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Schutzman DL, Kuter N, Salvador A, Wyatt D, Snijder J, Peregrino M, Basu R, Irigoyen M. Newborn Weight Loss Tool and Readmission for Hyperbilirubinemia. Am J Perinatol 2024; 41:1373-1378. [PMID: 36580979 DOI: 10.1055/s-0042-1759603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this study was to determine if the Newborn Weight Loss Tool (NEWT) can predict hospital readmission due to hyperbilirubinemia. STUDY DESIGN This is a case-control study of 93 newborns and 186 controls ≥35 weeks' gestation. All were discharged from the Mother-Baby unit of an urban academic center and subsequently readmitted for hyperbilirubinemia. Controls were matched for date of birth, gestational age, and Bhutani risk zone. All infants were screened for hyperbilirubinemia prior to discharge and managed according to American Academy of Pediatrics guidelines in place at the time. Chi-square, Fisher's exact test, and multivariate analysis were utilized as appropriate. RESULTS There was no significant difference between the groups for a NEWT < 50% at discharge. More cases than controls breastfed. A significantly greater percentage of cases had NEWT > 50% at readmission than discharge. NEWT > 90% was moderately associated with readmission for hyperbilirubinemia (p = 0.081). CONCLUSION NEWT provides a more nuanced assessment of weight loss following birth and can aid in highlighting newborns at risk for readmission due to hyperbilirubinemia. KEY POINTS · Weight loss is a risk factor for readmission after birth.. · NEWT is a more nuanced assessment of weight loss.. · NEWT > 90% is associated with readmission for jaundice..
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Affiliation(s)
- David L Schutzman
- Division of Neonatology, Department of Pediatrics, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Nazli Kuter
- Division of Neonatology, Department of Pediatrics, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Agnes Salvador
- Division of Neonatology, Department of Pediatrics, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Dorothy Wyatt
- Division of Neonatology, Department of Pediatrics, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Juan Snijder
- Division of Neonatology, Department of Pediatrics, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
- Department of Hematology-Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Manuel Peregrino
- Division of Neonatology, Department of Pediatrics, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Rhea Basu
- Division of Neonatology, Department of Pediatrics, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
- Division of Neonatology, Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matilde Irigoyen
- Division of Neonatology, Department of Pediatrics, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
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Flaherman VJ, Murungi J, Bale C, Dickinson S, Chen X, Namiiro F, Nankunda J, Pollack LM, Laleau V, Kim MO, Allison DB, Ginsburg AS, Braima de Sa A, Nankabirwa V. Breastfeeding and Once-Daily Small-Volume Formula Supplementation to Prevent Infant Growth Impairment. Pediatrics 2024; 153:e2023062228. [PMID: 38062778 DOI: 10.1542/peds.2023-062228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 01/02/2024] Open
Abstract
BACKGROUND Randomized controlled trials in Guinea-Bissau and Uganda have revealed that the intensive promotion of exclusive breastfeeding (EBF) impairs growth in early infancy. When newborn growth is impaired, small amounts of formula may be combined with breastfeeding to promote growth. METHODS To determine if breastfeeding combined with once-daily formula supplementation improves growth among at-risk newborns, we conducted a pilot randomized controlled trial in Bissau, Guinea-Bissau and Kampala, Uganda. We randomly assigned 324 healthy breastfeeding newborns who weighed 2000 g to 2499 g at birth or <2600 g at 4 days old to once-daily formula feeding through 30 days as a supplement to frequent breastfeeding followed by EBF from 31 days through 6 months, or to EBF through 6 months. The primary outcome was weight-for-age z score (WAZ) at 30 days. Other outcomes included weight-for-length z score (WLZ), length-for-age z score (LAZ), breastfeeding cessation, adverse events, and serious adverse events through 180 days. RESULTS Daily formula consumption in the intervention group was 31.9 ± 11.8 mL. The random assignment did not impact WAZ, WLZ, LAZ, breastfeeding cessation, adverse events, or serious adverse events through 180 days. In the intervention and control groups, 19 (12%) and 35 (21%) infants, respectively, reported nonformula supplementation in the first 30 days (P = .02). CONCLUSIONS Once-daily formula supplementation for 30 days was well-tolerated, but the small volume consumed did not alter growth through 180 days of age. Further research would be required to determine if larger formula volumes, longer duration of treatment, or more frequent feeding are effective at increasing growth for this at-risk population.
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Affiliation(s)
| | - Joan Murungi
- School of Public Health, Makerere University, Kampala, Uganda
| | - Carlito Bale
- International Partnership for Human Development, Bissau, Guinea-Bissau
| | | | - Xiwei Chen
- School of Public Health, Indiana University, Bloomington, Indiana
| | - Flavia Namiiro
- School of Public Health, Makerere University, Kampala, Uganda
| | - Jolly Nankunda
- School of Public Health, Makerere University, Kampala, Uganda
| | - Lance M Pollack
- School of Medicine, University of California, San Francisco, California
| | - Victoria Laleau
- School of Medicine, University of California, San Francisco, California
| | - Mi-Ok Kim
- School of Medicine, University of California, San Francisco, California
| | - David B Allison
- School of Public Health, Indiana University, Bloomington, Indiana
| | | | | | - Victoria Nankabirwa
- School of Public Health, Makerere University, Kampala, Uganda
- Centre for Intervention Science for Maternal and Child Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Cromb D, Chowdhury N, Teoh S. Fifteen-minute consultation: Baby with jaundice in the first 2 weeks of life. Arch Dis Child Educ Pract Ed 2022; 107:415-421. [PMID: 34462291 DOI: 10.1136/archdischild-2020-321148] [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] [Received: 01/31/2021] [Accepted: 08/12/2021] [Indexed: 11/03/2022]
Abstract
There are multiple causes of jaundice in the first 2 weeks of life. The aim of this article is to help explain what these causes are and why they occur. It discusses how to focus on the history, examination and investigations in such cases. Initial management will vary depending on the clinical context; as such, this article also outlines the initial management of the most common scenarios.
