Gestational diabetes increases the risk of a range of adverse perinatal outcomes, including breastfeeding failure, but the best cut-off point for gestational diabetes is unknown. The purpose of this study was to evaluate the association between mild gestational glucose tolerance impairment and the early cessation of exclusive breastfeeding (EBF). This is an observational study of 768 women with full term pregnancies that were screened for gestational diabetes at 24–28 weeks gestation. Subjects were divided into two groups: those with a normal 1-h glucose challenge test and those with an elevated 1-h glucose challenge test but still did not qualify for gestational diabetes. We constructed multivariable logistic regression models using data from 616 women with normal gestational glucose tolerance and 152 women with an isolated positive 1-h glucose challenge test. The risk of early exclusive breastfeeding cessation was found to increase in women with mildly impaired glucose tolerance during pregnancy (adjusted OR, 1.65; 95% CI: 1.11, 2.45). Risks of early EBF cessation were also independently associated with the amount of neonatal weight loss and admission to the neonatal ward. Instead, parity was associated with a decreased risk for shorter EBF duration. Insulin resistance—even in the absence of gestational diabetes mellitus—may be an impeding factor for EBF.

BackgroundThe definition for lower limit of safe birthweight loss among exclusively breastfed neonates is arbitrary. Despite this, in cases of great in-hospital weight loss, breastfeeding adequacy is immediately questioned. The aim of this study was to examine the relationship between weight loss at discharge from hospital, when babies are ready to go home, and eventual cessation of exclusive breastfeeding since birth.MethodsThis is a secondary analysis of a cohort study. Study participants were 788 full term, breastfed and stable babies, born in 2007–2012 consecutively enrolled to primary care pediatric clinics in Majorca, Spain. Data were collected by chart review. The main predictor was birthweight loss at discharge. Extreme weight loss was defined as the 90th and 95th centiles of birthweight loss for babies who were delivered by vaginal delivery and by cesarean section. Main outcomes were cessation of exclusive breastfeeding by 7, 15, 30 and 100 days of life. Multivariate regression analysis was performed to study the relationship of selected variables with exclusive breastfeeding cessation since birth.ResultsWe observed a median weight loss of 6%. In bivariate analysis, quartiles of birthweight loss at discharge were predictive of exclusive breastfeeding cessation at 15, 30 and 100 days postpartum. In multivariate analysis: in-hospital weight loss above the median did predict exclusive breastfeeding cessation by 15, 30 and 100 days of life, Adjusted Odds Ratios (AORs) (95% Confidence Intervals [CIs]): 1.57 (1.12, 2.19), 1.73 (1.26, 2.38) and 1.69 (1.25, 2.29), respectively. In contrast, we did not find that newborn extreme weight losses were associated with exclusive breastfeeding cessation.ConclusionsWe report that extreme birthweight loss does not trigger immediate formula supplementation. We do not identify any cut-off values to be used as predictors for the initiation of supplementary feeding, this research question remains unanswered.

Neonatal weight matters: An examination of weight changes in full-term breastfeeding newborns during the first 2 weeks of life.

line-associated bloodstream infections among extremely preterm infants with a gestational age of <26 weeks. 2 In our study, 82 extremely preterm infants were included: 40 in 2011-2013 (the 0.5% CHG-70% alcohol cohort) and 42 in 2013-2015 (the 0.2% CHG acetate cohort). The incidence of chemical burns was lower in the 0.2% CHG-acetate cohort (2/41 [4.9%]; 95% CI, 0.8%-15.2%) compared with the 0.5% CHG-70% alcohol cohort (9/41 [22.0%]; 95% CI, 11.3%-36.5%; P = .02). Infection prevention was not compromised, because the incidence of central line-associated bloodstream infections was 27.6% in the alcohol cohort vs 27.3% in the acetate cohort (P = .98). Our results demonstrated that using 0.2% CHG acetate and not 0.5% CHG-70% alcohol as a skin disinfectant in extremely preterm infants results in fewer chemical burns, without increasing the risk of central line-associated bloodstream infections. The use of 0.2% CHG acetate could be considered as an option for skin disinfection in extremely preterm infants.

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