1
|
Ahmed S, Rehman AU, Bibi Z, Iftikhar S, Raza M, Yousuf HMA, Naz F, Shah SAM, Mir SL, Bibi A, Khan WA, Salat MS, Ambreen G, Hussain K. Predictors for poor daily weight gain in preterm neonates exposed to different dose regimens of caffeine in ICU- a retrospective cohort study. BMC Pediatr 2024; 24:401. [PMID: 38898410 DOI: 10.1186/s12887-024-04850-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND With a wide therapeutic index, efficacy, ease of use, and other neuroprotective and respiratory benefits, caffeine citrate(CC) is currently the drug of choice for preterm neonates (PTNs). Caffeine-induced excessive energy expenditure, diuresis, natriuresis, and other CC-associated potential side-effects (CC-APSEs) result in lower daily-weight gain (WG) in premature neonates. This study aimed to evaluate the risk factors for daily-WG in neonates exposed to different dose regimens of caffeine in ICU. METHOD This retrospective cohort study included neonates of ≤ 36weeks gestational age (GA) and received CC-therapy. The same participants were followed for data analysis in two postnatal phases: 15-28 and 29-42 days of life (DOL). Based on daily CC-dose, formed group-I (received; standard-doses = 5 mg/kg/day), group-II (received;>5-7 mg/kg/day), and group-III (received;>7 mg/kg/day). Prenatal and postnatal clinical characteristics, CC-regimen, daily-WG, CC-APSEs, and concomitant risk-factors, including daily-caloric intake, Parenteral-Nutrition duration, steroids, diuretics, and ibuprofen exposure, were analyzed separately for group-II and group-III using group-I as standard. Regression analysis was performed to evaluate the risk factors for daily-WG. RESULTS Included 314 PTNs. During 15-28 DOL, the mean-daily-WG(MD-WG) was significantly higher in group-I than group-II [19.9 ± 0.70 g/kg/d vs. 17.7 ± 0.52 p = 0.036] and group-III [19.9 ± 0.70 g/kg/d vs. 16.8 ± 0.73 p < 0.001]. During 29-42 DOL the MD-WG of group-I was only significantly higher than group-III [21.7 ± 0.44 g/kg/d vs. 18.3 ± 0.41 g/kg/d p = 0.003] and comparable with group-II. During 15-28 DOL, observed CC-APSEs was significantly higher in group-II and III but during 29-42 DOL it was only significant in group-III. In the adjusted regression analysis for daily-WG during 15-28DOL, with respect to standard-dose, 5-7 mg/kg/day (β=-1.04; 95%CI:-1.62,-0.93) and > 7-10 mg/kg/day (β=-1.36; 95%CI:-1.56,-1.02) were associated with a lower daily-WG. However, during 29-42DOL, this association was present only for > 7-10 mg/kg/day (β=-1.54; 95%CI:-1.66,-1.42). The GA ≤ 27weeks (β=-1.03 95%CI:-1.24, -0.88) was associated with lower daily-WG only during 15-28DOL. During both periods of therapy, higher cumulative-caffeine dose and presence of culture proven sepsis, tachypnea, hyponatremia, and feeding intolerance were significantly associated with lower daily-WG. Conversely, daily kcal intake was found to be linked with an increase in daily-WG in both periods. CONCLUSION In this study cohort exposure to higher caffeine daily and cumulative doses is associated with lower postnatal daily-WG in PTNs than standard-daily doses, which may be due to its catabolic effects and CC-APSEs.
Collapse
Affiliation(s)
- Saeed Ahmed
- Department of Pediatrics & Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Ayaz Ur Rehman
- Department of Pediatrics & Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Zainab Bibi
- Department of Pediatrics & Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Sundus Iftikhar
- Department of Pediatrics & Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Maleeha Raza
- Department of Pediatrics & Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Fizzah Naz
- Department of Pediatrics & Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Ayesha Bibi
- Dow University of Health Sciences, Karachi, Pakistan
| | - Wasif Ahmed Khan
- Department of Pediatrics & Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Sohail Salat
- Department of Pediatrics & Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Gul Ambreen
- Department of Pediatrics & Child Health, Aga Khan University Hospital, Karachi, Pakistan.
| | - Kashif Hussain
- Department of Pharmacy , Aga Khan University Hospital, Karachi, Pakistan
| |
Collapse
|
2
|
Kumar N, Al-Nahar M, Harris N, Sampath V. Early and Higher Volumes of Formula Supplementation after Birth Impact Breastfeeding Rates at Discharge in Well-Baby Nursery: A Retrospective Cohort Study. Am J Perinatol 2024; 41:e3293-e3304. [PMID: 38011861 DOI: 10.1055/a-2217-9174] [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: 11/29/2023]
Abstract
OBJECTIVE Physiologic breast milk production in the first 24 hours is estimated to be between 2 and 10 mL per feed. Many mothers intending to breastfeed use formula supplementation (FS) early on, which can affect successful breastfeeding. Whether the volume and timing of FS introduced in the first 24 hours of life (24 HOL) impacts the rate of "breastfeeding at discharge" (BFAD) is not well-studied and was investigated herein. STUDY DESIGN Single-center, retrospective, chart review of breastfeeding infants born at ≥35 weeks who received supplementation in the first 24 HOL. Comprehensive demographic data pertaining to maternal and infant characteristics, along with infant feeding data, were collected. Four supplementation characteristics, (timing, rate, volume [mL/kg per feed], and type [expressed breast milk (EBM) or formula]) were correlated with BFAD. RESULTS Among 3,102 supplemented infants in whom mothers intended to breastfeed, 1,031 (33.2%) infants were BFAD. At baseline, African American, Medicaid-insured, and single mothers had lower odds of BFAD. The overall maximum volume of FS per feed was 11.0 mL/kg (interquartile range 8.0-14.4). With each hour of delay in first supplementation, the odds of BFAD increased by 2.8% (95% confidence interval [CI] 0.022, 0.035). With every 1 mL/kg increase in the first formula volume, subsequent supplementation frequency increased by 4.5%. A positive association was observed between BFAD and a lower rate of supplementation (cutoff value ≤35.1%). However, among infants with these lower rates of supplementation, each unit increase in maximum FS, from 2 to 15 mL/kg, decreased the probability of BFAD by 4.2% (3.6-4.7%). Additionally, we observed that infants who were given at least one EBM supplementation (n = 223; 7.2%) had substantially increased rates of BFAD (odds ratio [OR] = 9.8, 95% CI 7.2-13.3). CONCLUSION Early and higher volumes of FS negatively impacted BFAD. Birthweight-based FS of feeding with physiological volumes may increase breastfeeding rates at discharge. KEY POINTS · Higher volumes of first supplementation increases subsequent supplementation frequency.. · For each unit increase in maximum supplementation, BFAD probability decreases by 4.2%.. · Even one EBM supplementation increases rates of BFAD..
Collapse
Affiliation(s)
- Navin Kumar
- Department of Pediatrics/Neonatology, Hurley Children's Hospital, Flint, Michigan
| | - Mohammed Al-Nahar
- Department of Pediatrics/Neonatology, Hurley Children's Hospital, Flint, Michigan
| | - Nathalee Harris
- Department of Pediatrics/Neonatology, Hurley Children's Hospital, Flint, Michigan
| | - Venkatesh Sampath
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
| |
Collapse
|
3
|
Hussain I, Kumar M, Ali A, Naz F, Khan WA, Salat MS, Rauf S, Ambreen G, Hussain K. Dose-Response Study of Caffeine on Postnatal Weight Gain in Premature Neonates-A Retrospective Cohort Study. Dose Response 2024; 22:15593258241247185. [PMID: 38617389 PMCID: PMC11016235 DOI: 10.1177/15593258241247185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Accepted: 03/27/2024] [Indexed: 04/16/2024] Open
Abstract
Background Caffeine citrate (CC)-induced excessive energy expenditure, diuresis, natriuresis, and other CC-associated potential side effects (CC-APSEs) result in lower daily weight gain (WG) in premature neonates. This study aimed to assess higher CC-doses' effect on the mean daily-WG (MD-WG) and CC-APSE development, considering 5 mg/kg/day as the standard regimen. Method This retrospective cohort study included neonates of ≤36 weeks gestational age and received CC-therapy. The same participants were followed for data analysis in two postnatal phases: 15-28 and 29-42 days of life (DOL). Based on daily CC-dose, formed group-I=(5 mg/kg/day), group-II=(>5-7 mg/kg/day), and group-III=(>7 mg/kg/day). Data was analyzed separately for group-II and group-III using group-I as the standard. Results The study included 284 neonates. During phase-I, the MD-WG was significantly higher in group-I than group-II (19.9 ± .88 g/kg/d vs 17.5 ± .49, P = .031) and group-III (19.9 ± .88 g/kg/d vs 16.7 ± .71, P < .001). During 29-42 DOL, the MD-WG of group-I was only significantly higher than group-III (21.5 ± .42 g/kg/d vs 18.1 ± .39 g/kg/d, P = .003) and comparable with group-II. During 15-28 DOL, CC-APSEs were significantly higher in group-II and group-III but during 29-42 DOL was significant only in group-III. Conclusion Exposure to higher caffeine doses in this study cohort is associated with lower postnatal WG in preterm neonates than standard daily doses may be due to its catabolic effects and CC-APSEs.
Collapse
Affiliation(s)
- Ijaz Hussain
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Manoj Kumar
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Amin Ali
- Department of Neonatology & Paediatrics, Dow University of Health Sciences, Karachi, Pakistan
| | - Fizzah Naz
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Wasif Ahmed Khan
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Shahzad Rauf
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Gul Ambreen
- Department of Pharmacy, Aga Khan University Hospital, Karachi, Pakistan
| | - Kashif Hussain
- Department of Pharmacy, Aga Khan University Hospital, Karachi, Pakistan
| |
Collapse
|
4
|
Mallick LM, Shenassa ED. Variation in Breastfeeding Initiation and Duration by Mode of Childbirth: A Prospective, Population-Based Study. Breastfeed Med 2024; 19:262-274. [PMID: 38535749 DOI: 10.1089/bfm.2023.0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Introduction: Despite known benefits of breastfeeding, including prevention against infections for infants, in the presence of numerous barriers, less than half of infants in high-income countries breastfeed for 6 months. One potential barrier to breastfeeding is birth by cesarean section (C-Section), which can invoke long-term difficulties. However, our structured literature review found that existing empirical research does not fully elucidate this relationship due to differences in operationalization of C-section and breastfeeding, omission of important confounders, and failure to exclude those who did not initiate breastfeeding (or use time-to-event analyses). In this article, we attempt to overcome these limitations. Methods: We analyzed data from 14,414 mother-infant dyads enrolled in the United Kingdom-based prospective Millennium Cohort Study, beginning in 2001. Using multivariable logistic regression, we examined the association between mode of birth (vaginal, emergency C-section, and elective C-section) and likelihood of breastfeeding initiation. We then applied adjusted Accelerated Failure Time survival models to examine the associations between mode of birth and duration of any and exclusive breastfeeding. Results: Those with planned (but not emergency) C-section were less likely to initiate breastfeeding (odds ratio: 0.84, 95% confidence interval [CI]: 0.71-0.99) relative to vaginal births. However, those with either planned or unplanned C-section discontinued both any and exclusive breastfeeding sooner than vaginal births. This effect was more pronounced for those with planned C-section (time ratio [TR]: 0.75, 95% CI: 0.64-0.89) than unplanned C-section (TR: 0.85, 95% CI: 0.74, 0.97) compared with vaginal births. Conclusions: Through application of rigorous methods, this study provides compelling evidence that breastfeeding duration may be impeded by C-section birth. The findings suggest that additional support for mothers who intend to breastfeed and have a C-section birth may be warranted.
