Weight Change Nomograms for the First Month After Birth

Paul, Ian M.; Schaefer, Eric; Miller, Jennifer R.; Kuzniewicz, Michael W.; Li, Sherian X.; Walsh, Eileen M.; Flaherman, Valerie J.

doi:10.1542/peds.2016-2625

Cited by 54 publications

(51 citation statements)

References 16 publications

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“…For home deliveries (5.2%), birthweight had to be estimated based on the weight of the newborn taken post-partum at the health center (between 1 and 26 days after delivery). Birthweight was estimated by two independent researchers using the 50 th percentile of the weight change nomograms developed by Paul et al [17].…”

Section: Methodsmentioning

confidence: 99%

Detection and initial management of gestational diabetes through primary health care services in Morocco: An effectiveness-implementation trial

et al. 2018

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BackgroundGestational Diabetes Mellitus (GDM) testing and management in Morocco is associated with delays resulting in late commencement of treatment. To reduce delays and to increase access of women to GDM care, a country-adapted intervention targeting primary health care providers was designed to test the hypothesis that detection and initial management of GDM at the primary level of care improves newborn outcomes in terms of lower birthweights and less cases of macrosomia and impacts on maternal weight gain, glucose balance and pregnancy outcomes.Materials and methodsWe conducted a cluster randomized controlled trial in two districts of Morocco. In each district, 10 health centers were randomly selected to serve either as intervention or control sites. Pregnant women attending antenatal care in the study facilities were eligible to participate. At the intervention sites, women were offered GDM screening by capillary glucose testing following International Association of Diabetes in Pregnancy Study Groups/WHO criteria. Women diagnosed with GDM received counselling on nutrition and exercise and were followed up through their health center whereas at control facilities routine practice was applied. Primary outcome was birthweight and secondary outcomes maternal weight gain, glucose control and pregnancy complications. We further assessed GDM prevalence in the intervention arm. Statistical analysis was performed on 210 recruited women. Continuous variables were reported using means while categorical variables using frequencies with tests of independence applying chi-squared tests. Differences of outcome variables between the two groups were estimated by mixed-effects regression models and effect sizes adjusted for confounders. The trial is registered under NCT02979756 at ClinicalTrials.gov.ResultsGDM prevalence reached 23.7% in Marrakech. Birthweight in the intervention group was 147grams lower than in the control group (p = 0.08) as was the proportion of macrosomes (3.5% versus 18.4%; p< 0.001). In the intervention arm, women did two times more follow-ups than at control sites (p = 0.001) and mean follow-up intervals were shorter (11.3 days versus 18.7 days; p < 0.001). Overall, 30% more fasting blood sugar values were balanced (p = 0.005) and mean weekly maternal weight gain 49 grams lower (p = 0.032) in the intervention group. More women from control facilities had a delivery complication whereas more newborn complications were observed in women from intervention facilities. No difference between the two groups existed regarding mode of delivery and mean gestational age at delivery. One of the main limitations of the study was the Hawthorn-effect at control sites that might have led to an underestimation of the effect size.ConclusionA high GDM prevalence in Morocco calls for a context-adapted screening and management approach to enable early interventions. GDM detection and care through antenatal care at primary health facilities may have positively impacted on newborn birthweight but findings are inconclusive. ...

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Section: Methodsmentioning

confidence: 99%

Detection and initial management of gestational diabetes through primary health care services in Morocco: An effectiveness-implementation trial

et al. 2018

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“…Part of the reason for our observed pattern, which may potentially buck the contemporary trend, may be due to the neutral thermal environment that improves digestive function with circulatory stability, resulting in the neonatal capability to be fed sufficiently to meet basal metabolism and prolonged thermal regulation in LBW neonates [8,9,10,11,12]. Additionally, in a recent study with exclusively breastfed neonates, 50% of neonates recovered their weight around 10 days after birth [21]. By contrast, most of the neonates recovered their weight by 4 days after birth in our study, suggesting that our nutrition regulation with supplemental formula milk may successfully meet the basal metabolism in our high-risk population.…”

