of the study was to determine if small formula volumes before the onset of mature milk production might reduce formula use at 1 week and improve breastfeeding at 3 months for newborns at risk for breastfeeding problems. METHODS We randomly assigned 40 exclusively breastfeeding term infants, 24 to 48 hours old, who had lost ≥5% birth weight to early limited formula (ELF) intervention (10 mL formula by syringe after each breastfeeding and discontinued when mature milk production began) or control (continued exclusive breastfeeding). Our outcomes were breastfeeding and formula use at 1 week and 1, 2, and 3 months. RESULTS Among infants randomly assigned to ELF during the birth hospitalization, 2 (10%) of 20 used formula at 1 week of age, compared with 9 (47%) of 19 control infants assigned during the birth hospitalization to continue exclusive breastfeeding (P = .01). At 3 months, 15 (79%) of 19 infants assigned to ELF during the birth hospitalization were breastfeeding exclusively, compared with 8 (42%) of 19 controls (P = .02). CONCLUSIONS Early limited formula may reduce longer-term formula use at 1 week and increase breastfeeding at 3 months for some infants. ELF may be a successful temporary coping strategy for mothers to support breastfeeding newborns with early weight loss. ELF has the potential for increasing rates of longer-term breastfeeding without supplementation based on findings from this RCT.
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Affiliation(s)
- Valerie J. Flaherman
- Departments of Pediatrics,,Epidemiology and Biostatistics, School of Medicine, and
| | - Janelle Aby
- Department of Pediatrics, Stanford University, Stanford, California; and
| | - Anthony E. Burgos
- Department of Pediatrics, Kaiser Permanente Medical Center, Downey, California
| | - Kathryn A. Lee
- Family and Community Nursing, School of Nursing, University of California, San Francisco, California
| | - Michael D. Cabana
- Departments of Pediatrics,,Epidemiology and Biostatistics, School of Medicine, and
| | - Thomas B. Newman
- Departments of Pediatrics,,Epidemiology and Biostatistics, School of Medicine, and
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Davanzo R, Cannioto Z, Ronfani L, Monasta L, Demarini S. Breastfeeding and neonatal weight loss in healthy term infants. J Hum Lact 2013; 29:45-53. [PMID: 22554678 DOI: 10.1177/0890334412444005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neonatal weight loss is universally recognized, yet poorly understood. Limited professional consensus exists on the definition of lower limit of safe weight loss. OBJECTIVE Our aim was to assess the extent of neonatal weight loss and its association with selected clinical variables in a population of healthy term infants cared for using a specific protocol on weight loss. METHODS We retrospectively considered 1003 infants consecutively admitted to the regular nursery of the Institute for Maternal and Child Health "Burlo Garofolo" (Trieste, Italy). We studied the relationship of selected variables with neonatal weight loss recorded during the hospital stay. We also analyzed all readmissions in the first month of life as a result of weight loss and its complications. RESULTS We observed a mean absolute weight loss of 228 g ± 83g, and a mean percent weight loss of 6.7% ± 2.2%. Weight loss ≥ 10% and > 12% were 6% and 0.3%, respectively. In multivariate logistic regression, cesarean section, hot season, any formula feeding, and jaundice not requiring phototherapy were independently associated with neonatal weight loss ≥ 8%. Conversely, low gestational age status was associated with lower weight loss. Readmission within the first month of life because of dehydration occurred in 0.3% of infants. CONCLUSIONS Breastfeeding, compared to formula feeding, may not be a risk factor for greater early neonatal weight loss, at least in contexts in which weight is routinely monitored, breastfeeding is repeatedly assessed and appropriately supported, and careful supplementation is prescribed to limit and promptly treat excess weight loss and its related complications.
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Affiliation(s)
- Riccardo Davanzo
- Division of Neonatology and NICU, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
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DaMota K, Bañuelos J, Goldbronn J, Vera-Beccera LE, Heinig MJ. Maternal request for in-hospital supplementation of healthy breastfed infants among low-income women. J Hum Lact 2012; 28:476-82. [PMID: 22628291 DOI: 10.1177/0890334412445299] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND While hospital policies and medical issues are important factors in determining exclusive breastfeeding rates, medically unnecessary supplementation of infants is likely to be due, in part, to maternal request for formula. OBJECTIVES The goal of this project was to gain an understanding of the facilitating factors and decision-making processes surrounding maternal request for formula in the early postpartum period. METHODS A series of 12 focus groups were conducted among 97 English- and Spanish-speaking low-income participants in California's Supplementary Nutrition Program for Women, Infants, and Children (WIC). Mothers were asked to share their in-hospital infant-feeding experiences. RESULTS The overarching theme that emerged was "lack of preparation" for what the early postpartum period would be like. Specifically, the decisions to formula feed fell into the following categories: inadequate preparation for newborn care (the need for rest and unrealistic expectations about infant behavior), lack of preparation for the process of breastfeeding, and formula as a solution to breastfeeding problems. Cultural factors were not mentioned as reasons for supplementation. CONCLUSION Interventions to promote in-hospital exclusive breastfeeding must address mothers' real and perceived barriers, specifically mothers' expectations related to breastfeeding and infant behavior.