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Affiliation(s)
- Daniel Cromb
- Centre for the Developing Brain, King's College London, London, UK .,Department of General Paediatrics, King's College Hospital NHS Foundation Trust, London, UK
| | - Nadir Chowdhury
- Department of General Paediatrics, King's College Hospital NHS Foundation Trust, London, UK
| | - Sophia Teoh
- Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK
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Cheng FY, Shabanova V, Berkwitt AK, Grossman MR. Early Weight Loss Percentile Curves and Feeding Practices in Opioid-Exposed Infants. Hosp Pediatr 2022; 12:857-866. [PMID: 36073203 DOI: 10.1542/hpeds.2021-006137] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We examined weight loss patterns and feeding practices of infants hospitalized for neonatal opioid withdrawal syndrome (NOWS) managed by the eat, sleep, console approach, which emphasizes nonpharmacologic treatment. Although feeding practices during hospitalization vary widely, weight loss patterns for infants managed under this approach have not yet been described. METHODS Of 744 infants with NOWS born from 2014 to 2019 at our institution, 330 met inclusion criteria (≥35 weeks' gestation and no NICU transfer). We examined maximum weight loss and created weight loss percentile curves by delivery type using mixed effects quantile modeling with spline effect for hour of life; 95% confidence intervals (CI) were compared to published early weight loss nomograms. RESULTS In the cohort, the mean gestational age was 39.2 weeks, mean birth weight was 3.1 kg, and mean length of stay was 6.5 days; 94.6% did not require pharmacologic treatment. Median percent weight loss was significantly more compared to early weight loss nomograms for both vaginally-delivered infants at 48 hours (6.9% [95% CI: 5.8-8.5] vs 2.9%) and cesarean-delivered infants at 48 hours (6.5% [95% CI: 4.1-9.1] vs 3.7%) and 72 hours (7.2% [95%CI 4.7-9.9] vs 3.5%), all P < .001. Overall, 27.9% lost >10% birth weight. CONCLUSIONS We demonstrate weight loss patterns of infants with NOWS managed by the eat, sleep, console approach at a single center. Infants with NOWS lose significantly more weight than nonopioid exposed infants and are at increased risk of morbidity and health care use. Studies to address optimal feeding methods in these infants are warranted.
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Flaherman VJ, Robinson A, Creasman J, McCulloch CE, Paul IM, Pletcher MJ. Clinical Decision Support for Newborn Weight Loss: A Randomized Controlled Trial. Hosp Pediatr 2022; 12:e180-e184. [PMID: 35611641 DOI: 10.1542/hpeds.2021-006470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE The Newborn Weight Tool (NEWT) can inform newborn feeding decisions and might reduce health care utilization by preventing excess weight loss. Clinical decision support (CDS) displaying NEWT might facilitate its use. Our study's objective is to determine the effect of CDS displaying NEWT on feeding and health care utilization. METHODS At an hospital involved in NEWT development, we randomly assigned 2682 healthy infants born ≥36 weeks gestation in 2018-2019 either to CDS displaying NEWT with an electronic flag if most recent weight was ≥75th weight loss centile or to a control of usual care with NEWT accessed at clinician discretion. Our primary outcome was feeding type concordant with weight loss, defined as exclusive breastfeeding for those not flagged, exclusive breastfeeding or supplementation for those flagged once, and supplementation for those flagged more than once. Secondary outcomes included inpatient and outpatient utilization in the first 30 days. We used χ2 and Student's t tests to compare intervention infants with control and to compare trial infants with those born in 2017. RESULTS Feeding was concordant with for 1854 (74.5%) trial infants and did not differ between randomized groups (P = .65); concordant feeding was higher for all trial infants than for infants born in 2017 (64.4%; P < .0005). Readmission occurred for 51 (3.8%) CDS infants and 45 (3.4%) control infants (P = .56). Among the 60% of trial infants with outpatient records available, there were 3.5 ± 1.7 visits with no differences between randomized groups (P = .10). CONCLUSIONS At an hospital involved in NEWT development, CDS displaying NEWT did not alter either feeding or health care utilization compared with discretionary NEWT access.
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Affiliation(s)
| | | | | | | | - Ian M Paul
- Penn State College of Medicine, Hershey, Pennsylvania
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Ginsburg AS, Braima de Sa A, Nankabirwa V, Co R, Murungi J, Kim MO, Brim R, Namiiro F, Namugga O, Hartigan-O’Connor DJ, Roberts SB, Flaherman V. Randomized controlled trial of early, small-volume formula supplementation among newborns: A study protocol. PLoS One 2022; 17:e0263129. [PMID: 35120150 PMCID: PMC8815972 DOI: 10.1371/journal.pone.0263129] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022] Open
Abstract
Childhood undernutrition is a major health burden worldwide that increases childhood morbidity and mortality and causes impairment in infant growth and developmental delays that can persist into adulthood. The first weeks and months after birth are critical to the establishment of healthy growth and development during childhood. The World Health Organization recommends immediate and exclusive breastfeeding (EBF). In infants for whom EBF may not meet nutritional and caloric demands, early, daily, small-volume formula supplementation along with breastfeeding may more effectively avoid underweight wasting and stunting in early infancy than breastfeeding alone. The primary objective of this randomized controlled trial is to evaluate the efficacy of formula for 30 days among low birth weight (LBW) infants <6 hours of age and those not LBW with weights <2600 grams at 4 days of age. We will compare breastfeeding and formula (up to 59 milliliters administered daily) through 30 days of infant age vs recommendations for frequent EBF without supplementation, and test the hypothesis that formula increases weight-for-age z-score at 30 days of infant age. The trial will enroll and randomize 324 mother-infant pairs in Guinea-Bissau and Uganda, and follow them for 6 months for outcomes including growth, intestinal microbiota, breastfeeding duration, infant dietary intake, and adverse events. Conservatively estimating 20% loss to follow up, this sample size provides ≥80% power per weight stratum for intervention group comparison to detect a difference of 0.20 with respect to the outcome of WAZ at day 30. This trial was approved by the University of California, San Francisco Institutional Review Board (19-29405); the Guinea-Bissau National Committee on Ethics in Health (Comite Nacional de Etica na Saude, 075/CNES/INASA/2020); the Higher Degrees, Research and Ethics Committee of Makerere University (871); and the Uganda National Council of Science and Technology (HS1226ES). We plan to disseminate study results in peer-reviewed journals and international conferences. Trial registration number: NCT04704076.