Collapse
Affiliation(s)
- Lindsay M Mallick
- Maternal and Child Health Program, Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland, USA
- College of Behavioral and Social Sciences, Maryland Population Research Center, University of Maryland, College Park, Maryland, USA
- Avenir Health, Glastonbury, Connecticut, USA
| | - Edmond D Shenassa
- Maternal and Child Health Program, Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland, USA
- College of Behavioral and Social Sciences, Maryland Population Research Center, University of Maryland, College Park, Maryland, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, Maryland, USA
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
- Department of Epidemiology & Biostatistics, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| |
Collapse
|
5
|
Jurgelėnė V, Kuzmickienė V, Stonienė D. The Role of Skin-to-Skin Contact and Breastfeeding in the First Hour Post Delivery in Reducing Excessive Weight Loss. CHILDREN (BASEL, SWITZERLAND) 2024; 11:232. [PMID: 38397344 PMCID: PMC10887814 DOI: 10.3390/children11020232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/01/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
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.
Collapse
Affiliation(s)
- Valentina Jurgelėnė
- Department of Neonatology, Faculty of Medicine, Lithuanian University of Health Sciences, LT44307 Kaunas, Lithuania; (V.J.); (V.K.)
- Department of Neonatology, Hospital of Lithuanian University of Health Sciences (LUHS) Kauno Klinikos, LT50161 Kaunas, Lithuania
| | - Vilma Kuzmickienė
- Department of Neonatology, Faculty of Medicine, Lithuanian University of Health Sciences, LT44307 Kaunas, Lithuania; (V.J.); (V.K.)
- Department of Neonatology, Hospital of Lithuanian University of Health Sciences (LUHS) Kauno Klinikos, LT50161 Kaunas, Lithuania
| | - Dalia Stonienė
- Department of Neonatology, Faculty of Medicine, Lithuanian University of Health Sciences, LT44307 Kaunas, Lithuania; (V.J.); (V.K.)
| |
Collapse
|
6
|
Raj Kumawat S, Vyas H, Mohan R, Sasidharan R, Yadav B, Gupta N. 90 versus 60 min of early skin-to-skin contact on exclusive breastfeeding rate in healthy infants' ≥35 weeks: A randomised controlled trial. Acta Paediatr 2024; 113:199-205. [PMID: 37905336 DOI: 10.1111/apa.17021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/01/2023] [Accepted: 10/19/2023] [Indexed: 11/02/2023]
Abstract
AIM To compare the effect of 90 versus 60 min of early skin-to-skin contact (SSC) among vaginally born healthy infants ≥35 weeks of gestation on their exclusive breastfeeding rates and breastfeeding behaviour. METHODS This parallel-group, open-label, randomised controlled trial enrolled healthy term and late preterm infants born vaginally. Infants in the intervention group received early SSC for 90 min compared to 60 min in the control group. The primary outcome was the proportion of infants on exclusive breastfeeding at 60 ± 12 h. RESULTS One hundred ninety-eight mother-infant dyads were randomised (99 in each group). The infants in the 90-min SSC group were more likely to be exclusively breastfed at 60 ± 12 h as compared to the 60-min SSC group (RR, 95% CI-1.44, [1.15-1.79], p < 0.01). The modified infant breastfeeding assessment tool score at 60 ± 12 h was significantly higher in the 90-min SSC group (median [IQR]-9, [8, 10] versus 8 [7, 10], p = 0.03]. The proportion of infants on exclusive breastfeeding at 6, 10, and 14 weeks of age was also significantly higher in the 90-min SSC group (RR, 95% CI-1.39 [1.11-1.74], 1.36 [1.08-1.07], and 1.38 [1.08-1.75], respectively). CONCLUSION Increasing the duration of early SSC showed a dose-response benefit on exclusive breastfeeding rates and breastfeeding behaviour. TRIAL REGISTRATION CTRI/2018/09/015632, registered on 06/09/2018.
Collapse
Affiliation(s)
- Shalini Raj Kumawat
- College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Himanshu Vyas
- College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Remiya Mohan
- College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rohit Sasidharan
- Department of Neonatology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Bharti Yadav
- Department of Neonatology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Neeraj Gupta
- Department of Neonatology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| |
Collapse
|
7
|
Hsu CY, Syue JC. Working dilemmas in care for breastfed newborns: An exploratory study in a single center in Taiwan. Work 2024:WOR230249. [PMID: 38277329 DOI: 10.3233/wor-230249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Clinical medical staff should be aware of and examine the correlation between breastfeeding and neonatal hospitalization. Additional attention should be paid to work dilemmas experienced by the nursing staff caring for newborns to avoid exposing newborns to hospitalization risk. OBJECTIVE The present study investigated the working dilemmas by neonatal nurses caring for breastfed newborns and risk of newborn hospitalization. METHODS This hospital-based study in Taiwan surveyed 84 neonatal nurses using a structured questionnaire entitled "Working Dilemmas in Clinical Care for Breastfed Newborns." RESULTS Collected data were analyzed statistically (descriptive analysis, chi-square test, and t test) using Statistical Package for the Social Sciences (SPSS) software. Neonatal intensive care unit (NICU) staff noted that breastfed newborns showed a high risk of hospitalization and nursery staff highlighted a lack of manpower and time. NICU staff experienced more working dilemmas (117.460±12.260) than nursery staff (87.410±15.820) when caring for breastfed newborns (t = 1.080, P < 0.001). NICU staff reported a higher risk of hospitalization in breastfed newborns and experienced more working dilemmas caring for these patients compared with nursery staff, who reported a lack of manpower and time. CONCLUSION Our findings highlight the working dilemmas by neonatal nurses and can serve as a foundation for further critical studies.
Collapse
Affiliation(s)
- Chen-Yuan Hsu
- Department of Nursing, College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan
| | - Jia-Ci Syue
- Department of Nursing, College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Beretta S, Apparicio M, Toniollo GH, Cardozo MV. The importance of the intestinal microbiota in humans and dogs in the neonatal period. Anim Reprod 2023; 20:e20230082. [PMID: 38026003 PMCID: PMC10681130 DOI: 10.1590/1984-3143-ar2023-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/01/2023] [Indexed: 12/01/2023] Open
Abstract
The neonatal period represents a critical stage for the establishment and development of the gut microbiota, which profoundly influences the future health trajectory of individuals. This review examines the importance of intestinal microbiota in humans and dogs, aiming to elucidate the distinct characteristics and variations in the composition between these two species. In humans, the intestinal microbiota contributes to several crucial physiological processes, including digestion, nutrient absorption, immune system development, and modulation of host metabolism. Dysbiosis, an imbalance or disruption of the gut microbial community, has been linked to various disorders, such as inflammatory bowel disease, obesity, and even neurological conditions. Furthermore, recent research has unveiled the profound influence of the gut-brain axis, emphasizing the bidirectional communication between the gut microbiota and the central nervous system, impacting cognitive function and mental health. Similarly, alterations in the canine intestinal microbiota have been associated with gastrointestinal disorders, including chronic enteropathy, such as inflammatory bowel disease, food allergies, and ulcerative histiocytic colitis. However, our understanding of the intricacies and functional significance of the intestinal microbiota in dogs remains limited. Understanding the complex dynamics of the intestinal microbiota in both humans and dogs is crucial for devising effective strategies to promote health and manage disease. Moreover, exploring the similarities and differences in the gut microbial composition between these two species can facilitate translational research, potentially leading to innovative therapeutic interventions and strategies to enhance the well-being of both humans and dogs.
Collapse
Affiliation(s)
- Samara Beretta
- Departamento de Patologia, Reprodução e Saúde Única, Faculdade de Ciências Agrárias e Veterinárias (FCAV), Universidade Estadual Paulista (UNESP), Jaboticabal, SP, Brasil
| | - Maricy Apparicio
- Departamento de Cirurgia Veterinária e Reprodução Animal, Faculdade de Medicina Veterinária e Zootecnia (FMVZ), Universidade Estadual Paulista (UNESP), Botucatu, SP, Brasil
| | - Gilson Hélio Toniollo
- Departamento de Patologia, Reprodução e Saúde Única, Faculdade de Ciências Agrárias e Veterinárias (FCAV), Universidade Estadual Paulista (UNESP), Jaboticabal, SP, Brasil
| | - Marita Vedovelli Cardozo
- Laboratório de Fisiologia de Microorganismos, Departamento de Ciências Biomédicas e Saúde, Universidade do Estado de Minas Gerais (UEMG), Passos, MG, Brasil
| |
Collapse
|
10
|
Valentine GC, Perez K, Hair AB. Early Fluid and Nutritional Management of Extremely Preterm Newborns During the Fetal-To-Neonatal Transition. Clin Perinatol 2023; 50:545-556. [PMID: 37536763 DOI: 10.1016/j.clp.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
During the fetal-to-neonatal transitional period, extremely preterm newborns undergo significant intrabody fluid shifts and resulting weight loss due to increased insensible fluid losses due to immature skin, kidneys, among other factors. These ongoing physiologic changes make fluid and nutritional management complex in the neonatal-to-fetal transitional time period for extremely premature newborns. However, limited literature exists to guide optimal practices for providers caring for this population. Here, we review the evidence on optimal fluid and nutritional management during the fetal-to-neonatal transition of extremely preterm newborns.
Collapse
Affiliation(s)
- Gregory C Valentine
- Division of Neonatology, Department of Pediatrics, University of Washington, Box 356320, RR542 HSB, Seattle, WA, USA.
| | - Krystle Perez
- Division of Neonatology, Department of Pediatrics, University of Washington, Box 356320, RR542 HSB, Seattle, WA, USA
| | - Amy B Hair
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin Street, Suite W6104, Houston, TX 77030, USA
| |
Collapse
|
11
|
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.
