| Summary: | 碩士 === 國立臺灣大學 === 護理學研究所 === 103 === Breastfeeding is unquestionably the most natural way for a mother to nourish her baby, not to mention the fact that breast milk is the best source of nutrition for neonates. For more than a decade, the Health Promotion Administration Ministry of Health and Welfare has actively promoted breastfeeding programs, with more and more mothers choosing to breastfeed their babies. Given that the postpartum breastfeeding rate has risen sharply, it is critical not only to teach mothers how to breastfeed efficiently but also to educate them on the dangers of excess weight loss and subsequent complications. Therefore, this study aims to examine in depth the fluctuations in the body weight of neonates who are breastfed and mother-related factors that can lead to a decline in the birth weight, in hope of staving off excess loss in birth weight and reducing the incidence of hyperbilirubinemia and thus detrimental effects on the health of neonates. Ultimately, this will reduce the negative impacts of the use of supplementary infant formula on the success of breastfeeding.
We aim to analyze the maternal factors, intravenous fluid administration over the course of the cesarean section, the course of spontaneous delivery, the postpartum lactation and breastfeeding conditions, and the body weight changes of the neonates. This is a quantitative, descriptive, and retrospective cohort study. Cases were randomly collected from a children’s hospital under a leading medical center in Taipei City. The neonates satisfied the following conditions (1) single births, (2) birth after ≧37 weeks of pregnancy, and (3) birth weight of ≧2500g. We excluded neonates who required further treatment for diseases other than hyperbilirubinemia, whose mothers required stay in the intensive care unit, or whose mothers did not breastfeed entirely. From January 1, 2014 to December 31, 2014, 2931 neonates were born in said children’s hospital, and a total of 1838 neonates with body weight equal to or more than 2500 gm were admitted to the baby room. We made adjustments accordingly based on the percentage of neonates per month and the number of neonates per year, and the completeness of the medical records. We numbered the neonates sequentially each month, with the first 10 cases each drawing a number randomly from 1 to 10. The next 10 would draw a number randomly from 11 to 20, and so forth.
The study included a total of 406 mother-neonate pairs, with 224 boys and 182 girls and an average neonate birth weight of 3214.50 ± 355.31 grams. The data were canvassed from written or electronic medical records and subsequently numbered and stored in the computer. The data was analyzed with the SPSS for Windows 21.0 software package, using frequency distribution, percentage, mean, median, mode, standard deviation, maximum value, minimum value, t-test, Chi-square test, Pearson correlation coefficient, generalized estimating equation (GEE), and classification tree.
The results of the study are as follows:
1.The mean birth body weight was 3214.50 ± 355.31 gm.
2.A mean weight loss of 5.04 ± 2.25％, 8.34 ± 1.50％, 9.06 ± 2.46％, 7 ± 2.81％ of the birth weight was recorded at age 24, 48, 72, and 120 hours, respectively. The babies delivered via cesarean section experienced weight loss of 8.19 ± 2.45％ before gaining after 4 days. However, all babies delivered by either via normal spontaneous delivery or cesarean section typically lost at least 8.27% and 9.44% by 72 hours of age. Out of the 406 babies, 176 babies (44.1%) experienced excess weight loss during hospitalization and often before 72 hours of age (125 babies, 30.79%), while 341 (83.99%) experienced weight loss of >7% at 48 hours of age. During hospitalization, 53 babies (13.1%) were administered the phototherapy treatment for Hyperbilirubinemia, among which 22 babies (41.5%) experienced excess body weight loss.
3.The mean age of the first baby clinic health follow-up was around 35 ± 4.37 days old, with a mean body weight of 4508 ± 522.95 grams, a gain of 1.4 times.
4.The risk factors underpinning excess weight loss in neonates were advanced reproductive age, excess gestational weight gain by the mother, cesarean section, postpartum hemorrhage, and delayed onset of lactation. The risk was especially great if the mother had delayed the onset of lactation.
5.Certain conditions may result in a delayed onset of lactation, e.g. excess gestational weight gain by the mother,the lower pre-pregnancy BMI, BMI before delivery of >30 kg/m2, excess fluctuations in gestational weight, nulliparous women, painless labor, postpartum hemorrhage of >400ml, unanticipated cesarean section, Stage II labor duration of >1 hours, prolonged Stage III labor duration, and prolonged duration of intrapartum prophylaxis.
6.Some conditions may result in a delayed onset of lactation such as the mother’s excess gestational weight gain, pre-pregnancy BMI of ≦20 kg/m2, BMI before delivery of >30 kg/m2, gestational weight changes, nulliparous women, painless labor, postpartum hemorrhage of >400ml, unexpected cesarean section, stage II labor duration of >1 hours, prolonged stage III labor duration, and prolonged duration of intrapartum.
7.Hyperbilirubinemia is significantly related to the delayed onset of lactation. The delayed onset of lactation was a risk factor for excess weight loss in neonates. The greater the body weight loss in neonates, the higher the bilirubin values.
In conclusion, it is recommended that expecting mothers undergo adequate education at prenatal clinics to ensure a healthy pregnancy and to assist the mother in managing the discomforts of pregnancy, diet, exercise, and other lifestyle changes during pregnancy such as breastfeeding. These could aid nulliparous women, mothers with prolonged duration of hospitalization, BMI before delivery of >30 kg/m2, exhaustion, etc. Furthermore, healthy pregnancy may prevent delayed lactation or excess body weight loss in neonates.
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