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Affiliation(s)
| | | | - Victoria Nankabirwa
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Global Public Health and Primary Care, Centre for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health, University of Bergen, Bergen, Norway
| | - Raimundo Co
- International Partnership for Human Development, Bissau, Guinea-Bissau
| | - Joanitta Murungi
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mi-Ok Kim
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States of America
| | - Rachel Brim
- Department of Pediatrics, University of California, San Francisco, CA, United States of America
| | - Flavia Namiiro
- Mulago Specialized Women’s and Neonatal Hospital, Kampala, Uganda
| | - Olive Namugga
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Global Public Health and Primary Care, Centre for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health, University of Bergen, Bergen, Norway
| | - Dennis J. Hartigan-O’Connor
- Department of Medical Microbiology and Immunology and the California National Primate Research Center, University of California, Davis, CA, United States of America
- Division of Experimental Medicine, University of California, San Francisco, CA, United States of America
| | - Susan B. Roberts
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States of America
| | - Valerie Flaherman
- Department of Pediatrics, University of California, San Francisco, CA, United States of America
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Tagi N, Ergin A, Bilgen HS, Ozek E. The Use of the "Early Weight Loss Nomograms" as Compared to a Standard Weight Loss Percentage Protocol Will Decrease Postnatal Formula Supplementation. Breastfeed Med 2022; 17:137-142. [PMID: 34936479 DOI: 10.1089/bfm.2021.0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction: We compared the number of babies who needed formula supplementation, based on the "Early Weight Loss Nomograms," with the hypothetical outcomes that would have occurred in the same cohort if they had been managed according to a "weight loss percentage" protocol. Subjects and Methods: This study included 308 newborns. Supplemental formula was provided to babies whose weight loss was more than the 95th percentile according to the "Early Weight Loss Nomograms." Pathological weight loss was defined as when a weight loss was >5% at the 24th hour or >8% at the 48th hour. The number of babies who would have needed formula supplementation according to those two strategies were compared. Results: The mean postnatal first-second day weight losses for vaginal and cesarean deliveries were 3.06% versus 4.7% and 4.5%, versus 5.8%, respectively, and were significantly higher for babies born by cesarean section (p = 0.001). We found that 89.4% of vaginal deliveries and 89.2% of babies born by cesarean section were exclusively breastfed when the nomograms were in use. If the daily weight loss strategy would be applied instead of the nomograms to the study cohort, the rate of exclusive breastfeeding would be significantly lower for babies born by cesarean section (64.2% versus 89.2%) (p = 0.001). Conclusions: The use of the Early Weight Loss Nomograms will decrease the rate of formula supplementation.
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Affiliation(s)
- Nazmiye Tagi
- T.R. Ministry of Health İzmir Provincial Health Directorate Bakırçay University Çiğli Training and Research Hospital Yeni Mahalle, İzmir, Turkey
| | - Ayla Ergin
- Midwifery Department, Faculty of Health Sciences, Kocaeli University, Kocaeli, Turkey
| | - Hulya Selva Bilgen
- Division of Neonatology, Department of Pediatrics, Marmara University Medical School, Istanbul, Turkey
| | - Eren Ozek
- Division of Neonatology, Department of Pediatrics, Marmara University Medical School, Istanbul, Turkey
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Aby JL. No Shame, No Blame: The Art of Talking With Breastfeeding Mothers. Hosp Pediatr 2021; 11:e192-e194. [PMID: 34362760 DOI: 10.1542/hpeds.2021-005967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Janelle L Aby
- Lucile Packard Children's Hospital, Palo Alto, California; and Stanford University, Stanford, California
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Kelly AF, Kelly PK, Shah M. Auditory Brainstem Response Pass Rates Correlate with Newborn Hour of Life and Delivery Mode. J Pediatr 2021; 230:100-105. [PMID: 33098840 DOI: 10.1016/j.jpeds.2020.10.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine whether hour of life and mode of delivery affect auditory brainstem response (ABR) results in healthy infants with a gestational age of >35 weeks. STUDY DESIGN This retrospective cohort study reviewed 31 984 infants tested during a standard birth hospitalization from 2014 to 2016 at Prentice Women's Hospital of Chicago. Per policy, ABRs were performed after 6 and 12 hours of life for vaginally and cesarean-delivered infants, respectively. Testing was repeated before discharge for infants who were referred once. For those infants who referred again, a third ABR was offered at no cost to families 10-14 days after discharge starting in 2016. RESULTS ABR pass rates consistently and significantly increased with advancing hour of life at testing, starting at 10-11 hours of life for vaginally born infants and 30-32 hours for cesarean-born infants. This steady, incremental increase in the pass rate was maintained overall until the vaginal and cesarean groups reached plateaus at 42-44 and 48-52 hours of life, respectively. In 2016 and beyond, a third hearing screen after discharge lowered the referral rate to just 0.77%. CONCLUSIONS This study of the results of ABR tests in over 30 000 well newborns demonstrates that delaying hearing screening until 10-11 hours for vaginally born infants and 30-32 hours for cesarean-born infants results in a statistically significant improvement in hearing pass rates.