Collapse
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
| | | |
Collapse
|
12
|
Wood NK, Barbosa-Leiker C, Odom-Maryon T. Determinants of exclusive direct breastfeeding using constructs from the breastfeeding relationship scale. J Reprod Infant Psychol 2023:1-15. [PMID: 36939003 DOI: 10.1080/02646838.2023.2191113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
OBJECTIVES This study examined the relationship among constructs of the Breastfeeding Relationship Scale and exclusive direct breastfeeding (EDBF) while controlling for covariates in US breastfeeding dyads in the first 3 months. BACKGROUND The Breastfeeding Relationship Scale was developed to measure mother-infant mutual responsiveness during breastfeeding in response to perceived insufficient milk, but there is no clear understanding about the relationships between the Breastfeeding Relationship Scale's constructs and EDBF. METHODS A cross-sectional design was used. The convenience sample of 589 directly breastfeeding mothers in the US whose infants were between 1 and 12 weeks of age were included for analysis using a structural equation model. Covariates for EDBF included mother's age, education, marital status, parity, prior breastfeeding experience, infant's age, weight, and sex. RESULTS Mother-Infant Breastfeeding Interaction and Breastfeeding Synchronicity were related (β = 0.33, p < .001), as were Breastfeeding Synchronicity and Perceived Adequate Milk Supply (β = 0.35, p < .001) and Mother-Infant Breastfeeding Interaction and Perceived Adequate Milk Supply (β = 0.08, p = .05). The relationship between Mother-Infant Breastfeeding Interaction and Breastfeeding Synchronicity with EDBF was fully mediated by Perceived Adequate Milk Supply, where the odds of EDBF was higher for mothers with higher scores on Perceived Adequate Milk Supply (OR = 1.61, p < .001) and prior breastfeeding experience (OR = 2.31, p = .006). CONCLUSIONS Perceived Adequate Milk Supply and prior breastfeeding experience are major determinants of EDBF in the first 3 months. Breastfeeding Synchronicity can bolster Mother-Infant Breastfeeding Interaction and promote Perceived Adequate Milk. More attention should be paid to breastfeeding relationship to be the result of EDBF.
Collapse
Affiliation(s)
- Natsuko K Wood
- Assistant Professor, Washington State University College of Nursing, Spokane, WA, USA
| | - Celestina Barbosa-Leiker
- Executive Vice Chancellor For Research And Administration, Washington State University Health Sciences Spokane, Spokane, WA, USA
| | - Tamara Odom-Maryon
- Assistant Professor, Washington State University College of Nursing, Spokane, WA, USA.,Biostatistician at Washington State University College of Nursing, Spokane, WA, USA
| |
Collapse
|
13
|
Vesel L, Bellad RM, Manji K, Saidi F, Velasquez E, Sudfeld CR, Miller K, Bakari M, Lugangira K, Kisenge R, Salim N, Somji S, Hoffman I, Msimuko K, Mvalo T, Nyirenda F, Phiri M, Das L, Dhaded S, Goudar SS, Herekar V, Kumar Y, Koujalagi MB, Guruprasad G, Panda S, Shamanur LG, Somannavar M, Vernekar SS, Misra S, Adair L, Bell G, Caruso BA, Duggan C, Fleming K, Israel-Ballard K, Fishman E, Lee ACC, Lipsitz S, Mansen KL, Martin SL, Mokhtar RR, North K, Pote A, Spigel L, Tuller DE, Young M, Semrau KEA. Feeding practices and growth patterns of moderately low birthweight infants in resource-limited settings: results from a multisite, longitudinal observational study. BMJ Open 2023; 13:e067316. [PMID: 36792338 PMCID: PMC9933750 DOI: 10.1136/bmjopen-2022-067316] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVES To describe the feeding profile of low birthweight (LBW) infants in the first half of infancy; and to examine growth patterns and early risk factors of poor 6-month growth outcomes. DESIGN Prospective observational cohort study. SETTING AND PARTICIPANTS Stable, moderately LBW (1.50 to <2.50 kg) infants were enrolled at birth from 12 secondary/tertiary facilities in India, Malawi and Tanzania and visited nine times over 6 months. VARIABLES OF INTEREST Key variables of interest included birth weight, LBW type (combination of preterm/term status and size-for-gestational age at birth), lactation practices and support, feeding profile, birthweight regain by 2 weeks of age and poor 6-month growth outcomes. RESULTS Between 13 September 2019 and 27 January 2021, 1114 infants were enrolled, comprising 4 LBW types. 363 (37.3%) infants initiated early breast feeding and 425 (43.8%) were exclusively breastfed to 6 months. 231 (22.3%) did not regain birthweight by 2 weeks; at 6 months, 280 (32.6%) were stunted, 222 (25.8%) underweight and 88 (10.2%) wasted. Preterm-small-for-gestational age (SGA) infants had 1.89 (95% CI 1.37 to 2.62) and 2.32 (95% CI 1.48 to 3.62) times greater risks of being stunted and underweight at 6 months compared with preterm-appropriate-for-gestational age (AGA) infants. Term-SGA infants had 2.33 (95% CI 1.77 to 3.08), 2.89 (95% CI 1.97 to 4.24) and 1.99 (95% CI 1.13 to 3.51) times higher risks of being stunted, underweight and wasted compared with preterm-AGA infants. Those not regaining their birthweight by 2 weeks had 1.51 (95% CI 1.23 to 1.85) and 1.55 (95% CI 1.21 to 1.99) times greater risks of being stunted and underweight compared with infants regaining. CONCLUSION LBW type, particularly SGA regardless of preterm or term status, and lack of birthweight regain by 2 weeks are important risk identification parameters. Early interventions are needed that include optimal feeding support, action-oriented growth monitoring and understanding of the needs and growth patterns of SGA infants to enable appropriate weight gain and proactive management of vulnerable infants. TRIAL REGISTRATION NUMBER NCT04002908.
Collapse
Affiliation(s)
- Linda Vesel
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Roopa M Bellad
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India
| | - Karim Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Friday Saidi
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Esther Velasquez
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California, USA
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Katharine Miller
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mohamed Bakari
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kristina Lugangira
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Rodrick Kisenge
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nahya Salim
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sarah Somji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Irving Hoffman
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Kingsly Msimuko
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Tisungane Mvalo
- University of North Carolina Project Malawi, Lilongwe, Malawi
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Fadire Nyirenda
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Melda Phiri
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Leena Das
- Department of Paediatrics, SCB Medical College & Hospital, Cuttack, Orissa, India
| | - Sangappa Dhaded
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India
| | - Shivaprasad S Goudar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India
| | - Veena Herekar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India
| | - Yogesh Kumar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India
| | - M B Koujalagi
- Department of Paediatrics, JJM Medical College, Davangere, Karnataka, India
| | - Gowdar Guruprasad
- Department of Paediatrics, JJM Medical College, Davangere, Karnataka, India
| | | | - Latha G Shamanur
- Department of Paediatrics, SS Institute of Medical Sciences and Research Center, Davangere, Karnataka, India
| | - Manjunath Somannavar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India
| | - Sunil S Vernekar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India
| | - Sujata Misra
- Department of Paediatrics, SCB Medical College & Hospital, Cuttack, Orissa, India
| | - Linda Adair
- Department of Nutrition, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Griffith Bell
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Bethany A Caruso
- Hubert Department of Global Health, Emory University School of Public Health, Atlanta, Georgia, USA
| | - Christopher Duggan
- Center for Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Katelyn Fleming
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Eliza Fishman
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anne C C Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stuart Lipsitz
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kimberly L Mansen
- Maternal, Newborn, Child Health and Nutrition Program, PATH, Seattle, Washington, USA
| | - Stephanie L Martin
- Department of Nutrition, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Rana R Mokhtar
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Krysten North
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Arthur Pote
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lauren Spigel
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Danielle E Tuller
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Melissa Young
- Hubert Department of Global Health, Emory University School of Public Health, Atlanta, Georgia, USA
| | - Katherine E A Semrau
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
14
|
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 2022. [PMID: 36580979 DOI: 10.1055/s-0042-1759603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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..
Collapse
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
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Flaherman VJ, Ginsburg AS, Nankabirwa V, Braima da Sa A, Medel‐Herrero A, Schaefer E, Dongol S, Shrestha A, Nisar I, Altaf M, Liaquat K, Baloch B, Rahman N, Shafiq Y, Ariff S, Jehan F, Roberts SB. Newborn weight change and predictors of underweight in the neonatal period in Guinea‐Bissau, Nepal, Pakistan and Uganda. MATERNAL & CHILD NUTRITION 2022; 18:e13396. [PMID: 35821647 PMCID: PMC9480948 DOI: 10.1111/mcn.13396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 06/08/2022] [Accepted: 06/12/2022] [Indexed: 11/27/2022]
Abstract
In low‐ and middle‐income countries (LMIC), growth impairment is common; however, the trajectory of growth over the course of the first month has not been well characterised. To describe newborn growth trajectory and predictors of growth impairment, we assessed growth frequently over the first 30 days among infants born ≥2000 g in Guinea‐Bissau, Nepal, Pakistan and Uganda. In this cohort of 741 infants, the mean birth weight was 3036 ± 424 g. For 721 (98%) infants, weight loss occurred for a median of 2 days (interquartile range, 1–4) following birth until weight nadir was reached 5.9 ± 4.3% below birth weight. At 30 days of age, the mean weight was 3934 ± 592 g. The prevalence of being underweight at 30 days ranged from 5% in Uganda to 31% in Pakistan. Of those underweight at 30 days of age, 56 (59%) had not been low birth weight (LBW), and 48 (50%) had reached weight nadir subsequent to 4 days of age. Male sex (relative risk [RR] 2.73 [1.58, 3.57]), LBW (RR 6.41 [4.67, 8.81]), maternal primiparity (1.74 [1.20, 2.51]) and reaching weight nadir subsequent to 4 days of age (RR 5.03 [3.46, 7.31]) were highly predictive of being underweight at 30 days of age. In this LMIC cohort, country of birth, male sex, LBW and maternal primiparity increased the risk of impaired growth, as did the modifiable factor of delayed initiation of growth. Interventions tailored to infants with modifiable risk factors could reduce the burden of growth impairment in LMIC. In our study, 98% of infants initially lost weight after birth before beginning weight gain. Although most infants began weight gain by 2 days of age, those with delayed initiation of weight gain were more likely to be underweight at 30 days of age. Male sex, country of birth, low birth weight, maternal primiparity and delayed initiation of weight gain were predictors of being underweight at 30 days of age and of wasting at 30 days of age.
