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

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          Abstract

          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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          Most cited references34

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          Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss.

          Some mothers have difficulty initiating lactation even when highly motivated to breastfeed. The purpose of this study was to determine the incidence of and risk factors for suboptimal infant breastfeeding behavior (SIBB), delayed onset of lactation, and excess neonatal weight loss among mother-infant pairs in a population with high educational levels and motivation to breastfeed. All mothers residing in Davis, California, who gave birth to a healthy, single, term infant at 1 of 5 area hospitals during the 10-month recruitment period in 1999 were invited to participate if they were willing to attempt to breastfeed exclusively for at least 1 month. Lactation guidance was provided and data were collected in the hospital (day 0) and on days 3, 5, 7, and 14. Infant breastfeeding behavior was evaluated by trained lactation consultants using the Infant Breastfeeding Assessment Tool. Onset of lactation was defined based on maternal report of changes in breast fullness. Infant weight loss was considered excessive if it was >or=10% of birth weight by day 3. Of the 328 eligible mothers, 280 (85%) participated in the study. The prevalence of SIBB was 49% on day 0, 22% on day 3, and 14% on day 7. SIBB was significantly associated with primiparity (days 0 and 3), cesarean section (in multiparas, day 0), flat or inverted nipples, infant status at birth (days 0 and 3), use of nonbreast milk fluids in the first 48 hours (days 3 and 7), pacifier use (day 3), stage II labor >1 hour (day 7), maternal body mass index >27 kg/m(2) (day 7) and birth weight 72 hours) occurred in 22% of women and was associated with primiparity, cesarean section, stage II labor >1 hour, maternal body mass index >27 kg/m(2), flat or inverted nipples, and birth weight >3600 g (in primiparas). Excess weight loss occurred in 12% of infants and was associated with primiparity, long duration of labor, use of labor medications (in multiparas), and infant status at birth. The risk of excess infant weight loss was 7.1 times greater if the mother had delayed onset of lactation, and 2.6 times greater if the infant had SIBB on day 0. Early lactation success is strongly influenced by parity, but may also be affected by potentially modifiable factors such as delivery mode, duration of labor, labor medications, use of nonbreast milk fluids and/or pacifiers, and maternal overweight. All breastfeeding mother-infant pairs should be evaluated at 72 to 96 hours' postpartum.
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            Breastfeeding protects against infectious diseases during infancy in industrialized countries. A systematic review.

            Firstly, this review was performed to assess the effect of breastfeeding on infections during infancy in industrialized countries. Secondly, the effect of duration and exclusiveness of breastfeeding were explored. Studies were identified using Medline, Cochrane Library, Science Citation Index and by a manual search from bibliographies of articles from August 1986 to January 2008. Follow-up, case-control and randomized controlled trial (RCT) studies performed in an industrialized country, published in English, with breastfeeding as a determinant, with overall infections, gastrointestinal or respiratory tract infections as a major outcome, and at least 40 participants in the study were included. Using Bauchner's criteria published in a review in 1986, two reviewers and a peer reviewer assessed the internal validity of those studies. Twenty-one studies that met the inclusion and internal validity criteria were included. These included 16 follow-up and four case-control studies and one RCT. Four out of five studies observed decreased effects on overall infections in breastfed infants. With regard to gastrointestinal infections, six out of eight studies suggested that breastfeeding had a protective effect. Thirteen out of 16 studies concluded that breastfeeding protects infants against respiratory tract infections. Five studies combined duration and exclusiveness of breastfeeding. All studies observed a protective dose/duration-response effect on gastrointestinal or respiratory tract infections. These studies strongly suggest that breastfeeding protects infants against overall infections, gastrointestinal and respiratory tract infections in industrialized countries. The optimal duration of exclusive breastfeeding for protection against infectious diseases needs to be studied in more detail.
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              Physiology of fetal lung fluid clearance and the effect of labor.

              Respiratory morbidity in near term (> or =34 and <37 weeks) infants delivered spontaneously or by elective cesarean section (ECS) has been well documented in the literature, and accounts for a significant number of admissions to intensive care units among these neonates. Given the high rates of near-term deliveries in the USA and worldwide, the public health and economic impact of morbidity in this subgroup is considerable. Causes of respiratory distress include transient tachypnea of the newborn (TTNB), surfactant deficiency, pneumonia, and pulmonary hypertension. There is considerable evidence that physiologic events in the last few weeks of pregnancy coupled with the onset of spontaneous labor are accompanied by changes in the hormonal milieu of the fetus and its mother, resulting in rapid maturation and preparation of the fetus for delivery and neonatal transition. A surge in endogenous steroids and catecholamines accompanies term gestation and spontaneous vaginal delivery, and is responsible for some of the maturational effects. Rapid clearance of fetal lung fluid clearance plays a key role in the transition to air breathing. The bulk of this fluid clearance is mediated by transepithelial sodium reabsorption through amiloride-sensitive sodium channels in the alveolar epithelial cells with only a limited contribution from mechanical factors and Starling forces. Disruption of this process can lead to retention of fluid in air spaces, setting the stage for alveolar hypoventilation. When infants are delivered near-term, especially by cesarean section (repeat or primary) before the onset of spontaneous labor, the fetus is often deprived of these hormonal changes, making the neonatal transition more difficult. This chapter discusses the physiologic mechanisms underlying fetal lung fluid absorption and explores potential strategies for facilitating neonatal transition.
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                Author and article information

                Contributors
                niamh.m.kelly@kcl.ac.uk
                Journal
                Matern Child Nutr
                Matern Child Nutr
                10.1111/(ISSN)1740-8709
                MCN
                Maternal & Child Nutrition
                John Wiley and Sons Inc. (Hoboken )
                1740-8695
                1740-8709
                27 November 2019
                April 2020
                : 16
                : 2 ( doiID: 10.1111/mcn.v16.2 )
                : e12914
                Affiliations
                [ 1 ] Dept. of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, St Thomas' Hospital Campus King's College London London UK
                [ 2 ] Maternity Department Imperial College Healthcare NHS Trust London UK
                [ 3 ] Warwick Clinical Trials Unit, Warwick Medical School University of Warwick Coventry UK
                Author notes
                [*] [* ] Correspondence

                Niamh M. Kelly, Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, St Thomas' Hospital Campus, King's College London, Westminster Bridge Road, SE1 7EH, UK.

                Email: niamh.m.kelly@ 123456kcl.ac.uk

                Author information
                https://orcid.org/0000-0002-1248-2612
                https://orcid.org/0000-0003-2936-2841
                https://orcid.org/0000-0003-3675-9978
                Article
                MCN12914 MCN-05-19-RA-3867.R3
                10.1111/mcn.12914
                7083401
                31777183
                1b30a9d3-3bd9-4959-9f58-55e10bfc3727
                © 2019 The Authors. Maternal & Child Nutrition published by John Wiley & Sons, Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 02 May 2019
                : 25 October 2019
                : 30 October 2019
                Page count
                Figures: 2, Tables: 1, Pages: 11, Words: 5564
                Categories
                Review Article
                Review Articles
                Custom metadata
                2.0
                April 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.8 mode:remove_FC converted:20.03.2020

                breastfeeding,caesarean section,excessive weight loss,infant feeding,infant growth,mode of delivery,neonatal growth,neonatal weight loss

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