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Affiliation(s)
- Annemarie F Kelly
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Northwestern Medicine Prentice Women's Hospital, Feinberg School of Medicine, Chicago, IL.
| | - Patrick K Kelly
- Department of Science in Analytics, University of Chicago Graham School of Continuing Liberal and Professional Studies, Chicago, IL
| | - Malika Shah
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Northwestern Medicine Prentice Women's Hospital, Feinberg School of Medicine, Chicago, IL
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Valderrama CE, Marzbanrad F, Juarez M, Hall-Clifford R, Rohloff P, Clifford GD. Estimating birth weight from observed postnatal weights in a Guatemalan highland community. Physiol Meas 2020; 41:025008. [PMID: 32028276 PMCID: PMC7126327 DOI: 10.1088/1361-6579/ab7350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Low birth weight is one of the leading contributors to global perinatal deaths. Detecting this problem close to birth enables the initiation of early intervention, thus reducing the long-term impact on the fetus. However, in low-and middle-income countries, sometimes newborns are weighted days or months after birth, thus challenging the identification of low birth weight. This study aims to estimate birth weight from observed postnatal weights recorded in a Guatemalan highland community. APPROACH With 918 newborns recorded in postpartum visits at a Guatemalan highland community, we fitted traditional infant weight models (Count's and Reeds models). The model that fitted the observed data best was selected based on typical newborn weight patterns reported in the medical literature and previous longitudinal studies. Then, estimated birth weights were determined using the weight gain percentage derived from the fitted weight curve. MAIN RESULTS The best model for both genders was the Reeds2 model, with a mean square error of 0.30 kg2 and 0.23 kg2 for male and female newborns, respectively. The fitted weight curves exhibited similar behavior to those reported in the literature, with a maximum weight loss around three to five days after birth, and birth weight recovery, on average, by day ten. Moreover, the estimated birth weight was consistent with the 2015 Guatemalan National Survey, no having a statistically significant difference between the estimated birth weight and the reported survey birth weights (two-sided Wilcoxon rank-sum test; [Formula: see text]). SIGNIFICANCE By estimating birth weight at an opportune time, several days after birth, it may be possible to identify low birth weight more accurately, thus providing timely treatment when is required.
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Affiliation(s)
- Camilo E Valderrama
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States of America
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Hudson JA, Charron E, Maple B, Krom M, Heavner-Sullivan SF, Mayo RM, Dickes L, Rennert L. Baby-Friendly Hospital Initiative Is Associated with Lower Rates of Neonatal Hyperbilirubinemia. Breastfeed Med 2020; 15:176-182. [PMID: 31934778 DOI: 10.1089/bfm.2019.0220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: The Baby-Friendly Hospital Initiative (BFHI) advances practices that support exclusive breastfeeding. BFHI practices are associated with increased breastfeeding rates, however, other patient outcomes are not well described. This study examined the association of BFHI practices with hyperbilirubinemia and phototherapy between groups of newborns born before and after BFHI implementation at an urban, tertiary academic medical center in South Carolina. Materials and Methods: We conducted a retrospective study of healthy, term newborns born between July and September 2011 (n = 956), before BFHI implementation, and newborns born during the same period in 2013 (n = 1,131) after BFHI implementation. Primary outcomes were neonatal hyperbilirubinemia, phototherapy treatment, and hospital readmissions for hyperbilirubinemia within 30 days of discharge. We compared rates of outcomes between the study groups using unadjusted and adjusted odds ratios (OR). Results: Among newborns born before versus after BFHI implementation, 20.3% versus 6.98% were diagnosed with hyperbilirubinemia (p < 0.001), 5.75% versus 1.95% received phototherapy (p < 0.001), and 0.31% versus 0.35% were readmitted to the hospital for hyperbilirubinemia within 30 days (p = 0.88). In adjusted analyses, newborns born after BFHI implementation were significantly less likely to develop neonatal hyperbilirubinemia (OR 0.28 [95% confidence intervals; CI 0.20-0.37]) and receive phototherapy treatment (OR 0.27 [95% CI 0.15-0.49]) than newborns born before BFHI implementation. Conclusions: Implementation of BFHI practices is associated with significant decreases in neonatal hyperbilirubinemia and phototherapy without affecting readmission rates. Exclusive breastfeeding has traditionally been considered a risk factor for the development of neonatal jaundice. This study demonstrates that BFHI practices may mitigate that risk.
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Affiliation(s)
- Jennifer A Hudson
- Department of Pediatrics, Prisma Health Upstate, Greenville, South Carolina
| | - Elizabeth Charron
- Department of Public Health Sciences and Recreation and Tourism Management, Clemson University, Clemson, South Carolina
| | - Britni Maple
- Department of Pediatrics, Prisma Health Upstate, Greenville, South Carolina
| | - Mark Krom
- Department of Pediatrics, Prisma Health Upstate, Greenville, South Carolina
| | - Smith F Heavner-Sullivan
- Department of Public Health Sciences and Recreation and Tourism Management, Clemson University, Clemson, South Carolina
| | - Rachel M Mayo
- Department of Public Health Sciences and Recreation and Tourism Management, Clemson University, Clemson, South Carolina
| | - Lori Dickes
- Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, South Carolina
| | - Lior Rennert
- Department of Public Health Sciences and Recreation and Tourism Management, Clemson University, Clemson, South Carolina
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Kelly NM, Keane JV, Gallimore RB, Bick D, Tribe RM. Neonatal weight loss and gain patterns in caesarean section born infants: integrative systematic review. MATERNAL AND CHILD NUTRITION 2019; 16:e12914. [PMID: 31777183 PMCID: PMC7083401 DOI: 10.1111/mcn.12914] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 10/25/2019] [Accepted: 10/30/2019] [Indexed: 11/29/2022]
Abstract
There is evidence that caesarean section delivery can impact on neonatal weight loss and weight gain patterns in the first 5 days of life. We conducted an integrative systematic review to examine the association of mode of delivery on early neonatal weight loss. Pubmed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Excerpta Medica dataBASE, and Medical Literature Analysis and Retrieval System Online were searched for relevant papers published before June 2019. Reference lists from the relevant papers were then backwards and forwards searched. As neonatal weight loss was reported in different formats, a meta‐analysis could not be carried out. Most studies did not distinguish between elective and emergency caesarean sections or instrumental and nonassisted vaginal deliveries. Seven papers were included. All papers except one found that caesarean section was associated with higher weight loss in the early days of life. Two papers presented data from studies on babies followed up to 1 month. One study found that on day 25, babies born by caesarean section had significantly higher weight gain than those born vaginally, while another found that by day 28, babies born vaginally gained more weight per day (11.9 g/kg/day) than those born by caesarean section (10.9 g/kg/day; p = .02). Overall, infants born by caesarean section lost more weight than those born vaginally, but due to the small number of studies included, more are needed to look at this difference and why it may occur. This discrepancy in weight between the two groups may be corrected over time, but future studies will need larger sample sizes and longer follow‐up periods to examine this.