Collapse
Affiliation(s)
| | - Amy S. Ginsburg
- Clinical Trials Center University of Washington Seattle Washington USA
| | | | | | | | - Eric Schaefer
- Penn State College of Medicine Hershey Pennsylvania USA
| | - Srijana Dongol
- Kathmandu University School of Medical Sciences Dhulikhel Nepal
| | - Akina Shrestha
- Kathmandu University School of Medical Sciences Dhulikhel Nepal
| | - Imran Nisar
- Department of Paediatrics and Child Health Aga Khan University Karachi Pakistan
| | - Muddassir Altaf
- Department of Paediatrics and Child Health Aga Khan University Karachi Pakistan
| | - Khushboo Liaquat
- Department of Paediatrics and Child Health Aga Khan University Karachi Pakistan
| | - Benazir Baloch
- Department of Paediatrics and Child Health Aga Khan University Karachi Pakistan
| | - Najeeb Rahman
- Department of Paediatrics and Child Health Aga Khan University Karachi Pakistan
| | - Yasir Shafiq
- Department of Paediatrics and Child Health Aga Khan University Karachi Pakistan
| | - Shabina Ariff
- Department of Paediatrics and Child Health Aga Khan University Karachi Pakistan
| | - Fyezah Jehan
- Department of Paediatrics and Child Health Aga Khan University Karachi Pakistan
| | - Susan B. Roberts
- The Gerald J and Dorothy R Friedman School of Nutrition Science and Policy Tufts University Boston Massachusetts USA
| |
Collapse
|
17
|
del Castillo-Hegyi C, Achilles J, Segrave-Daly BJ, Hafken L. Fatal Hypernatremic Dehydration in a Term Exclusively Breastfed Newborn. CHILDREN 2022; 9:children9091379. [PMID: 36138688 PMCID: PMC9498092 DOI: 10.3390/children9091379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022]
Abstract
Hypernatremic dehydration in term newborns has steadily increased in incidence with increasing efforts to promote exclusive breastfeeding before hospital discharge, a key metric of the Baby-Friendly Hospital Initiative. The following report details a case of a term newborn infant who had evidence of poor intake while exclusively breastfeeding during his hospital stay that may not have been recognized by health care providers. The infant was discharged home and was subsequently found by the parents in cardiac arrest 12 h after discharge and was found to have hypernatremic dehydration. Although return of spontaneous circulation was achieved after fluid resuscitation, the infant sustained extensive hypoxic-ischemic brain injury due to cardiovascular collapse. Due to the infant’s extremely poor prognosis, life support was withdrawn at 19 days of age and the infant expired. This sentinel case demonstrates multiple pitfalls of current perceptions of normal vs. abnormal newborn feeding behavior, weight loss percentages, elimination patterns, and acceptable clinical thresholds believed to be safe for neonates. Newer data have shown that hypernatremia occurs commonly in healthy, term breastfed newborns at weight loss percentages previously deemed normal by most health professionals and hospital protocols. In-hospital strategies to prevent excessive weight loss and screening for hypernatremia in response to signs of inadequate feeding have the potential to prevent tens of thousands of readmissions for feeding complications a year, as well as hundreds of millions in health care costs.
Collapse
Affiliation(s)
- Christie del Castillo-Hegyi
- Department of Emergency Medicine, CHI St. Vincent, Little Rock, AR 72205, USA
- Fed is Best Foundation, Little Rock, AR 72223, USA
- Correspondence:
| | - Jennifer Achilles
- Fed is Best Foundation, Little Rock, AR 72223, USA
- TelePeds, Santa Fe, NM 87505, USA
| | | | - Lynnette Hafken
- Fed is Best Foundation, Little Rock, AR 72223, USA
- Holy Cross Hospital, Silver Spring, MD 20910, USA
| |
Collapse
|
18
|
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: 1] [Impact Index Per Article: 0.5] [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.
Collapse
|
19
|
Garrigues Q, Apper E, Chastant S, Mila H. Gut microbiota development in the growing dog: A dynamic process influenced by maternal, environmental and host factors. Front Vet Sci 2022; 9:964649. [PMID: 36118341 PMCID: PMC9478664 DOI: 10.3389/fvets.2022.964649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Microorganisms of the gastrointestinal tract play a crucial role in the health, metabolism and development of their host by modulating vital functions such as digestion, production of key metabolites or stimulation of the immune system. This review aims to provide an overview on the current knowledge of factors shaping the gut microbiota of young dogs. The composition of the gut microbiota is modulated by many intrinsic (i.e., age, physiology, pathology) and extrinsic factors (i.e., nutrition, environment, medication) which can cause both beneficial and harmful effects depending on the nature of the changes. The composition of the gut microbiota is quickly evolving during the early development of the dog, and some crucial bacteria, mostly anaerobic, progressively colonize the gut before the puppy reaches adulthood. Those bacterial communities are of paramount importance for the host health, with disturbance in their composition potentially leading to altered metabolic states such as acute diarrhea or inflammatory bowel disease. While many studies focused on the microbiota of young children, there is still a lack of knowledge concerning the development of gut microbiota in puppies. Understanding this early evolution is becoming a key aspect to improve dogs' short and long-term health and wellbeing.
Collapse
Affiliation(s)
- Quentin Garrigues
- NeoCare, ENVT, Université de Toulouse, Toulouse, France
- *Correspondence: Quentin Garrigues
| | | | | | - Hanna Mila
- NeoCare, ENVT, Université de Toulouse, Toulouse, France
| |
Collapse
|
20
|
Kemper AR, Newman TB, Slaughter JL, Maisels MJ, Watchko JF, Downs SM, Grout RW, Bundy DG, Stark AR, Bogen DL, Holmes AV, Feldman-Winter LB, Bhutani VK, Brown SR, Maradiaga Panayotti GM, Okechukwu K, Rappo PD, Russell TL. Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics 2022; 150:188726. [PMID: 35927462 DOI: 10.1542/peds.2022-058859] [Citation(s) in RCA: 112] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Alex R Kemper
- Division of Primary Care Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Thomas B Newman
- Departments of Epidemiology & Biostatistics and Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California
| | | | - M Jeffrey Maisels
- Department of Pediatrics, Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Jon F Watchko
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephen M Downs
- Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina
| | - Randall W Grout
- Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana
| | - David G Bundy
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Debra L Bogen
- Allegheny County Health Department, Pittsburgh, Pennsylvania
| | - Alison Volpe Holmes
- Geisel School of Medicine at Dartmouth, Children's Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire
| | - Lori B Feldman-Winter
- Department of Pediatrics, Division of Adolescent Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Vinod K Bhutani
- Department of Pediatrics, Neonatal and Developmental Medicine Stanford University School of Medicine, Stanford, California
| | | | - Gabriela M Maradiaga Panayotti
- Division of Primary Care, Duke Children's Hospital and Health Center, Duke University Medical Center, Durham, North Carolina
| | - Kymika Okechukwu
- Department of Quality, American Academy of Pediatrics, Itasca, Illinois
| | | | | |
Collapse
|
21
|
Qiao L, Zhang H, Yuan Y, Zhu W, Yuan J, Hu Y, Zhu H. The Relationship between Gestational Newborn Weight Loss and Hospitalization in the First Week after Birth. Appl Bionics Biomech 2022; 2022:9871177. [PMID: 35979238 PMCID: PMC9377975 DOI: 10.1155/2022/9871177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate the association of weight loss daily of term infants with hospitalization in the first week after birth. Methods This prospective cohort study was conducted among 1865 infants from May 2020 to June 2021, born in the Department of Obstetrics, Kunshan's First People's Hospital Affiliated to Jiangsu University and Huai'an Maternal and Child Health Care Center. The infants' weight was collected daily in the hospital, and the weight loss was calculated daily. According to the weight loss daily, the infants were divided into 3 groups. Group A: the weight loss per day was less than 2% of birth weight, and the total weight loss was less than 10%. Group B: the weight loss per day was between 2 and 4% of the birth weight, and the total weight loss was less than 10%. Group C: the weight loss per day was more than 4% of the birth weight, or the total weight was more than 10%. The infants in group C were monitored carefully in the hospital or Outpatient Department (OPD) daily. The primary outcome was the incidence of hospitalization. Results Of the 1865 term infants enrolled, 1052 were completed on the 7th day (356 in group A, 513 in group B, and 183 in group C). There was no significant difference among the three groups of subjects in terms of infant data, including birth weight, gender, Apgar scores, and gestational age. The number of C-sections and primiparas was substantially higher in groups C and B than in group A. The incidence of hospitalization in group C was significantly higher than that in group A and group B (30.6%, 12.1%, and 12.5%, respectively). The incidence of exclusive breastfeeding in group C was significantly lower than that in group A and group B (28.4%, 41%, and 38.4%, respectively). There was no significant difference between group A and group B in the incidence of hospitalization and exclusive breastfeeding. Most of the hospitalization was because of hyperbilirubinemia, and in group C, there were 2 babies because of dehydration fever and 3 because of hypoglycemia. Conclusions The neonates whose weight loss daily after birth was more than 4% of the total weight loss of more than 10% had higher hospitalization rates.
Collapse
Affiliation(s)
- Linxiao Qiao
- Department of Pediatrics, The First People's Hospital of Kunshan Affiliated to Jiangsu University, China
- Department of Pediatrics, Kunshan Maternity and Children's Health Care Hospital, Kunshan, China
| | - Haiyan Zhang
- Department of Pediatrics, The First People's Hospital of Kunshan Affiliated to Jiangsu University, China
- Department of Pediatrics, Kunshan Maternity and Children's Health Care Hospital, Kunshan, China
| | - Yufeng Yuan
- Department of Pediatrics, The First People's Hospital of Kunshan Affiliated to Jiangsu University, China
- Department of Pediatrics, Kunshan Maternity and Children's Health Care Hospital, Kunshan, China
| | - Wenying Zhu
- Department of Pediatrics, The First People's Hospital of Kunshan Affiliated to Jiangsu University, China
- Department of Pediatrics, Kunshan Maternity and Children's Health Care Hospital, Kunshan, China
| | - Jing Yuan
- Department of Pediatrics, Kunshan Maternity and Children's Health Care Hospital, Kunshan, China
| | - Yuanyuan Hu
- Department of Pediatrics, Huai'an Maternal and Child Health Care Center, Huaian, Jiangsu, China
| | - Hongli Zhu
- Department of Pediatrics, Huai'an Maternal and Child Health Care Center, Huaian, Jiangsu, China
| |
Collapse
|
22
|
Valentine GC, Perez KM, Wood TR, Mayock DE, Comstock BA, Puia-Dumitrescu M, Heagerty PJ, Juul SE. Postnatal maximal weight loss, fluid administration, and outcomes in extremely preterm newborns. J Perinatol 2022; 42:1008-1016. [PMID: 35338252 DOI: 10.1038/s41372-022-01369-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/31/2022] [Accepted: 03/10/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Evaluate maximal weight loss (MWL) and total fluid administration (TFA) association in first week after birth with outcomes among extremely preterm (EP) newborns. STUDY DESIGN We performed a retrospective analysis of the Preterm Erythropoietin Neuroprotection Trial evaluating first-week MWL, TFA, and association with in-hospital outcomes. RESULTS Among n = 883 included EP neonates, n = 842 survived ≥ 7 days and were included in outcome analyses. MWL between 5% to 15% was associated with decreased odds of necrotizing enterocolitis compared to MWL > 15% (OR 0.49, 95% CI 0.25-0.98). Average TFA > 150 mL/kg birthweight/day was associated with increased odds of necrotizing enterocolitis (OR 3.22, 95% CI 1.40-7.42) and patent ductus arteriosus requiring surgery (OR 2.14, 95% CI 1.10-4.15). CONCLUSION MWL between 5% to 15% is a potentially optimal window of MWL. Increasing average TFA in the first week is associated with adverse neonatal outcomes. Prospective studies evaluating MWL and TFA and relationship to outcomes in EP neonates are needed. CLINICAL TRIAL REGISTRATION This study is a secondary analysis of pre-existing data from the PENUT Trial Registration: NCT01378273, https://clinicaltrials.gov/ct2/show/NCT01378273 .
