Intrapartum intravenous fluids for caesarean delivery and newborn weight loss: a retrospective cohort study

The Role of Skin-to-Skin Contact and Breastfeeding in the First Hour Post Delivery in Reducing Excessive Weight Loss

BACKGROUND AND AIMS

An excessive weight loss (EWL) of >10% after birth is associated with serious health outcomes. The aim of this study was to determine factors that can reduce weight loss in full-term, exclusively breastfed infants after birth.

METHODS

This is a retrospective, observational, single-center study. We included 642 healthy, full-term, exclusively breastfed neonates born in 2019 in a baby-friendly hospital, and their healthy mothers. The exclusion criteria were as follows: supplementation with formula, multiple pregnancies, and neonates or mothers with health issues.

RESULTS

The mean percentage of neonatal weight loss after 24 h of life was 5.13%, and that after 48 h was 6.34%. Neonates delivered via a caesarean section lost more weight after 24 and 48 h of life than those delivered via vaginal delivery (p < 0.01). There is a noticeable pattern that neonates tend to lose more weight if they do not get skin-to-skin contact (SSC) and breastfeeding within the first hour after birth (p > 0.05).

CONCLUSIONS

Neonates born via a CS tend to lose more weight after 24 and 48 h of life. Immediate SSC and breastfeeding in the first hour after delivery may decrease the excessive weight loss.

Reply to Akça, B.; Bilotta, F. Time and Type of Administered Fluids during Cesarean Section Might Not Matter for Hemodynamic Outcomes, but There Are Significant Patient Safety Concerns Regarding Colloid Use in Parturients. Comment on "Theodoraki et al. Colloid Preload versus Crystalloid Co-Load in the Setting of Norepinephrine Infusion during Cesarean Section: Time and Type of Administered Fluids Do Not Matter. J. Clin. Med. 2023, 12, 1333"

We would like to take this opportunity to thank Drs Akça and Bilotta for their interest and their insightful comments [...].

The Relationship Between Maternal Fluid Intake During Labor and Neonatal Weight Loss: A Review of the Literature

Introduction

Though in-hospital supplementation of the newborn is associated with decreased breastfeeding success, excessive neonatal weight loss is a medical indication for supplementation. Studies have theorized that maternal fluid intake during labor may impact neonatal weight loss, resulting in unnecessary supplementation. The purpose of this review was to synthesize evidence regarding the relationship between maternal fluid intake during labor and neonatal weight loss.

Methods

Literature searches were conducted in relevant databases using controlled vocabulary. The main findings and outcomes were compared across studies and calculations conducted to report the proportion of studies reporting significant findings.

Results

11 studies were included in the review. Overall, 7 studies (64%) identified a significant relationship between maternal fluid intake during labor and neonatal weight loss.

Conclusions

Given the risk to the newborn associated with excessive weight loss, it is not prudent to incorporate maternal fluid intake into supplementation guidelines based on existing evidence. Further research is needed before practice recommendations can be made.

Newborn Weight Loss as a Predictor of Persistence of Exclusive Breastfeeding up to 6 Months

Objectives

To investigate the association between neonatal weight loss and persistence of exclusive breastfeeding up to 6 months.

Study Design

An observational cohort study in the setting of a Baby Friendly Hospital, enrolling 1,260 healthy term dyads. Neonatal percentage of weight loss was collected between 48 and 72 h from birth. Using a questionnaire, all mothers were asked on the phone what the infant's mode of feeding at 10 days, 42 days and 6 months (≥183 days) from birth were. The persistence of exclusive breastfeeding up to 6 months and the occurrence of each event that led to the interruption of exclusive breastfeeding were verified through a logistic analysis that included 40 confounders.

Results

Infants with a weight loss ≥7% were exclusively breastfed at 6 months in a significantly lower percentage of cases than infants with a weight loss <7% (95% CI 0.563 to 0.734, p < 0.001). Weight loss ≥7% significantly increases the occurrence of either sporadic integration with formula milk (95% CI 0.589 to 0.836, p < 0.001), complementary feeding (95% CI 0.460 to 0.713, p < 0.001), exclusive formula feeding (95% CI 0.587 to 0.967, p < 0.001) or weaning (95% CI 0.692 to 0.912, p = 0.02) through the first 6 months of life.

Conclusions

With the limitations of a single-center study, a weight loss ≥7% in the first 72 h after birth appears to be a predictor of an early interruption of exclusive breastfeeding before the recommended 6 months in healthy term exclusively breastfed newborns.