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Affiliation(s)
- Niamh M Kelly
- Dept. of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, St Thomas' Hospital Campus, King's College London, London, UK
| | - Jessica V Keane
- Dept. of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, St Thomas' Hospital Campus, King's College London, London, UK
| | | | - Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel M Tribe
- Dept. of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, St Thomas' Hospital Campus, King's College London, London, UK
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Flaherman VJ, Cabana MD, McCulloch CE, Paul IM. Effect of Early Limited Formula on Breastfeeding Duration in the First Year of Life: A Randomized Clinical Trial. JAMA Pediatr 2019; 173:729-735. [PMID: 31157878 PMCID: PMC6547125 DOI: 10.1001/jamapediatrics.2019.1424] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Breastfeeding through 6 and 12 months are 2 goals of the Centers for Disease Control and Prevention Healthy People 2020 initiative, but the 6-month goal is met for only 52% of US infants and the 12-month goal for 30% of US infants. OBJECTIVE To determine whether structured, short-term formula supplementation for at-risk neonates affects the proportion still breastfeeding at 6 and 12 months. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial conducted at 2 US academic medical centers enrolled 164 exclusively breastfeeding mother-infant dyads of mothers who were not yet producing copious milk and infants who were 24 to 72 hours old with newborn weight loss at or above the 75th percentile for age. Participants were enrolled from January 2015 through September 2016. INTERVENTIONS Early Limited Formula (ELF), a structured formula supplementation protocol (10 mL formula fed after each breastfeeding until mothers produced copious milk), compared with control dyads, who continued exclusive breastfeeding and received a safety teaching intervention. MAIN OUTCOMES AND MEASURES The study's primary outcome was any breastfeeding at 6 months. Secondary outcomes included age at breastfeeding cessation and any breastfeeding at 12 months. All outcomes were assessed by maternal phone survey. RESULTS Eighty-two newborns were randomized to ELF and 82 to the control group. Mean (SD) maternal age was 31.4 (5.9) years, and 114 (69.5%) self-identified as non-Hispanic white; 20 (12.2%), Hispanic; 17 (10.4%), Asian; 5 (3.0%), non-Hispanic black; and 7 (4.3%), other. Compared with controls, mothers randomized to ELF were less likely to be married (n = 53 [64.6%] vs n = 66 [80.5%]; P = .03) and had shorter mean (SD) intended duration of breastfeeding (8.6 [3.4] vs 9.9 [4.4] months; P = .049). Median (interquartile range) duration of breastfeeding in the cohort was 9 (6-12) months. At 6 months, 47 (65%) infants randomized to ELF were breastfeeding, compared with 60 (77%) of the control infants (absolute difference, -12%; 95% CI, -26% to 3%; P = .12). At 12 months, 21 of the 71 ELF infants available for analysis (29.6%) were breastfeeding, compared with 37 of the available 77 (48.1%) control infants (risk difference, -18%; 95% CI, -34% to -3%). Marital status and intended breastfeeding duration were both associated with breastfeeding duration; models adjusting for these found a hazard ratio for time-to-event of breastfeeding cessation through 12 months of 0.74 (95% CI, 0.48-1.14) for ELF infants compared with infants in the control group. CONCLUSIONS AND RELEVANCE In this cohort with high breastfeeding prevalence, ELF was not associated with any improvement in breastfeeding duration. Future research should examine the effect of ELF in populations at higher risk of early cessation. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02313181.
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Affiliation(s)
- Valerie J. Flaherman
- Department of Pediatrics, University of California, San Francisco,Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Michael D. Cabana
- Department of Pediatrics, University of California, San Francisco,Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Ian M. Paul
- Penn State College of Medicine, Hershey, Pennsylvania
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14
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Kubota S, Zaitsu M, Yoshihara T. Growth Patterns of Neonates Treated with Thermal Control in Neutral Environment and Nutrition Regulation to Meet Basal Metabolism. Nutrients 2019; 11:nu11030592. [PMID: 30862112 PMCID: PMC6471570 DOI: 10.3390/nu11030592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 11/16/2022] Open
Abstract
Little is known about the growth patterns of low birth weight neonates (<2500 g) during standardized thermal control and nutrition regulation to meet basal metabolism requirements compared to those of non-low birth weight neonates (2500 g and above). We retrospectively identified 10,544 non-low birth weight and 681 low birth weight neonates placed in thermo-controlled incubators for up to 24 h after birth. All neonates were fed a 5% glucose solution 1 h after birth and breastfed every 3 h (with supplementary formula milk if applicable) to meet basal metabolism requirements. Maximum body-weight loss (%), percentage body-weight loss from birth to peak weight loss (%/day), and percentage body-weight gain from peak weight loss to day 4 (%/day) were assessed by multivariable linear regression. Overall, the growth curves showed a uniform J-shape across all birth weight categories, with a low mean maximum body-weight loss (1.9%) and incidence of neonatal jaundice (0.3%). The body-weight loss patterns did not differ between the two groups. However, low birth weight neonates showed significantly faster growth patterns for percentage body-weight gain: β = 0.52 (95% confidence interval, 0.46 to 0.58). Under thermal control and nutrition regulation, low birth weight neonates might not have disadvantages in clinical outcomes or growth patterns.
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Affiliation(s)
- Shiro Kubota
- Kubota Life Science Laboratory Co., Ltd., Saga 840-0535, Japan.