Collapse
Affiliation(s)
- Gregory C Valentine
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA. .,Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine at Baylor College of Medicine, Houston, TX, USA.
| | - Krystle M Perez
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
| | - Thomas R Wood
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
| | - Dennis E Mayock
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
| | - Bryan A Comstock
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Mihai Puia-Dumitrescu
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
| | | | - Sandra E Juul
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA.,Center on Human Development and Disability, University of Washington, Seattle, WA, USA
| |
Collapse
|
23
|
Glasofer A, Donato SE, Werfel E, Galosi G, Epstein HAB, Moraca C. The Relationship Between Maternal Fluid Intake During Labor and Neonatal Weight Loss: A Review of the Literature. CLINICAL LACTATION 2022. [DOI: 10.1891/cl.2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IntroductionThough 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.MethodsLiterature 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.Results11 studies were included in the review. Overall, 7 studies (64%) identified a significant relationship between maternal fluid intake during labor and neonatal weight loss.ConclusionsGiven 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.
Collapse
|
24
|
Study on the Effect of Early Comprehensive Intervention of Skin Contact Combined with Breastfeeding on Improving Blood Glucose in Early Birth of Newborns with Gestational Diabetes Mellitus. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2305239. [PMID: 35958808 PMCID: PMC9357809 DOI: 10.1155/2022/2305239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/30/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022]
Abstract
Objective To explore the value of early comprehensive intervention of skin contact combined with breastfeeding on improving early blood glucose in newborns with gestational diabetes mellitus (GDM). Methods A total of 300 newborns from pregnant women with gestational diabetes who were hospitalized in Wuxi People's Hospital from January 2021 to December 2021 were randomly assigned into the observation group (n = 150) and the control group (n = 150). The former group received early comprehensive intervention of skin contact combined with breastfeeding, and the latter group received postnatal naked contact, physical examination after late navel severing, and routine nursing intervention such as early contact and early sucking in 30 min. The peripheral blood microglucose value at 1 and 2 hours after birth, neonatal hospitalization rate, ear temperature of 30 min, 60 min, 90 min, and 120 min after birth, neonatal crying, incidence of postpartum hemorrhage, uterine contraction/wound pain index, lactation before delivery, immediately after delivery, early sucking 15 min, and 2 hours postpartum were observed. Results Compared to the control group, the values of trace blood glucose at 1 hour and 2 hours after birth in the observation group were higher, and the difference between groups was statistically significant (P < 0.05), the neonatal hospitalization rate in the observation group was lower, and the difference between groups was statistically significant (P < 0.05); the ear temperature of 30 min, 60 min, 90 min and 120 min after birth in the observation group was higher, and the difference between groups was statistically significant (P < 0.05). The crying frequency of newborns in the observation group was lower, and the difference between groups was statistically significant (P < 0.05). The incidence of postpartum hemorrhage in the observation group was lower, and the difference between groups was statistically significant (P < 0.05). The rate of uterine contraction/wound pain index grade 1 in the observation group was higher, and the difference between groups was statistically significant (P < 0.05). The rates of uterine contraction/wound pain index grade 2 and grade 3 in the observation group were lower, and the difference between groups was statistically significant (P < 0.05). The rate of lactation at 2 hours postpartum in the observation group was higher, and the difference between groups was statistically significant (P < 0.05). Conclusion Early comprehensive intervention of skin contact combined with breastfeeding can significantly increase the early blood glucose of newborns with GDM, effectively promote the occurrence of early hypoglycemia of GDM newborns, avoid a series of serious complications caused by excessive fluctuation of blood sugar, promote the stability of vital signs of newborns, reduce the hospitalization rate of newborns, improve the success rate of breastfeeding, reduce uterine contraction/wound pain, and reduce the incidence of postpartum hemorrhage. My clinical registration number is chictr220059454.
Collapse
|
25
|
Meek JY, Noble L. Technical Report: Breastfeeding and the Use of Human Milk. Pediatrics 2022; 150:188348. [PMID: 35921641 DOI: 10.1542/peds.2022-057989] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 01/12/2023] Open
Abstract
Breastfeeding and human milk are the normative standards for infant feeding and nutrition. The short- and long-term medical and neurodevelopmental advantages of breastfeeding make breastfeeding or the provision of human milk a public health imperative. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for approximately 6 months after birth. Furthermore, the AAP supports continued breastfeeding, along with appropriate complementary foods introduced at about 6 months, as long as mutually desired by mother and child for 2 years or beyond. These recommendations are consistent with those of the World Health Organization (WHO). Medical contraindications to breastfeeding are rare. The AAP recommends that birth hospitals or centers implement maternity care practices shown to improve breastfeeding initiation, duration, and exclusivity. The Centers for Disease Control and Prevention and The Joint Commission monitor breastfeeding practices in United States hospitals. Pediatricians play a critical role in hospitals, their practices, and communities as advocates of breastfeeding and, thus, need to be trained about the benefits of breastfeeding for mothers and children and in managing breastfeeding. Efforts to improve breastfeeding rates must acknowledge existing disparities and the impact of racism in promoting equity in breastfeeding education, support, and services.
Collapse
Affiliation(s)
- Joan Younger Meek
- Department of Clinical Sciences, Florida State University College of Medicine, Orlando, Florida
| | - Lawrence Noble
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Mount Sinai, New York.,New York City Health+Hospitals Elmhurst
| |
Collapse
|
26
|
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.
Collapse
Affiliation(s)
| | | | | | | | - Ian M Paul
- Penn State College of Medicine, Hershey, Pennsylvania
| | | |
Collapse
|
27
|
Virú-Loza MA, Pajuelo MJ. Prediction of Significant Hyperbilirubinemia in Peruvian Term Newborns. Glob Pediatr Health 2022; 9:2333794X221086568. [PMID: 35299728 PMCID: PMC8922171 DOI: 10.1177/2333794x221086568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
28
|
Mtove G, Abdul O, Kullberg F, Gesase S, Scheike T, Andersen FM, Madanitsa M, Ter Kuile FO, Alifrangis M, Lusingu JPA, Minja DTR, Schmiegelow C. Weight change during the first week of life and a new method for retrospective prediction of birthweight among exclusively breastfed newborns. Acta Obstet Gynecol Scand 2022; 101:293-302. [PMID: 35156190 DOI: 10.1111/aogs.14323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Identification of low birthweight and small for gestational age is pivotal in clinical management and many research studies, but in low-income countries, birthweight is often unavailable within 24 h of birth. Newborn weights measured within days after birth and knowledge of the growth patterns in the first week of life can help estimate the weight at birth retrospectively. This study aimed to generate sex-specific prediction maps and weight reference charts for the retrospective estimation of birthweight for exclusively breastfed newborns in a low-resource setting. MATERIAL AND METHODS This was a prospective cohort study nested in a clinical trial of intermittent preventive treatment in pregnancy for malaria with either dihydroartemisinin-piperaquine with/without azithromycin or sulfadoxine-pyrimethamine in Korogwe District, north-eastern Tanzania (Clinicaltrials.gov: NCT03208179). Newborns were weighed at birth or in the immediate hours after birth and then daily for 1 week. Reference charts, nadir, time to regain weight, and prediction maps were generated using nonlinear mixed-effects models fitted to the longitudinal data, incorporating interindividual variation as random effects. Predictions and prediction standard deviations were computed using a linear approximation approach. RESULTS Between March and December 2019, 513 live newborns with birthweights measured within 24 h of delivery were weighed daily for 1 week. Complete datasets were available from 476 exclusively breastfed newborns. There was a rapid decline in weight shortly after delivery. The average weight loss, time of nadir, and time to regain weight were 4.3% (95% confidence interval [CI] 3.8-4.9) at 27 h (95% CI 24-30) and 105 h (95% CI 91-120) in boys and 4.9% (95% CI 4.2-5.6) at 28 h (95% CI 23-33) and 114 h (95% CI 93-136) in girls, respectively. The data were used to generate prediction maps with 1-h time intervals and 0.05 kg weight increments showing the predicted birthweights and weight-for-age and weight-change-for-age reference charts depicting variation in weight loss from <1 to >10%. CONCLUSIONS The prediction maps and reference charts can be used by researchers in low-resource settings to retrospectively estimate birthweights using weights collected up to 168 h after delivery, thereby maximizing data utilization. Clinical practitioners can also use the prediction maps to retrospectively classify newborns as low birthweight or small for gestational age.
Collapse
Affiliation(s)
- George Mtove
- National Institute for Medical Research, Tanga Medical Research Centre, Tanga, Tanzania
| | - Omari Abdul
- National Institute for Medical Research, Tanga Medical Research Centre, Tanga, Tanzania
| | - Fanny Kullberg
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Samwel Gesase
- National Institute for Medical Research, Tanga Medical Research Centre, Tanga, Tanzania
| | - Thomas Scheike
- Department of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Feiko O Ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Michael Alifrangis
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - John P A Lusingu
- National Institute for Medical Research, Tanga Medical Research Centre, Tanga, Tanzania.,Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Daniel T R Minja
- National Institute for Medical Research, Tanga Medical Research Centre, Tanga, Tanzania
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| |
Collapse
|
29
|
Hoyt-Austin AE, Kair LR, Larson IA, Stehel EK. Academy of Breastfeeding Medicine Clinical Protocol #2: Guidelines for Birth Hospitalization Discharge of Breastfeeding Dyads, Revised 2022. Breastfeed Med 2022; 17:197-206. [PMID: 35302875 PMCID: PMC9206473 DOI: 10.1089/bfm.2022.29203.aeh] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. The Academy of Breastfeeding Medicine recognizes that not all lactating individuals identify as women. Using gender-inclusive language, however, is not possible in all languages and all countries and for all readers. The position of the Academy of Breastfeeding Medicine (https://doi.org/10.1089/bfm.2021.29188.abm) is to interpret clinical protocols within the framework of inclusivity of all breastfeeding, chestfeeding, and human milk-feeding individuals.
