External Validation of Early Weight Loss Nomograms for Exclusively Breastfed Newborns

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

doi:10.1089/bfm.2015.0126

Cited by 10 publications

(5 citation statements)

References 32 publications

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“…22 We will also be integrating the Newborn Weight Loss Tool into our EMR to better identify excess weight loss earlier in these at-risk newborns. 23 Our intention is to optimize nutrition through supplementation and fortification, lactation support, DHM, and speech and language pathology evaluation before starting medication. 17 Breastfeeding is known to decrease symptoms of NAS.…”

Section: Discussionmentioning

confidence: 99%

A Quality Improvement Initiative to Improve the Care of Infants Born Exposed to Opioids by Implementing the Eat, Sleep, Console Assessment Tool

Achilles

Castaneda-Lovato

2019

Hospital Pediatrics

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The incidence of infants born exposed to opioids continues to rise. Historically, newborns with neonatal abstinence syndrome have been treated with medication-weaning protocols, leading to costly and prolonged hospital stays. We aimed to reduce the proportion of newborns with neonatal abstinence syndrome who receive opioid medications for treatment of withdrawal symptoms through a quality improvement program. METHODS: In 2016, we formed a multidisciplinary team and used quality improvement methodology to conduct plan-do-study-act cycles. Interventions included prenatal education, family engagement, nonpharmacologic treatments, morphine as needed, and the eat, sleep, console assessment tool. Primary metrics were the proportion of newborns exposed to opioids requiring pharmacologic treatment and the cumulative dose of opioids per exposed newborn requiring pharmacologic treatment. RESULTS: There were 81 infants in the baseline period (January 2015-September 2016) and 100 infants in the postintervention group (October 2016-August 2018). For infants who required medication for treatment, the postintervention group had significantly lower total cumulative dose in methadone equivalents (1.3 mg vs 6.6 mg), shorter length of stay (10.9 days vs 18.7 days), and nonsignificant lower direct costs ($11 936 vs $15 039). CONCLUSIONS: The described intervention effectively replaced the Finnegan Neonatal Abstinence Scoring System and had improved outcomes in more exposed infants receiving no opioid treatment, and when medication was required, the total cumulative dose of opioids was lower. The postintervention group had shorter average length of stay and lower costs.

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Section: Discussionmentioning

confidence: 99%

A Quality Improvement Initiative to Improve the Care of Infants Born Exposed to Opioids by Implementing the Eat, Sleep, Console Assessment Tool

Achilles

Castaneda-Lovato

2019

Hospital Pediatrics

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“…While important health benefits from DHM have been identified in the high-risk, preterm infant population 19,20 , our results indicate that further evaluation of the impact of donor milk on breastfeeding is needed before DHM can be recommended for use in the well newborn nursery setting. Since it is possible that the effect of donor milk on breastfeeding duration may vary based on the degree of newborn weight loss, future projects might consider categorizing newborn weight loss using published nomograms 21,22 . Assessment of the impact of donor milk supplementation on infant intestinal microbiota and allergic status may also be informative, as the benefits for infants of pasteurized, banked donor milk may not be identical to the benefits of fresh maternal milk.…”

Section: Limitationsmentioning

confidence: 99%

“…Since it is possible that the effect of donor milk on breastfeeding duration may vary based on the degree of newborn weight loss, future projects might consider categorizing newborn weight loss using published nomograms. 21,22 Assessment of the impact of donor milk supplementation on infant intestinal microbiota and allergic status may also be informative, as the benefits for infants of pasteurized, banked donor milk may not be identical to the benefits of fresh maternal milk.…”

Section: Limitations and Strengthsmentioning

confidence: 99%

Effect of Donor Milk Supplementation on Breastfeeding Outcomes in Term Newborns: A Randomized Controlled Trial

Kair

Flaherman

Colaizy

2019

Clin Pediatr (Phila)

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Background. Pasteurized donor human milk (DHM) use for healthy newborns is increasing; however, no studies have explored its effect on breastfeeding outcomes. Patients and Methods. We enrolled 60 healthy, term breastfeeding newborns with ≥4.5% weight loss in the first 36 hours in a randomized controlled trial. Thirty newborns were randomly assigned to early limited-volume DHM supplementation and 30 newborns to exclusive breastfeeding. Mothers were surveyed at 1 week and 1, 2, and 3 months regarding the mode of infant feeding. Comparing infants randomized to DHM supplementation with those exclusively breastfeeding, there was no significant difference in the proportion using formula at 1 week (21% vs 7%, P = .15), nor in the proportion of any breastfeeding (79% vs 90%, P = .30) or breastfeeding without formula at 3 months (62% vs 77%, P = .27). Conclusion For newborns with ≥4.5% weight loss in the first 36 hours, early limited-volume supplementation with DHM is unlikely to have a significant favorable impact on breastfeeding outcomes.

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“…Weight loss was calculated in four studies around the time of inpatient discharge (Mezzacappa & Ferreira, 2016;Miller et al, 2015;Schaefer et al, 2015;Verd et al, 2018). 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.…”

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confidence: 99%

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

Kelly

Keane

Gallimore

et al. 2019

Maternal & Child Nutrition

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There is evidence that caesarean section delivery can impact on neonatal weight loss and weight gain patterns in the first 5 days of life. We conducted an integrative systematic review to examine the association of mode of delivery on early neonatal weight loss. Pubmed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Excerpta Medica dataBASE, and Medical Literature Analysis and Retrieval System Online were searched for relevant papers published before June 2019. Reference lists from the relevant papers were then backwards and forwards searched. As neonatal weight loss was reported in different formats, a meta‐analysis could not be carried out. Most studies did not distinguish between elective and emergency caesarean sections or instrumental and nonassisted vaginal deliveries. Seven papers were included. All papers except one found that caesarean section was associated with higher weight loss in the early days of life. Two papers presented data from studies on babies followed up to 1 month. One study found that on day 25, babies born by caesarean section had significantly higher weight gain than those born vaginally, while another found that by day 28, babies born vaginally gained more weight per day (11.9 g/kg/day) than those born by caesarean section (10.9 g/kg/day; p = .02). Overall, infants born by caesarean section lost more weight than those born vaginally, but due to the small number of studies included, more are needed to look at this difference and why it may occur. This discrepancy in weight between the two groups may be corrected over time, but future studies will need larger sample sizes and longer follow‐up periods to examine this.

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External Validation of Early Weight Loss Nomograms for Exclusively Breastfed Newborns

Abstract: The published newborn weight loss nomograms for breastfed neonates were externally validated in a geographically distinct population.

Cited by 10 publications

References 32 publications

A Quality Improvement Initiative to Improve the Care of Infants Born Exposed to Opioids by Implementing the Eat, Sleep, Console Assessment Tool

A Quality Improvement Initiative to Improve the Care of Infants Born Exposed to Opioids by Implementing the Eat, Sleep, Console Assessment Tool

Effect of Donor Milk Supplementation on Breastfeeding Outcomes in Term Newborns: A Randomized Controlled Trial

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

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