- Kubota Maternity Clinic, Fukuoka 810-0014, Japan.
| | - Masayoshi Zaitsu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan.
| | - Tatsuya Yoshihara
- Kubota Maternity Clinic, Fukuoka 810-0014, Japan.
- Clinical Research Center, Fukuoka Mirai Hospital, Fukuoka 813-0017, Japan.
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15
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Flaherman V, Schaefer EW, Kuzniewicz MW, Li SX, Walsh EM, Paul IM. Health Care Utilization in the First Month After Birth and Its Relationship to Newborn Weight Loss and Method of Feeding. Acad Pediatr 2018; 18:677-684. [PMID: 29191700 DOI: 10.1016/j.acap.2017.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 11/16/2017] [Accepted: 11/19/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Guidelines recommend closer outpatient follow-up for exclusively breastfed newborns, especially those with pronounced weight loss, because of increased risk of hyperbilirubinemia and dehydration that might require readmission. Our objective was to determine how feeding method and weight loss are associated with neonatal health care utilization. METHODS A retrospective cohort study conducted at Northern California Kaiser Permanente hospitals in 2009-2013 assessed 143,889 neonates to study the inpatient method of feeding as well as inpatient and outpatient weights. The main outcome measures were inpatient and outpatient health care utilization in the 30 days after birth. RESULTS Newborn weight loss and feeding method were both associated with utilization. Exclusively breastfed newborns had higher readmission rates than those exclusively formula fed for both vaginal (4.3% compared to 2.1%) (P < .001) and cesarean deliveries (2.1% compared to 1.5%) (P = .025). Those exclusively breastfed also had more neonatal outpatient visits compared to those exclusively formula fed for both vaginal (means of 3.0 and 2.3, P < .001) and cesarean deliveries (means of 2.8 and 2.2, P < .001). Among vaginally delivered newborns of all feeding types, newborns with weight loss >10% at discharge had a relative risk of readmission of 1.10 (95% confidence interval [CI],1.00, 1.20) compared to those with <8% weight loss at discharge; among the subset weighed as inpatients or outpatients between 48 and 72 hours, those with >10% weight loss between 48-72 hours had a relative risk of readmission of 2.11 (95% CI, 1.95, 2.26) compared to those with <8% weight loss at 48-72 hours. CONCLUSIONS Exclusive breastfeeding and weight loss are associated with increased neonatal health care utilization. Improving clinical management of exclusively breastfed neonates with pronounced weight loss might reduce health care utilization.
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Affiliation(s)
- Valerie Flaherman
- Department of Pediatrics, University of California-San Francisco, San Francisco, Calif.
| | - Eric W Schaefer
- Department of Pediatrics, University of California-San Francisco, San Francisco, Calif
| | - Michael W Kuzniewicz
- Department of Pediatrics, University of California-San Francisco, San Francisco, Calif
| | - Sherian X Li
- Department of Pediatrics, University of California-San Francisco, San Francisco, Calif
| | - Eileen M Walsh
- Department of Pediatrics, University of California-San Francisco, San Francisco, Calif
| | - Ian M Paul
- Department of Pediatrics, University of California-San Francisco, San Francisco, Calif
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16
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Wilbaux M, Kasser S, Gromann J, Mancino I, Coscia T, Lapaire O, van den Anker JN, Pfister M, Wellmann S. Personalized weight change prediction in the first week of life. Clin Nutr 2018; 38:689-696. [PMID: 29703559 DOI: 10.1016/j.clnu.2018.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/24/2018] [Accepted: 04/02/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND & AIMS Almost all neonates show physiological weight loss and consecutive weight gain after birth. The resulting weight change profiles are highly variable as they depend on multiple neonatal and maternal factors. This limits the value of weight nomograms for the early identification of neonates at risk for excessive weight loss and related morbidities. The objective of this study was to characterize weight changes and the effect of supplemental feeding in late preterm and term neonates during the first week of life, to identify and quantify neonatal and maternal influencing factors, and to provide an educational online prediction tool. METHODS Longitudinal weight data from 3638 healthy term and late preterm neonates were prospectively recorded up to 7 days of life. Two-thirds (n = 2425) were randomized to develop a semi-mechanistic model characterizing weight change as a balance between time-dependent rates of weight gain and weight loss. The dose-dependent effect of supplemental feeding on weight gain was characterized. A population analysis applying nonlinear mixed-effects modeling was performed using NONMEM 7.3. The model was evaluated on the remaining third of neonates (n = 1213). RESULTS Key population characteristics (median [range]) of the whole sample were gestational age 39.9 [34.4-42.4] weeks, birth weight 3400 [1980-5580] g, maternal age 32 [15-51] years, cesarean section 26%, and girls 50%. The model demonstrated good predictive performance (bias 0.01%, precision 0.56%), and is able to accurately predict individual weight change (bias 0.15%, precision 1.43%) and the dose-dependent effects of supplemental feeding up to 1 week after birth based on weight measurements during the first 3 days of life, including birth weight, and the following characteristics: gestational age, gender, delivery mode, type of feeding, maternal age, and parity. CONCLUSIONS We present the first mathematical model not only to describe weight change in term and late preterm neonates but also to provide an educational online tool for personalized weight prediction in the first week of life.
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Affiliation(s)
- Mélanie Wilbaux
- Paediatric 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.
| | - Julia Gromann
- Division of Neonatology, University of Basel Children's Hospital (UKBB), Basel, Switzerland.
| | - Isabella Mancino
- Division of Neonatology, University of Basel Children's Hospital (UKBB), Basel, Switzerland.
| | - Tania Coscia
- 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 Neonatology, University of Basel Children's Hospital (UKBB), Basel, Switzerland; Division of Clinical Pharmacology, Children's National Health System, Washington, DC, USA.
| | - Marc Pfister
- Division of Neonatology, University of Basel Children's Hospital (UKBB), Basel, Switzerland; Quantitative Solutions LP, Menlo Park, CA, USA.
| | - Sven Wellmann
- Division of Neonatology, University of Basel Children's Hospital (UKBB), Basel, Switzerland.