Collapse
Affiliation(s)
- Adrienne E Hoyt-Austin
- Department of Pediatrics, University of California Davis Medical Center, Sacramento, California, USA
| | - Laura R Kair
- Department of Pediatrics, University of California Davis Medical Center, Sacramento, California, USA
| | - Ilse A Larson
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Elizabeth K Stehel
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | |
Collapse
|
30
|
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.
Collapse
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
| |
Collapse
|
31
|
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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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.
Collapse
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
| |
Collapse
|
32
|
DiTomasso D, Wambach KA, Roberts MB, Erickson-Owens DA, Quigley A, Newbury JM. Maternal Worry About Infant Weight and its Influence on Artificial Milk Supplementation and Breastfeeding Cessation. J Hum Lact 2022; 38:177-189. [PMID: 33705242 DOI: 10.1177/08903344211000284] [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: 11/17/2022]
Abstract
BACKGROUND Maternal worry about infant weight has inconsistently been reported as a breastfeeding barrier. Weight monitoring is a critical tool to assess adequacy of infant feeding. Yet, little is known about the intensity of maternal worry about infant weight or associated breastfeeding outcomes. RESEARCH AIMS To examine (1) the frequency and intensity of maternal worry about infant weight; (2) the relationship between worry about weight and use of artificial milk; and 3) the relationship between worry about weight and breastfeeding cessation. METHODS A prospective cross-sectional design was used. A questionnaire was completed by women in the United States (N = 287) from 12 web-based maternal support groups. RESULTS Sixty-three percent of women (n = 182) had some worry about infant weight. Participants breastfeeding for the first time had more worry (p = .035). Participants still breastfeeding had less worry about weight compared to those who had stopped (67%, n = 147 vs. 41%, n = 28). Exclusive breastfeeding participants had less worry (p < .001) compared to those who supplemented with artificial milk. Increased worry was associated with the use of artificial milk within 1 week of birth (p < .001) and early breastfeeding cessation (p < .001). CONCLUSIONS Worry about weight is a significant breastfeeding barrier. It is associated with first time breastfeeding, less exclusive breastfeeding, use of artificial milk, and earlier breastfeeding cessation. Lactating mothers need anticipatory guidance about expected neonatal weight changes and interventions to help relieve worry about infant weight.
Collapse
Affiliation(s)
| | | | - Mary B Roberts
- Brown University Center for Primary Care & Prevention, Care New England Medical Group/Primary Care & Specialty Services, USA
| | | | - Aimee Quigley
- 21444 Lactation Consultant, South County Hospital, Wakefield, RI, USA
| | | |
Collapse
|
33
|
Carpenter RM, Billah SM, Lyons GR, Siraj MS, Rahman QS, Thorsten V, McClure EM, Haque R, Petri WA. U-Shaped Association between Maternal Hemoglobin and Low Birth Weight in Rural Bangladesh. Am J Trop Med Hyg 2022; 106:424-431. [PMID: 34844203 PMCID: PMC8832918 DOI: 10.4269/ajtmh.21-0268] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 10/25/2021] [Indexed: 01/01/2023] Open
Abstract
Low birth weight (LBW) is associated with a higher risk of neonatal mortality and the development of adult-onset chronic disease. Understanding the ongoing contribution of maternal hemoglobin (Hgb) levels to the incidence of LBW in South Asia is crucial to achieve the World Health Assembly global nutrition target of a 30% reduction in LBW by 2025. We enrolled pregnant women from the rural Tangail District of Bangladesh in a Maternal Newborn Health Registry established under The Global Network for Women's and Children's Health Research. We measured the Hgb of pregnant women at enrollment and birth weights of all infants born after 20 weeks gestation. Using logistic regression to adjust for multiple potential confounders, we estimated the association between maternal Hgb and the risk of LBW. We obtained Hgb measurements and birth weights from 1,665 mother-child dyads between July 2019 and April 2020. Using trimester-specific cutoffs for anemia, 48.3% of the women were anemic and the mean (±SD) Hgb level was 10.6 (±1.24) g/dL. We identified a U-shaped relationship where the highest risk of LBW was seen at very low (< 7.0 g/dL, OR = 2.00, 95% CI = 0.43-7.01, P = 0.31) and high (> 13.0 g/dL, OR = 2.17, 95% CI = 1.01-4.38, P = 0.036) Hgb levels. The mechanisms underlying this U-shaped association may include decreased plasma expansion during pregnancy and/or iron dysregulation resulting in placental disease. Further research is needed to explain the observed U-shaped relationship, to guide iron supplementation in pregnancy and to minimize the risk of LBW outcomes.
Collapse
Affiliation(s)
- Rebecca M. Carpenter
- Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Sk Masum Billah
- The International Center for Diarrhoeal Disease and Research, Dhaka, Bangladesh;,The University of Sydney School of Public Health, Sydney, Australia
| | - Genevieve R. Lyons
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Md Shahjahan Siraj
- The International Center for Diarrhoeal Disease and Research, Dhaka, Bangladesh
| | - Qazi S. Rahman
- The International Center for Diarrhoeal Disease and Research, Dhaka, Bangladesh
| | | | | | - Rashidul Haque
- The International Center for Diarrhoeal Disease and Research, Dhaka, Bangladesh
| | - William A. Petri
- Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, Virginia;,Address correspondence to William Petri, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, 345 Crispell Drive, Charlottesville VA 22908-1340. E-mail:
| |
Collapse
|
34
|
Suliman OSM, Abd Elgadir SMA, Elabidien KZ. Breastfeeding associated hypernatraemia: clinical presentations, complications and outcome in a subset of Sudanese neonates. Sudan J Paediatr 2022; 22:156-165. [PMID: 36875954 PMCID: PMC9983774 DOI: 10.24911/sjp.106-1634805557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 07/26/2022] [Indexed: 02/21/2023]
Abstract
A descriptive cross-sectional hospital-based study was conducted with the objectives to study clinical presentations, complications and outcomes of breastfeeding-associated hypernatraemia (BFAHN) in full-term neonates admitted to Ibrahim Malik Teaching Hospital, Khartoum, Sudan, during the period September 2017-2019. Eighty-four neonates with BFAHN were enrolled in the study. Collected demographic data of the neonates and their mothers included age at presentation, gender, birth weight, current weight, mode and place of delivery, maternal age, parity, education level, time of starting breastfeeding, presenting symptoms and signs, complications and outcome. The prevalence of the BFAHN was 15.5%. The mean age at presentation was 9.38 ± 5.95 days, range of 2-27 days and 59.5% were males. Most of them delivered vaginally (85.7%) and in hospital (63.1%). The mothers were multigravida in 58% and with a mean age of 28.14 ± 6.68 years and 3/4th of them started breastfeeding within the first hour. The most common symptoms and signs were fever, poor feeding, decreased urine output, jaundice, dehydration and loss of weight more than 10% of birth weight. The mortality rate was 21.4%. Complications included acute kidney injury in 82.1%, two patients needed peritoneal dialysis, one-third developed convulsions and two patients had intracranial bleeding. Factors associated with the development of the BFAHN were excessive loss of weight, multigravida, low maternal education level and vaginal delivery. Associated factors for death included thrombocytopenia, convulsions and severe hypernatraemia. Breast-milk sodium levels in mothers of 10 of the patients were high compared to 10 controls.
Collapse
Affiliation(s)
- Omer S M Suliman
- Department of Paediatrics and Child Health, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | | | - Kamal Z Elabidien
- Department of Paediatrics and Child Health, Faculty of Medicine, International University of Africa, Khartoum, Sudan
| |
Collapse
|
35
|
Wilde VK. Breastfeeding Insufficiencies: Common and Preventable Harm to Neonates. Cureus 2021; 13:e18478. [PMID: 34659917 PMCID: PMC8491802 DOI: 10.7759/cureus.18478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 11/05/2022] Open
Abstract
Insufficient milk intake in breastfed neonates is common, frequently missed, and causes preventable hospitalizations for jaundice/hyperbilirubinemia, hypernatremia/dehydration, and hypoglycemia - accounting for most U.S. neonatal readmissions. These and other consequences of neonatal starvation and deprivation may substantially contribute to fully preventable morbidity and mortality in previously healthy neonates worldwide. Previous advanced civilizations recognized this problem of breastfeeding insufficiencies and had an infrastructure to solve it: Wetnursing, shared nursing, and prelacteal feeding traditions used to be well-organized and widespread. Modern societies accidentally destroyed that infrastructure. Then, modern reformers missing a few generations of direct knowledge transmission about safe breastfeeding invented a new, historically anomalous conception of breastfeeding defined in terms of exclusivity. As that new intervention has become increasingly widespread, so too have researchers widely reported associated possible harms of the longer neonatal starvation/deprivation and later infant under-nutrition periods that it creates when breastfeeding is insufficient. Early insufficient nutrition/hydration has possible long-term effects including neurodevelopmental consequences such as attention deficit hyperactivity disorder, autism, cerebral palsy, cognitive and developmental delay, epilepsy, hearing impairment, kernicterus, language disorder, mood disorders, lower IQ, and specific learning disorder. Current early infant feeding guidelines conflict with the available evidence. Recent reform efforts have tended to focus on using more technology and measurement to harm fewer neonates instead of proposing the indicated paradigm shift in early infant feeding to prevent more harm. The scientific evidence is already sufficient to mandate application of the precautionary principle to feed neonates early, adequate, and often milk before mothers' milk comes in and whenever signs of hunger persist, mitigating possible risks including death or disability. In most contexts, the formula is the best supplementary milk for infants at risk from breastfeeding insufficiencies. National-level reviews of scientific evidence, health policy, and research methods and ethics are needed to initiate the early infant feeding paradigm shift that the data already support. Policy experiments and related legislative initiatives might also contribute to the shift, as insurers might decline or be required by law to decline reimbursing hospitals for costs of this type of preventable hospitalization, which otherwise generates profit.
Collapse
Affiliation(s)
- Vera K Wilde
- Methods, Ethics, and Technology, Independent Researcher, Berlin, DEU
| |
Collapse
|
36
|
Humbert G. [Impact of mode of delivery on the weight kinetics of the breastfed infant]. SOINS. PÉDIATRIE, PUÉRICULTURE 2021; 42:40-46. [PMID: 34489081 DOI: 10.1016/j.spp.2021.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In various studies, the introduction of infant formulas during the stay in the maternity ward has been shown to increase the risk of breastfeeding failure and the development of cow's milk protein allergy. How can they be avoided when the infant loses weight in an "abnormal" way? A team from the Polyclinique Majorelle, in Nancy, studied the impact of the mode of delivery on the weight of the newborn in order to improve its accompaniment while respecting the real needs and rhythms of each child.
