Margaret McLaren
University of Connecticut School of Medicine, USA
Title: Using 24-hour weight as reference for weight loss calculation to promote exclusive breastfeeding in term newborns delivered by Cesarean section
Biography
Biography: Margaret McLaren
Abstract
Exclusive breastfeeding for the first 6 months of life is recommended to promote maternal and infant health. Supplementing the newborns can interfere with the successful establishment and duration of exclusive breastfeeding and are only warranted if medical indications exist, such as clinical evidence of dehydration. Loss of ≥10% of birth weight frequently triggers supplementation due to nursery staff’s concern for dehydration even if not clinically evident. Studies have demonstrated that transplacental passage of maternal intravenous fluids for epidural or spinal anesthesia may inflate birth weight. Researchers have proposed using a newborn’s 24-hour weight, after diuresis of this fluid, as the preferred reference for weight loss calculation. The mother-infant unit at Hartford Hospital, a Baby-Friendly Hospital in Connecticut, USA, implemented this recommendation into routine practice in March, 2014. To evaluate efficacy and safety of this clinical practice in decreasing supplementation, we performed a retrospective chart review on healthy full term newborns delivered by C-section in the 12 months before (n=404) and 12 months after implementation (n=263). The overall supplementation rate decreased from 43.6% pre- to 27.4% post-intervention and in first-time mothers from 51.9% to 31.0%. Among infants losing ≥10% of birth weight (n=97 and 84), the supplementation rate decreased from 63.9% to 26.2%. Hence, there was no significant increase in maximum weight loss, peak transcutaneous bilirubin level, or length of stay overall or in those with ≥10% weight loss from birth; indicating that using the 24-hour infant weight as routine reference for weight loss calculation was safe and effective in reducing supplementation.