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17
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Bogen DL, Hanusa BH, Baker R, Medoff-Cooper B, Cohlan B. Randomized Clinical Trial of Standard- Versus High-Calorie Formula for Methadone-Exposed Infants: A Feasibility Study. Hosp Pediatr 2018; 8:7-14. [PMID: 29263124 PMCID: PMC5744267 DOI: 10.1542/hpeds.2017-0114] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Newborns who are prenatally exposed to methadone are at risk for neonatal abstinence syndrome and the associated excess weight loss and poor weight gain. This pilot feasibility study aimed to evaluate early caloric enhancement on weight patterns among infants born to women receiving methadone maintenance therapy while pregnant. METHODS In this double-blind pilot feasibility study, we randomly assigned infants with fetal methadone exposure to 24 or 20 kcal/oz formula from days 3 to 21. Randomization was stratified by any breastfeeding, sex of the infant, and gestational age. Eligible infants were ≥35 weeks' gestation and weighed ≥2200 g. Outcomes were days to weight nadir, maximum percent weight loss, days to birth weight, percentage weight change per day, and feasibility. RESULTS A total of 49 infants were randomly assigned (22 to standard- and 27 to high-calorie formula); groups had comparable demographic characteristics. Main outcomes comparing standard- to high-calorie formula groups were not significant (days to weight nadir, 5.0 vs 4.4 days; P = .20; maximum percent weight loss, -9.4% vs -8.6%; P = .15; days to birth weight, 14.7 vs 13.6 days; P = .07); however, in longitudinal analyses (days 4 to 21), the high-calorie group had a higher percent weight gained per day compared with the standard-calorie group (P <.001). There were high levels of protocol adherence, and no adverse effects were observed. CONCLUSIONS Study findings suggest that early initiation of high-calorie formula for infants with prenatal methadone exposure may be beneficial for weight gain; evaluation in a larger study is warranted.
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Affiliation(s)
| | | | - Robyn Baker
- Newborn Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania; and
| | - Barbara Medoff-Cooper
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Barbara Cohlan
- Newborn Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania; and
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18
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Affiliation(s)
- Maya Bunik
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO
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19
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Paul IM, Maisels MJ. Can I Stop Phototherapy for This Baby? Pediatrics 2017; 139:peds.2016-3832. [PMID: 28196933 DOI: 10.1542/peds.2016-3832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ian M Paul
- Departments of Pediatrics, and .,Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania; and
| | - M Jeffrey Maisels
- Department of Pediatrics, Beaumont Children's Hospital and Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
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20
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Eltonsy S, Blinn A, Sonier B, DeRoche S, Mulaja A, Hynes W, Barrieau A, Belanger M. Intrapartum intravenous fluids for caesarean delivery and newborn weight loss: a retrospective cohort study. BMJ Paediatr Open 2017; 1:e000070. [PMID: 29637114 PMCID: PMC5862158 DOI: 10.1136/bmjpo-2017-000070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To examine weight loss (WL) and excess weight loss (EWL) among newborns of caesarean delivery, comparing colloids plus crystalloids versus crystalloids only. Also, to examine different doses of intrapartum intravenous fluids on WL and EWL. DESIGN Comparative safety retrospective cohort study. SETTING University Teaching Hospital, Moncton, Canada. PATIENTS Mothers exposed to intravenous fluids with caesarean delivery between 2008 and 2016. INTERVENTIONS Exposure to colloids plus crystalloids was compared with crystalloids only, and dose-response analyses were performed for colloids, crystalloids and total intravenous fluids doses. Linear and logistic regression models were used, adjusting for potential confounders. MAIN OUTCOME MEASURES Infants' WL was measured at days 1, 2 and 3 post partum, and EWL defined as loss of >7% of birth weight. RESULTS From 801 mother-infant pairs, 176 were exposed to colloids plus crystalloids and 625 were exposed to crystalloids only (overall mean birth weight=3416 g, EWL=2%, 41.4% and 55.5% on days 1, 2 and 3, respectively). No significant difference in newborns' WL was observed on any of the days assessed. Adjusted OR (95% CI) of EWL was 1.0 (0.3 to 3.3) at 24 hours, 1.0 (0.7 to 1.5) at 48 hours and 1.4 (0.9 to 2.2) at 72 hours. No dose-response relationship was detected with type-specific and total intravenous fluids exposures. CONCLUSIONS The risk of EWL was similar with colloids plus crystalloids and crystalloids only, suggesting that both therapeutic options can be considered during caesarean delivery. The absence of dose-response relationships adds confirmatory evidence to the intravenous fluids safety profiles.
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Affiliation(s)
- Sherif Eltonsy
- Centre de formation médicale du Nouveau-Brunswick, Moncton, Canada.,The Maritime SPOR SUPPORT Unit (MSSU), Moncton, Canada
| | - Alain Blinn
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Canada.,Dieppe Family Medicine Unit, Dieppe, Canada
| | | | - Steven DeRoche
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Canada.,Dieppe Family Medicine Unit, Dieppe, Canada
| | - Aubin Mulaja
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Canada.,Dieppe Family Medicine Unit, Dieppe, Canada
| | - William Hynes
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Canada.,Dieppe Family Medicine Unit, Dieppe, Canada
| | - André Barrieau
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Canada.,Dieppe Family Medicine Unit, Dieppe, Canada
| | - Mathieu Belanger
- Centre de formation médicale du Nouveau-Brunswick, Moncton, Canada.,Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Canada.,Dieppe Family Medicine Unit, Dieppe, Canada.,Research Centre, Vitalité Health Network, Moncton, Canada
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21
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Paul IM, Schaefer EW, Miller JR, Kuzniewicz MW, Li SX, Walsh EM, Flaherman VJ. Weight Change Nomograms for the First Month After Birth. Pediatrics 2016; 138:peds.2016-2625. [PMID: 27940721 DOI: 10.1542/peds.2016-2625] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Clinicians expect newborns to surpass birth weight by age 10 to 14 days, yet few studies have examined the natural history of weight change in the weeks after birth. We sought to determine the distribution of weight loss and subsequent regain during the first month, the proportion not surpassing birth weight by 14 and 21 days, and whether findings differed by delivery mode. METHODS For 161 471 singleton neonates delivered at ≥36 weeks' gestation at Kaiser Permanente Northern California Medical Centers between 2009 and 2013 and weighing 2000 to 5000 g at birth, we extracted daily weights from inpatient electronic records and weights from outpatient visits in the first month. Quantile regression appropriate for repeated measures was used to estimate percentiles of weight change as a function of time after birth, stratified by delivery mode. RESULTS After exclusions, weight data were analyzed from 143 889 newborns (76% born vaginally). Based on percentile estimates, 50% of newborns were at or above birth weight at 9 and 10 days after vaginal and cesarean delivery, respectively. Among those delivered vaginally, 14% and 5% were not back to birth weight by 14 and 21 days, respectively. For those delivered by cesarean, 24% and 8% were not back to birth weight by 14 and 21 days, respectively. CONCLUSIONS It is not uncommon for newborns to be below birth weight 10 to 14 days after delivery. A larger percentage of newborns delivered by cesarean had yet to regain birth weight at every time point through 1 month.
