A total of 66 facilities, including 27 perinatal centers, are accredited as Baby-Friendly Hospitals in Japan [ 35 ]. In our hospital, early cord clamping is performed after a baby is delivered. We do not have any lactation consultants. However, trained midwives or nurses help mothers after delivery to assure adequate breastfeeding.
All newborns are weighed daily between birth and discharge while naked with an electronic scale by a nurse or a midwife. Prepregnancy BMI was calculated with maternal height at the first antenatal visit and self-reported prepregnancy weight. It included chronic hypertension, gestational hypertension, preeclampsia, and eclampsia. Diabetes included type 1, type 2, and gestational diabetes. All elective Caesarean sections were categorized as antepartum Caesarean sections.
Emergency Caesarean sections could be antepartum or intrapartum Caesarean sections. We examined whether there were any newborns who required intravenous therapy due to hypoglycemia or dehydration. We also investigated the association between neonatal jaundice requiring phototherapy and a higher weight loss. The mean plasma osmolality results were compared among the groups stratified according to the mode of delivery.
Data were entered in the Microsoft Excel software program version The Kolmogorov—Smirnov test was used to examine normality. Then, we conducted multivariate logistic regression analysis.
Weight Loss in the Breastfed Baby
Neonatal jaundice requiring phototherapy was not included in the regression model of the primary outcome because neonatal jaundice is not the cause but the result of weight loss. Statistical interaction was examined between parity and the mode of delivery. This study was approved by the Research Ethics Committee of the National Hospital Organization Nagasaki Medical under protocol number , approved on October 10, , with opt-out consent to obtain patient data from the medical records.
No ethical issues arose during this study as it was retrospective and all data were anonymous. The mean percentage of weight reduction was 9. The weight reached its nadir at day 3.
According to the univariate analysis, maternal age, primiparity, infertility treatment, antepartum Caesarean section, postpartum hemorrhaging, and the hemoglobin level after delivery were associated with excessive weight loss in newborns. No statistical interaction was noted between parity and the mode of delivery, or between maternal age and infertility treatment. No full-term newborn included in this study required intravenous therapy due to hypoglycemia or dehydration.
However, neonatal jaundice requiring phototherapy was associated with a higher weight loss percentage odds ratio: 1. Our data showed a high mean percentage of weight reduction 9. The mean percentage of weight reduction in our center was much higher than that reported in the literature in other developed countries 2.
Background
This discrepancy may be partly due to the delayed lactogenesis in Asians compared to other ethnic groups [ 41 ]. It is also because we check the weight every day and keep a baby in the hospital until we confirm a nadir of the weight. The rate is also higher than that of other perinatal centers accredited as Baby-Friendly Hospitals in Japan.
In , the mean weight reduction rates at 27 perinatal centers accredited as Baby-Friendly Hospitals in Japan were 8. In comparison, the rates were 9. This difference of the weight reduction is possibly related to the high rate of exclusively breastfed newborns. An older maternal age [ 29 ] and primiparity [ 19 , 30 ] also have been shown as risk factors for excessive newborn weight loss in previous studies [ 29 , 30 ]. An older maternal age [ 43 , 44 ] and primiparity [ 30 , 45 , 46 ] are associated with excessive weight loss in newborns due to the delayed onset of lactation.
The most notable finding of this study was that there was a significant difference in the frequency of excessive weight loss between the newborns delivered by antepartum Caesarean section and those delivered by vaginal delivery, while no marked difference was noted between infants delivered via intrapartum Caesarean section and those delivered by vaginal delivery. Most of the previous studies on this topic did not distinguish between antepartum Caesarean section and intrapartum Caesarean section.
Our finding is consistent with one previous study [ 47 ]. In addition, an observational cohort study has demonstrated that primary antepartum Caesarean section is an independent risk factor for the failure of exclusive breastfeeding [ 48 ]. However, their study outcome was different from ours, and the study did not distinguish between the experience of never trying to breastfeed and that of trying but not succeeding. Three hypotheses may explain these findings. First, labor causes hormonal changes in the mother, and these changes promote lactogenesis.
Some studies suggest that labor can elevate the plasma concentrations of oxytocin and prolactin [ 49 , 50 ]. Second, labor causes hormonal changes in newborns, and these changes affect the kidney function and insensible water loss. For example, glucocorticoids are known to reduce the rate of insensible water loss in newborns [ 51 ], and oxytocin is an antidiuretic [ 52 ].
Third, labor itself or the excessive administration of fluids to the mother before she gives birth may affect the amount of total body water in the newborn at birth. An observational cohort study has shown that the timing and the amount of maternal intravenous fluids are related to the neonatal output and newborn weight loss [ 53 ]. Further research is necessary to determine the mechanisms involved.
The results of the present study suggest that earlier intervention including closer monitoring of mothers and babies as well as earlier initiation of formula feeding in cases with an older maternal age, primiparity, and antepartum Caesarean section may help to prevent complications in newborns due to excessive weight loss. Several limitations associated with the present study warrant mention.
First, because our study population was derived from one hospital in Japan, the generalizability of our study results might be limited to some extent. Second, there might be other factors associated with excessive weight loss in newborns. For example, we did not examine the rate of weight loss or the feeding methods in previous pregnancies. In addition, we did not analyze drug use in labor or pregnancy except for oxytocin and magnesium sulfate use in labor, which might affect infant feeding.
Third, prepregnancy BMI is subject to memory bias and the timing of weight measurement is imprecise.
Weight Loss | North Bristol NHS Trust
However this had little effect on weight loss because minimal amount was usually given in a single dose. An older maternal age, primiparity, and antepartum Caesarean section were found to be independent risk factors for excessive weight loss in breastfed full-term newborns in this study. Closer monitoring of these infants is recommended and earlier supplementation with artificial milk may be indicated. The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
Early weight loss nomograms for exclusively breastfed newborns. Weight change nomograms for the first month after birth. Physiological weight loss in the breastfed neonate: a systematic review. Open Med. Google Scholar.
- 3 month slim down diet.
- can you lose weight not working out.
- Infant with Loss of 10% Birth Weight;
Brace AR. Fluid and electrolyte metabolism. Fetal and neonatal physiology.
Philadelphia: Saunders; Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev. Weight loss percentage prediction of subsequent neonatal hyperbilirubinemia in exclusively breastfed neonates. Pediatr Neonatol. Significant weight loss in breastfed term infants readmitted for hyperbilirubinemia. BMC Pediatr. Weight loss and jaundice in healthy term newborns in partial and full rooming-in. J Matern Fetal Neonatal Med. Differential risk for early breastfeeding jaundice in a multi-ethnic Asian cohort.
Ann Acad Med Singap. Clinical presentation of hypernatremic dehydration in exclusively breastfed neonates. Indian J Pediatr. A nationwide study on hospital admissions due to dehydration in exclusively breastfed infants in the Netherlands: its incidence, clinical characteristics, treatment and outcome.
Feeding changes
Acta Paediatr. Life-threatening hypernatraemic dehydration in breastfed babies. Arch Dis Child. Severe neonatal hypernatraemia: a population based study. Hypernatraemic dehydration and breast feeding: a population study. Hypernatraemic dehydration and necrotizing enterocolitis.