Section: Discussionmentioning

confidence: 99%

Growth Patterns of Neonates Treated with Thermal Control in Neutral Environment and Nutrition Regulation to Meet Basal Metabolism

2019

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Little is known about the growth patterns of low birth weight neonates (<2500 g) during standardized thermal control and nutrition regulation to meet basal metabolism requirements compared to those of non-low birth weight neonates (2500 g and above). We retrospectively identified 10,544 non-low birth weight and 681 low birth weight neonates placed in thermo-controlled incubators for up to 24 h after birth. All neonates were fed a 5% glucose solution 1 h after birth and breastfed every 3 h (with supplementary formula milk if applicable) to meet basal metabolism requirements. Maximum body-weight loss (%), percentage body-weight loss from birth to peak weight loss (%/day), and percentage body-weight gain from peak weight loss to day 4 (%/day) were assessed by multivariable linear regression. Overall, the growth curves showed a uniform J-shape across all birth weight categories, with a low mean maximum body-weight loss (1.9%) and incidence of neonatal jaundice (0.3%). The body-weight loss patterns did not differ between the two groups. However, low birth weight neonates showed significantly faster growth patterns for percentage body-weight gain: β = 0.52 (95% confidence interval, 0.46 to 0.58). Under thermal control and nutrition regulation, low birth weight neonates might not have disadvantages in clinical outcomes or growth patterns.

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“…The data are mixed on acceptable growth patterns and the definition of failure to thrive in 10-day-old infants, 16 but cleft palate can result in inadequate oral intake because of ineffective breastfeeding from an inability to create suction. 17,18 There is some evidence supporting cleft bottle-only feeds, but far stronger in this case is the medical team's experience.…”

Section: Can An Option That Is Not Consistent With Standard Practice mentioning

confidence: 99%

Gaps in the Implementation of Shared Decision-making: Illustrative Cases

et al. 2019

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Shared decision-making (SDM) has emerged as the preferred decision-making model in the clinician-patient relationship. Through collaboration, SDM helps to facilitate evidence-based medical decisions that are closely aligned with patient or surrogate preferences, values, and goals. How to implement SDM in clinical pediatric practice, however, remains elusive, in part because SDM in pediatrics is complicated by the involvement of parents as a special class of surrogate decision-maker. A provisional framework for the process of SDM in pediatrics was recently proposed by Opel to help facilitate its implementation. To identify aspects of the framework that require refinement, we applied it across a diverse range of clinical cases from multiple pediatric specialties. In doing so, several questions surfaced that deserve further scrutiny: (1) For which medical decisions is consideration of SDM required? (2) What is considered medically reasonable when there is variability in standard practice? (3) Can an option that is not consistent with standard practice still be medically reasonable? (4) How should public health implications be factored into SDM? (5) How should variability in preference sensitivity be approached? (6) How should the developing autonomy of adolescents be integrated into SDM?; and (7) How should SDM address parental decisional burden for emotionally charged decisions? We conduct a brief analysis of each question raised to illustrate key areas for future research.

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Weight Change Nomograms for the First Month After Birth

Abstract: It is not uncommon for newborns to be below birth weight 10 to 14 days after delivery. A larger percentage of newborns delivered by cesarean had yet to regain birth weight at every time point through 1 month.

Cited by 54 publications

References 16 publications

Detection and initial management of gestational diabetes through primary health care services in Morocco: An effectiveness-implementation trial

Detection and initial management of gestational diabetes through primary health care services in Morocco: An effectiveness-implementation trial

Growth Patterns of Neonates Treated with Thermal Control in Neutral Environment and Nutrition Regulation to Meet Basal Metabolism

Gaps in the Implementation of Shared Decision-making: Illustrative Cases

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