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Affiliation(s)
- Ian M Paul
- Departments of Pediatrics and .,Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Eric W Schaefer
- Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Michael W Kuzniewicz
- Division of Research, Kaiser Permanente, Oakland, California; and.,Departments of Pediatrics and
| | - Sherian X Li
- Division of Research, Kaiser Permanente, Oakland, California; and
| | - Eileen M Walsh
- Division of Research, Kaiser Permanente, Oakland, California; and
| | - Valerie J Flaherman
- Departments of Pediatrics and.,Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California
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22
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Morbidity and mortality among exclusively breastfed neonates with medium-chain acyl-CoA dehydrogenase deficiency. Genet Med 2016; 18:1315-1319. [PMID: 27148938 DOI: 10.1038/gim.2016.49] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/11/2016] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Despite greatly improved morbidity and mortality among infants with medium-chain acyl-CoA dehydrogenase deficiency (MCAD) since the implementation of universal newborn screening (NBS), a population of neonates still becomes ill before their positive screen results are available. Exclusive breastfeeding is a proposed risk factor in this group. Since initial studies of MCAD NBS, breastfeeding rates have increased substantially. In this study, we quantify the current risk of early decompensation in neonates with MCAD and identify factors associated with poor outcomes. METHODS We completed a retrospective analysis of neonates with MCAD referred to our center between 2010 and 2015. RESULTS Of 46 infants with MCAD, 11 (23.9%) were symptomatic before the return of the NBS results. Four died or had cardiac arrest; the remaining seven had lethargy and hypoglycemia. All symptomatic patients were exclusively breastfed; only 40.6% of asymptomatic patients were exclusively breastfed. Breastfeeding rates increased from 45.5% in 2010-2011 to 64.7% in 2012-2013 and 87.5% in 2014-2015. Over these same periods, rates of early decompensation increased from 9.09% to 23.5% and 75%, respectively. CONCLUSIONS Exclusively breastfed neonates with MCAD are at risk for early metabolic decompensation. As breastfeeding rates increase, close management of feeding difficulties is essential for all neonates awaiting NBS results.Genet Med 18 12, 1315-1319.
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Tinius RA, Cahill AG, Strand EA, Cade WT. Maternal inflammation during late pregnancy is lower in physically active compared with inactive obese women. Appl Physiol Nutr Metab 2015; 41:191-8. [PMID: 26799789 DOI: 10.1139/apnm-2015-0316] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The primary purpose of this study was to compare maternal plasma inflammation between physically active and inactive obese women during late pregnancy. The secondary purpose was to examine the relationships between maternal plasma inflammation and lipid metabolism and maternal and neonatal metabolic health in these women. A cross-sectional, observational study design was performed in 16 obese-inactive (OBI; means ± SD; age, 25.0 ± 4.8 years; prepregnancy body mass index (BMI), 36.3 ± 4.3 kg/m(2); body fat percentage in late gestation, 37.7% ± 3.5%) and 16 obese-active (OBA; age, 28.9 ± 4.8 years; prepregnancy BMI, 34.0 ± 3.7 kg/m(2); body fat in late gestation, 36.6% ± 3.8%) women during the third trimester of pregnancy. Maternal plasma inflammation (C -reactive protein (CRP)) and insulin resistance (Homeostatic Model Assessment-Insulin Resistance) were measured at rest. Plasma lipid concentration and metabolism (lipid oxidation and lipolysis) were measured at rest, during a 30-min bout of low-intensity (40% peak oxygen uptake) exercise, and during a resting recovery period using indirect calorimetry. Umbilical cord blood was collected for measurement of neonatal plasma insulin resistance, inflammation, and lipid concentration. Neonatal body composition was measured via air displacement plethysmography. Maternal plasma CRP concentration was significantly higher in OBI compared with OBA women (9.1 ± 4.0 mg/L vs. 6.3 ± 2.5 mg/L, p = 0.02). Maternal plasma CRP concentration was significantly associated with maternal lipolysis (r = 0.43, p = 0.02), baseline lipid oxidation rate (r = 0.39, p = 0.03), and baseline plasma free fatty acid concentration (r = 0.36, p = 0.04). In conclusion, maternal physical activity may reduce inflammation during pregnancy in obese women. Maternal lipid metabolism is related to systemic inflammation.
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Affiliation(s)
- Rachel A Tinius
- a Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63139, USA
| | - Alison G Cahill
- b Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Eric A Strand
- b Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - W Todd Cade
- a Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63139, USA
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24
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Ahn Y, Kim N, Lee E, Kwak M. Weight Variation in Term Newborns Hospitalized during Early Postnatal Period. CHILD HEALTH NURSING RESEARCH 2015. [DOI: 10.4094/chnr.2015.21.4.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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