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Brownell E, Howard CR, Lawrence RA, Dozier AM. Delayed onset lactogenesis II predicts the cessation of any or exclusive breastfeeding. J Pediatr 2012; 161:608-14. [PMID: 22575242 PMCID: PMC3670592 DOI: 10.1016/j.jpeds.2012.03.035] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 03/05/2012] [Accepted: 03/20/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate the association between delayed lactogenesis II (>3 days postpartum; delayed onset lactogenesis II [DLII]) and the cessation of any and exclusive breastfeeding at 4-weeks postpartum. STUDY DESIGN We constructed multivariable logistic regression models using data from 2491 mothers enrolled in the prospective Infant Feeding Practice Study II cohort. Models included DLII, known risk factors for breastfeeding cessation (age, education, race, parity/previous breastfeeding, and exclusive breastfeeding plan), and potential confounders identified in bivariate analyses (P ≤ .1). Backward selection processes (P ≤ .1) determined risk factor retention in the final model. RESULTS DLII was associated with cessation of any and exclusive breastfeeding at 4-weeks postpartum (OR 1.62; CI 1.14-2.31; OR 1.62; CI 1.18-2.22, respectively); numerous independent risk factors qualified for inclusion in the multivariable model(s) and were associated with the outcome(s) of interest (eg, supplemental nutrition program for women, infants, and children enrollment, onset of prenatal care, feeding on-demand, time initiated first breastfeed, hospital rooming-in, obstetric provider preference for exclusive breastfeeding, and maternal tobacco use). CONCLUSIONS Women experiencing DLII may be less able to sustain any and/or exclusive breastfeeding in the early postpartum period. Routine assessment of DLII in postpartum breastfeeding follow-up is warranted. Women with DLII may benefit from additional early postpartum interventions to support favorable breastfeeding outcomes.
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Affiliation(s)
- Elizabeth Brownell
- Department of Research, Connecticut Children's Medical Center, Hartford, CT 06106, USA.
| | - Cynthia R. Howard
- Rochester General Hospital, and Departments of Pediatrics and Community and Preventive Medicine, University of Rochester
| | - Ruth A. Lawrence
- Departments of Pediatrics and Obstetrics and Gynecology, University of Rochester
| | - Ann M. Dozier
- Department of Community and Preventive Medicine, University of Rochester
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Bakar FT, Ozen A, Karatepe HÖ, Berber M, Ercan H. Impact of early weight loss on growth of Caesarean delivered babies: how long does it last? Child Care Health Dev 2012; 38:706-13. [PMID: 21827527 DOI: 10.1111/j.1365-2214.2011.01291.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND We hypothesized that Caesarean delivered babies might experience excessive weight loss during neonatal period. AIM To investigate amount of weight loss among Caesarean delivered babies with exclusive breastfeeding and to identify role of relative weight change (RWC) in early postnatal period on the growth of infants in subsequent months. METHODS We studied healthy infants born ≥36 completed weeks, by Caesarean section between September 2008 and August 2009, with Apgar scores >7. Weight measurements were performed at birth, at 24 h postpartum and at days 2, 4, 7, 14, 30 and monthly up to 6 months. Predictive roles of RWC at each assessment on detecting excessive weight loss and poor weight gain in 1st month, as well as bodyweight z scores in subsequent months were assessed. RESULTS We studied 160 infants (88 female, 72 male) with a mean gestational age of 38.01 ± 1 weeks and birthweight of 3239 ± 421 g. Overall, 22.5% of infants lost >10% of birthweight; 11.9% at day 2, 16.9% at day 4 and 6.6% at day 7. Degree of weight loss was not related with parity, gestational age, birthweight or type of anaesthesia. Predictive values of RWCs in detecting poor weight gain in 0-30 days were: 2nd day; limit =-9.4%, specificity = 91.5%, 4th day; limit =-10.2%, specificity = 89.4%, 7th day; limit =-6.3%, specificity = 85%, sensitivity = 78%, 14th day; limit =+0.8%, specificity = 91.5%, sensitivity = 83.3%. Adjusting for birthweight z scores, RWC at 14th day had a significant influence on 1st and 2nd month bodyweight z scores. Bodyweight z scores were significantly correlated with the z scores of bodyweight in 1-5 months but not with that of 6 months. CONCLUSION Incidence of excessive weight loss is very high among Caesarean delivered babies. RWC at earlier measurements proves satisfactory in predicting poor infant growth. Management strategies based on identifying infants at risk could prevent excessive weight loss and improve future growth of those infants.
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Affiliation(s)
- F T Bakar
- Department of Neonatology, Yeditepe University School of Medicine, Istanbul, Turkey.
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