Excessive weight loss in exclusively breastfed full-term newborns in a Baby-Friendly Hospital

Abstract

Objective:To determine the risk factors for weight loss over 8% in full-term newborns at postpartum discharge from a Baby Friendly Hospital.Methods:The cases were selected from a cohort of infants belonging to a previous study. Healthy full-term newborns with birth weight ≥2.000g, who were exclusively breastfed were included and excluded twins and those undergoing phototherapy as well as those discharged after 96h of life. The analyzed maternal and neonatal variables were maternal age, parity, ethnicity, type of delivery, maternal diabetes, gender, gestational age and appropriate weight for age. Adjusted multiple and univariate Cox regression analyses were used, considering as significant p<0.05.Results:We studied 414 newborns, of whom 107 (25.8%) had excessive weight loss. Through the univariate regression, risk factors associated with weight loss>8% were cesarean delivery and older maternal age. At the adjusted multiple regression analysis, the model to explain the weight loss was cesarean delivery (Relative risk 2.27, 95% of Confidence Interval 1.54–3.35).Conclusions:The independent predictor for weight loss>8% in exclusively breastfed full-term newborns in a Baby-Friendly Hospital was the cesarean delivery. It is possible to reduce the number of cesarean sections to minimize neonatal excessive weight loss and the resulting use of infant formula during the first week of life.

Neonatal weight loss and gain patterns in caesarean section born infants: integrative systematic review

“…However, infants born vaginally are often discharged earlier than those born by CS due to maternal recovery time from surgery, introducing possible confounding as vaginally delivered babies may continue to lose weight after discharge. Mezzacappa and Ferreira () accounted for this in their analysis; however, Verd et al () did not. Miller et al () and Flaherman et al () weighed babies every 24 hr until discharge, with an extra timepoint for CS infants due to longer hospital stay (96 hr) but compared weight loss at set timepoints (24 and 72 hr).…”

“…Of the seven papers included, two were retrospective cohort studies (Flaherman et al, ; Miller et al, ), three were prospective cohort studies (Manganaro, Mamì, Marrone, Marseglia, & Gemelli, ; Saki, Eshraghian, Mohammad, Foroushani, & Bordbar, ; Samayam, Ranganathan, & Balasundaram, ), and two were secondary analyses of prospective cohorts (Mezzacappa & Ferreira, ; Verd, de Sotto, Fernandez, & Gutierrez, ). Two studies were carried out with the same United States of America (USA) cohort, and single studies were based in Italy, Spain, Iran, India, and Brazil.…”

“…Mezzacappa and Ferreira () studied 414 full‐term exclusively breastfed babies from a baby friendly hospital in Brazil to identify factors involved in infants losing >8% of their birthweight at the time of hospital discharge. In this cohort, 286 (69%) of infants were born vaginally, and 128 (31%) were born by CS.…”

“…Two papers did not directly compare groups, and although there seemed to be a difference in weight trajectories based on the data presented, they did not provide formal measures of difference (Flaherman et al, ; Miller et al, ). Of the papers that did report statistical significance, four found that babies born by CS lost more weight within the first 5 post‐natal days (Manganaro et al, ; Mezzacappa & Ferreira, ; Saki et al, ; Samayam et al, ), while one found no difference (Verd et al, ). Only one study, Saki et al (), examined weight loss separately in male and female infants.…”

“…Weight loss was calculated in four studies around the time of inpatient discharge (Mezzacappa & Ferreira, ; Miller et al, ; Schaefer et al, ; Verd et al, ). However, infants born vaginally are often discharged earlier than those born by CS due to maternal recovery time from surgery, introducing possible confounding as vaginally delivered babies may continue to lose weight after discharge.…”