Maternal intrapartum fluids and neonatal weight loss in the breastfed infant
Significant weight loss during early life can be of serious concern and assessing weight is key in decisions regarding supplementation. However, supplementation is a significant risk factor for early breastfeeding cessation. Recognising differential causes of weight loss supports identification of genuinely unwell infants and targets practices that support exclusive breastfeeding appropriately. This study's aim was to identify whether maternal fluid balance/load is associated with neonatal weight loss.
The databases CINAHL, MEDLINE, EMBASE, EMCARE were searched for relevant literature. Data were extracted using a structured form based on the Cochrane handbook. Meta-analysis was not possible because of the heterogeneity of all aspects of study design and outcome definitions.
Eight studies presented original data. Four reported an association between maternal intravenous fluid intake and neonatal weight loss, and four did not. No two studies collected the same outcome data at the same time, using the same comparator or intervention.
Further research is required to clarify the relationship between maternal fluid intake and neonatal weight loss in a clinically useful way.
Reduction in weight is a physiological process (Kellams et al, 2017), as an infant adjusts from dependence on maternal circulation for continuous nutrition to managing their own intermittent nutritional intake. Weight nadir usually occurs between days 2 and 4 after birth, recovering to birth weight by the end of the second week (National Institute for Health and Care Excellence, 2017). Acceptable parameters of loss remain unclear in the literature (Rich, 2022) but 10% loss from birth weight is generally cited as a threshold for intervention (National Institute for Health and Care Excellence, 2017). In the context of significant weight loss in a breastfed infant, efficacy of milk transfer becomes a central concern for clinicians (Jayaraj et al, 2020).
Administration of intravenous fluids during the intrapartum period is common practice when anaesthesia is required or complications occur. Intrauterine fluid resuscitation is routinely undertaken to support fetal wellbeing when compromise is suspected (Mahfouz et al, 2022). Transplacental passage of fluids administered to a mother intravenously in the intrapartum period appears to have an association with neonatal birth weight and subsequent loss through diuresis in the early days of life (Mulder and Gardner, 2015; Deng and McLaren, 2018).
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