Collapse
Affiliation(s)
- Gwénaëlle Humbert
- Maternité de la polyclinique Majorelle, 95 rue Ambroise-Paré, 54000 Nancy, France.
| |
Collapse
|
37
|
Loyal J, Wood KE. Advancing the Evidence Base in the Care of Term and Late Preterm Infants. Hosp Pediatr 2021; 11:e189-e191. [PMID: 34341065 DOI: 10.1542/hpeds.2021-006203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Jaspreet Loyal
- Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Kelly E Wood
- Stead Family Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| |
Collapse
|
38
|
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
| |
Collapse
|
39
|
Abstract
This article attempts to highlight contemporary issues relating to term neonatal hyperbilirubinemia and to focus attention on controversial issues and concepts with the potential to effect change in clinical approach. On the one hand, the focus is bilirubin neurotoxicity, which is now known to encompass a wide, diverse spectrum of features. The various aspects of this spectrum are outlined and defined. On the other hand, bilirubin also possesses antioxidant properties. As such, mild hyperbilirubinemia is suggested as actually offering the neonate some protective advantage.
Collapse
|
40
|
Von Kohorn I, Flaherman V. Human Milk for the Term Newborn. Clin Perinatol 2021; 48:513-531. [PMID: 34353578 DOI: 10.1016/j.clp.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Human milk provides optimal nutrition for term newborns, but the prevalence of its use is below target, and risks have been identified. Infants of black mothers as well as term newborns admitted to the neonatal intensive care unit are at risk for not receiving human milk. To improve human milk intake, multiple individual-level interventions have been shown to be effective, but some popular system-level interventions are ineffective or harmful. Expressed milk and donor milk may be less beneficial than direct breastfeeding. Nuanced public policies can help support lactation while promoting individual choice and equity.
Collapse
Affiliation(s)
- Isabelle Von Kohorn
- Department of Pediatrics, Holy Cross Health, 1500 Forest Glen Road, Silver Spring, MD 20910, USA; Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
| | - Valerie Flaherman
- Department of Pediatrics, University of California, San Francisco, 3333 California Street, Box 0503, San Francisco, CA 94118, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
41
|
Groß M, Jürges H, Wiesen D. The effects of audits and fines on upcoding in neonatology. HEALTH ECONOMICS 2021; 30:1978-1986. [PMID: 33951233 DOI: 10.1002/hec.4272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 12/06/2020] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
Upcoding is a common type of fraud in healthcare. However, how audit policies need to be designed to cope with upcoding is not well understood. We provide causal evidence on the effect of random audits with different probabilities and financial consequences. Using a controlled laboratory experiment, we mimic the decision situation of obstetrics staff members to report birth weights of neonatal infants. Subjects' payments in the experiment depend on their reported birth weights and follow the German non-linear diagnosis-related group remuneration for neonatal care. Our results show that audits with low detection probabilities only reduce fraudulent birth-weight reporting, when they are coupled with fines for fraudulent reporting. For audit policies with fines, increasing the probability of an audit only effectively enhances honest reporting, when switching from detectable to less gainful undetectable upcoding is not feasible. Implications for audit policies are discussed.
Collapse
Affiliation(s)
- Mona Groß
- Department of Business Administration and Healthcare Management, University of Cologne, Cologne, Germany
| | - Hendrik Jürges
- Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany
| | - Daniel Wiesen
- Department of Business Administration and Healthcare Management, University of Cologne, Cologne, Germany
| |
Collapse
|
42
|
Rutherford JN, Ross CN, Ziegler T, Burke LA, Steffen AD, Sills A, Layne Colon D, deMartelly VA, Narapareddy LR, Tardif SD. Womb to womb: Maternal litter size and birth weight but not adult characteristics predict early neonatal death of offspring in the common marmoset monkey. PLoS One 2021; 16:e0252093. [PMID: 34106943 PMCID: PMC8189522 DOI: 10.1371/journal.pone.0252093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/09/2021] [Indexed: 02/03/2023] Open
Abstract
A singular focus on maternal health at the time of a pregnancy leaves much about perinatal mortality unexplained, especially when there is growing evidence for maternal early life effects. Further, lumping stillbirth and early neonatal death into a single category of perinatal mortality may obscure different causes and thus different avenues of screening and prevention. The common marmoset monkey (Callithrix jacchus), a litter-bearing nonhuman primate, is an ideal species in which to study the independent effects of a mother’s early life and adult phenotypes on pregnancy outcomes. We tested two hypotheses in 59 marmoset pregnancies at the Southwest National Primate Research Center and the Barshop Institute for Longevity and Aging Studies. We explored 1) whether pregnancy outcomes were predicted independently by maternal adult weight versus maternal litter size and birth weight, and 2) whether stillbirth and early neonatal death were differentially predicted by maternal variables. No maternal characteristics predicted stillbirth and no maternal adult characteristics predicted early neonatal death. In univariate Poisson models, triplet-born females had a significantly increased rate of early neonatal death (IRR[se] = 3.00[1.29], p = 0.011), while higher birth weight females had a decreased rate (IRR[se] = 0.89[0.05], p = 0.039). In multivariate Poisson models, maternal litter size remained an independent predictor, explaining 13% of the variance in early neonatal death. We found that the later in the first week those neonates died, the more weight they lost. Together these findings suggest that triplet-born and low birth weight females have distinct developmental trajectories underlying greater rates of infant loss, losses that we suggest may be attributable to developmental disruption of infant feeding and carrying. Our findings of early life contributions to adult pregnancy outcomes in the common marmoset disrupt mother-blaming narratives of pregnancy outcomes in humans. These narratives hold that the pregnant person is solely responsible for pregnancy outcomes and the health of their children, independent of socioecological factors, a moralistic framing that has shaped clinical pregnancy management. It is necessary to differentiate temporal trajectories and causes of perinatal loss and view them as embedded in external processes to develop screening, diagnostic, and treatment tools that consider the full arc of a mother’s lived experience, from womb to womb and beyond.
Collapse
Affiliation(s)
- Julienne N. Rutherford
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, United States of America
- * E-mail:
| | - Corinna N. Ross
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, United States of America
| | - Toni Ziegler
- Wisconsin National Primate Research Center, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Larisa A. Burke
- Office for Research Facilitation, College of Nursing, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Alana D. Steffen
- Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Aubrey Sills
- Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Donna Layne Colon
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, United States of America
| | - Victoria A. deMartelly
- Department of Biobehavioral Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Laren R. Narapareddy
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States of America
| | - Suzette D. Tardif
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, United States of America
| |
Collapse
|
43
|
Arterial hypertension and cystatin C during neonatal physiologic dehydration. J Hum Hypertens 2021; 36:554-560. [PMID: 33935283 DOI: 10.1038/s41371-021-00541-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/27/2021] [Accepted: 04/14/2021] [Indexed: 11/09/2022]
Abstract
A reduced nephron number may play a role in the pathogenesis of arterial hypertension (AH), and it is well recognized that individual nephron endowment is widely variable. However, nephrons count is technically impossible in vivo. Based on the observation that subjects with a reduced nephron mass exhibit an increase in renal functional biomarkers during acute dehydration, we hypothesized that cystatin C concentration during neonatal physiological dehydration could identify subjects with reduced nephron endowment. This is a prospective, observational, cohort study enrolling healthy, caucasian, term neonates born after an uneventful pregnancy. Two groups of newborns were compared: neonates born to fathers on antihypertensive treatment (HF) versus those born to proven normotensive fathers older than 40 years of age (NF). Enrolled newborns underwent cystatin C determination at the time of newborn screening. Forty newborns with HF and 80 with NF were enrolled. No differences in baseline characteristics were observed between the two groups except for the number of hypertensive grandparents higher among newborns to HF (47.8% vs. 21.1%; p: 0.001). Cystatin C was significantly higher in newborns with HF (1.62 ± 0.30 mg/L vs 1.41 ± 0.27 mg/L; p < 0.001). Linear regression analysis corrected for confounders confirmed that paternal hypertension was the only variable significantly associated with high cystatin C level during post-natal dehydration. Besides offering new insights on the pathogenesis of familial hypertension, our results support the specific role of nephron endowment and suggest the possibility of identifying subjects at risk for reduced nephron endowment as early as at birth.
Collapse
|
44
|
Ventura AK, Lore B, Mireles O. Associations Between Variations in Breast Anatomy and Early Breastfeeding Challenges. J Hum Lact 2021; 37:403-413. [PMID: 32484716 DOI: 10.1177/0890334420931397] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mothers with anatomic variability (e.g., shorter, wider nipples; denser areolas) may experience breastfeeding challenges disproportionately. RESEARCH AIM To examine whether variations in breast anatomy are associated with risk for early breastfeeding challenges. METHODS Participants included mothers < 6 weeks postpartum. Nipple base width, nipple length, and areolar density were measured on the right and left breast separately. Experiences with early breastfeeding challenges were determined through a combination of maternal report and clinical assessment. RESULTS Participants (N = 119) had an average nipple diameter of 23.4 (SD = 3.0) mm for left nipples and 23.5 (SD = 3.0) mm for right nipples (range = 10-34 mm). Average nipple length was 8.5 (SD = 3.2) mm for left breasts and 9.1 (SD = 3.2) mm for right breasts (range = 5-20 mm); 35% of participants had dense areolas on the left breast and 36% had dense areolas on the right breast. The combination of wider and longer nipples was associated with greater risk for difficulties with latch; the combination of wider nipples and denser areolas was associated with greater risk for sore nipples. For participants with more dense areolas, shorter and wider nipples were associated with greater risk for low milk supply and slow infant weight gain. For participants with less dense areolas, longer and wider nipples were associated with greater risk for low milk supply and slow infant weight gain. CONCLUSION Further research is needed to understand how measures of breast anatomy can be used to guide targeted intervention efforts.
Collapse
Affiliation(s)
- Alison K Ventura
- 7173 Department of Kinesiology and Public Health; Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Brittany Lore
- 7173 Department of Kinesiology and Public Health; Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Olga Mireles
- 6066 Dignity Health French Hospital Medical Center Breastfeeding Center, San Luis Obispo, CA, USA
| |
Collapse
|
45
|
Chiu YW, Cheng SW, Yang CY, Weng YH. Breastfeeding in Relation to Neonatal Jaundice in the First Week After Birth: Parents' Perceptions and Clinical Measurements. Breastfeed Med 2021; 16:292-299. [PMID: 33666511 DOI: 10.1089/bfm.2020.0293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Parents may consider interrupting breastfeeding to manage neonatal jaundice (NJ). Our aims were to determine correlations of breastfeeding with NJ by examining infants' manifestations in the first week after birth and to understand parents' perceptions toward NJ in relation to breastfeeding. Materials and Methods: This prospective cross-sectional study was conducted in a tertiary medical center by examining infants and administering a questionnaire survey to their parents. All healthy infants admitted to the well-baby nursery were eligible for enrollment. A 16-item questionnaire was distributed to parents of enrolled infants from October 2017 to February 2019. Items of the questionnaire included perceptions and knowledge of NJ. In addition, clinical information of enrolled infants was obtained from medical records. Hyperbilirubinemia was defined as a peak transcutaneous bilirubinometer value ≥15 mg/dL. Results: In total, 449 parents completed the consent form and participated in the study. Results showed that exclusive breastfeeding was more common in infants with a vaginal delivery (p < 0.001), who were nonprimiparous (p = 0.004) and who had weight loss of >7% (p < 0.001). There was no significant correlation of exclusive breastfeeding with hyperbilirubinemia (p = 0.414). Approximately two-thirds of parents were worried about NJ occurring in their child. Most parents were aware of phototherapy as management of NJ. However, their knowledge of risk factors, complications, and assessments of NJ was relatively deficient. Overall, 29.6% of parents rated breastfeeding as a risk factor for NJ, and 24% of parents indicated that cessation of breastfeeding was a management option for NJ. Conclusions: The results indicated that NJ in the first few days after birth poses a significant barrier to breastfeeding. Our findings provide critical information for plotting strategies to enhance parents' willingness to continue breastfeeding.
Collapse
Affiliation(s)
- Ya-Wen Chiu
- PhD Program in Global Health and Health Security, Master Program in Global Health and Development, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Shao-Wen Cheng
- Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Chun-Yuh Yang
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Hao Weng
- Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| |
Collapse
|
46
|
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.
Collapse
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
| |
Collapse
|
47
|
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.
Collapse
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
| |
Collapse
|
48
|
Knowles V, Yajamanyam PK. Physiological weight loss in term newborn infants. Arch Dis Child 2021; 106:195-197. [PMID: 33023887 DOI: 10.1136/archdischild-2020-319158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 11/03/2022]
|
49
|
Dumitriu D, Emeruwa UN, Hanft E, Liao GV, Ludwig E, Walzer L, Arditi B, Saslaw M, Andrikopoulou M, Scripps T, Baptiste C, Khan A, Breslin N, Rubenstein D, Simpson LL, Kyle MH, Friedman AM, Hirsch DS, Miller RS, Fernández CR, Fuchs KM, Keown MK, Glassman ME, Stephens A, Gupta A, Sultan S, Sibblies C, Whittier S, Abreu W, Akita F, Penn A, D’Alton ME, Orange JS, Goffman D, Saiman L, Stockwell MS, Gyamfi-Bannerman C. Outcomes of Neonates Born to Mothers With Severe Acute Respiratory Syndrome Coronavirus 2 Infection at a Large Medical Center in New York City. JAMA Pediatr 2021; 175:157-167. [PMID: 33044493 PMCID: PMC7551222 DOI: 10.1001/jamapediatrics.2020.4298] [Citation(s) in RCA: 138] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
IMPORTANCE Limited data on vertical and perinatal transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and health outcomes of neonates born to mothers with symptomatic or asymptomatic coronavirus disease 2019 (COVID-19) are available. Studies are needed to inform evidence-based infection prevention and control (IP&C) policies. OBJECTIVE To describe the outcomes of neonates born to mothers with perinatal SARS-CoV-2 infection and the IP&C practices associated with these outcomes. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort analysis reviewed the medical records for maternal and newborn data for all 101 neonates born to 100 mothers positive for or with suspected SARS-CoV-2 infection from March 13 to April 24, 2020. Testing for SARS-CoV-2 was performed using Cobas (Roche Diagnostics) or Xpert Xpress (Cepheid) assays. Newborns were admitted to well-baby nurseries (WBNs) (82 infants) and neonatal intensive care units (NICUs) (19 infants) in 2 affiliate hospitals at a large academic medical center in New York, New York. Newborns from the WBNs roomed-in with their mothers, who were required to wear masks. Direct breastfeeding after appropriate hygiene was encouraged. EXPOSURES Perinatal exposure to maternal asymptomatic/mild vs severe/critical COVID-19. MAIN OUTCOMES AND MEASURES The primary outcome was newborn SARS-CoV-2 testing results. Maternal COVID-19 status was classified as asymptomatic/mildly symptomatic vs severe/critical. Newborn characteristics and clinical courses were compared across maternal COVID-19 severity. RESULTS In total, 141 tests were obtained from 101 newborns (54 girls [53.5%]) on 0 to 25 days of life (DOL-0 to DOL-25) (median, DOL-1; interquartile range [IQR], DOL-1 to DOL-3). Two newborns had indeterminate test results, indicative of low viral load (2.0%; 95% CI, 0.2%-7.0%); 1 newborn never underwent retesting but remained well on follow-up, and the other had negative results on retesting. Maternal severe/critical COVID-19 was associated with newborns born approximately 1 week earlier (median gestational age, 37.9 [IQR, 37.1-38.4] vs 39.1 [IQR, 38.3-40.2] weeks; P = .02) and at increased risk of requiring phototherapy (3 of 10 [30.0%] vs 6 of 91 [7.0%]; P = .04) compared with newborns of mothers with asymptomatic/mild COVID-19. Fifty-five newborns were followed up in a new COVID-19 Newborn Follow-up Clinic at DOL-3 to DOL-10 and remained well. Twenty of these newborns plus 3 newborns followed up elsewhere had 32 nonroutine encounters documented at DOL-3 to DOL-25, and none had evidence of SARS-CoV-2 infection, including 6 with negative retesting results. CONCLUSIONS AND RELEVANCE No clinical evidence of vertical transmission was identified in 101 newborns of mothers positive for or with suspected SARS-CoV-2 infection, despite most newborns rooming-in and direct breastfeeding practices.
Collapse
Affiliation(s)
- Dani Dumitriu
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York,NewYork–Presbyterian Hospital, New York, New York,Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York,Sackler Institute, Zuckerman Institute, and the Columbia Population Research Center, Columbia University, New York, New York
| | - Ukachi N. Emeruwa
- NewYork–Presbyterian Hospital, New York, New York,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Erin Hanft
- Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Grace V. Liao
- Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Elizabeth Ludwig
- NewYork–Presbyterian Hospital, New York, New York,Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Lauren Walzer
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York,NewYork–Presbyterian Hospital, New York, New York
| | - Brittany Arditi
- NewYork–Presbyterian Hospital, New York, New York,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Minna Saslaw
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York,NewYork–Presbyterian Hospital, New York, New York
| | - Maria Andrikopoulou
- NewYork–Presbyterian Hospital, New York, New York,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Tessa Scripps
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York,NewYork–Presbyterian Hospital, New York, New York
| | - Caitlin Baptiste
- NewYork–Presbyterian Hospital, New York, New York,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Adrita Khan
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York,NewYork–Presbyterian Hospital, New York, New York
| | - Noelle Breslin
- NewYork–Presbyterian Hospital, New York, New York,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - David Rubenstein
- NewYork–Presbyterian Hospital, New York, New York,Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Lynn L. Simpson
- NewYork–Presbyterian Hospital, New York, New York,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Margaret H. Kyle
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Alexander M. Friedman
- NewYork–Presbyterian Hospital, New York, New York,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Daniel S. Hirsch
- NewYork–Presbyterian Hospital, New York, New York,Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Russell S. Miller
- NewYork–Presbyterian Hospital, New York, New York,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Cristina R. Fernández
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York,NewYork–Presbyterian Hospital, New York, New York
| | - Karin M. Fuchs
- NewYork–Presbyterian Hospital, New York, New York,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - M. Kathleen Keown
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York,NewYork–Presbyterian Hospital, New York, New York
| | - Melissa E. Glassman
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York,NewYork–Presbyterian Hospital, New York, New York
| | - Ashley Stephens
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York,NewYork–Presbyterian Hospital, New York, New York
| | - Archana Gupta
- NewYork–Presbyterian Hospital, New York, New York,Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Sally Sultan
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York,NewYork–Presbyterian Hospital, New York, New York
| | - Caroline Sibblies
- NewYork–Presbyterian Hospital, New York, New York,Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Susan Whittier
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | - Wanda Abreu
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York,NewYork–Presbyterian Hospital, New York, New York
| | - Francis Akita
- NewYork–Presbyterian Hospital, New York, New York,Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Anna Penn
- NewYork–Presbyterian Hospital, New York, New York,Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Mary E. D’Alton
- NewYork–Presbyterian Hospital, New York, New York,Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Jordan S. Orange
- NewYork–Presbyterian Hospital, New York, New York,Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Dena Goffman
- NewYork–Presbyterian Hospital, New York, New York,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York,Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Lisa Saiman
- NewYork–Presbyterian Hospital, New York, New York,Division of Pediatric Infectious Diseases, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Melissa S. Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York,NewYork–Presbyterian Hospital, New York, New York,Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Cynthia Gyamfi-Bannerman
- NewYork–Presbyterian Hospital, New York, New York,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| |
Collapse
|
50
|
Zia MTK, Golombek S, Nitkowski-Keever S, Paudel U. Weight loss monitoring reduces the occurrence of neonatal hypernatremic dehydration in breastfeeding neonates. Int J Pediatr Adolesc Med 2021; 9:22-26. [PMID: 35573072 PMCID: PMC9072242 DOI: 10.1016/j.ijpam.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/14/2021] [Indexed: 11/30/2022]
Abstract
Background Excessive weight loss enhances the incidence of neonatal hypernatremic dehydration (NHD). We compared the effect of a new breastfeeding policy against an old breastfeeding policy on neonatal weight change and the incidence of NHD. Methods This was a QA project between two sets of breastfeeding (BF) protocols for exclusively BF newborns. Under our old BF policy, a number of neonates had a significant loss of weight after birth and were admitted to the NICU due to NHD. We implemented a new BF policy that was used when a newborn loses>5% of previously recorded weight within a 24-h interval. Two groups were compared: the preintervention group (old BF policy) and postintervention group (new BF policy). Additionally, characteristics of newborns admitted to NICU were separately compared with the subgroup of pre- and post intervention dehydration groups. Results Preintervention = 1320 and postintervention = 1450. Neonates with weight loss of ≥ 5% within the first 24-h time interval were higher in the postintervention group (19.7%) as compared to the preintervention group (10.2%) (P < .05). However, the number of infants diagnosed to have NHD was lower in the postintervention group (0.68%) than in the preintervention group (1.66%), (P < .03). Neonatal characteristics were comparable between subgroups of dehydration. Conclusion An intervention at ≥ 5% neonatal weight loss markedly reduces the incidence of NHD-associated NICU admissions.
Collapse
|