Journal Club August

Wednesday, August 18, 2010
Notes by Laurel Wilson, BS, IBCLC, CLE, CCCE, CLD
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Article: Lamp, JM and Macke, JK. Relationships among Intrapartum Maternal Fluid Intake, Birth Type, Neonatal Output, and Neonatal Weight Loss During the First 48 Hours After Birth. JOGNN 2010; 39 (No 2, March/April):169-177. Presented by Catherine A. Janoka, RN, BSN, IBCLC, Lactation Consultant, Memorial Health System

Trying to find out if fluids received during labor, birth type were indicators of weight loss (to put the "she had excess fluids during labor so we should expect the baby to lose more weight” theory). All confounders were taken into account.

Findings:

• Factors that did effect neonatal weight loss were epidurals use, higher birth weight, gender and neonatal feeding type
• Intrapartum maternal fluid intake does not appear significantly related to neonatal weight loss (contrary to what we have thought)
• Breastfed babies experienced higher weight loss than formula fed infants
• Neonates who had a vaginal birth with epidural lose about 1 and 3/4% more of their birth eight than those who had a vaginal birth with no epidural
• Risk factors - females lose more weight than males, vaginal with epidural/oxytocin lose more weight

There are two new studies in the works, "The Butterball Turkey Effect - Maternal IV fluids and Infant Weight” and a study in Ontario. Will keep eyes open for these.

Article: Bramson, L, Lee, JW, Moore, E, et al. Effect of Early Skin-to-Skin Mother-Infant Contact During the First 3 Hours Following Birth on Exclusive Breastfeeding During the Maternity Hospital Stay. J Hum Lact 2010; 26(2);130-137. Presented by Carol Anderson RN, IBCLC, Lactation Consultant, Rose Medical Center

Cohort was enormous: 21,842 mothers! Did an excellent job at considering confounders.

Results: Mothers who breastfed exclusively were more likely to be Hispanic, have a high school education, have an intent to BF, have vaginal delivery, non-CNS anesthesia/analgesia, and receive more than 1 hour of STS.
Appears to be a dose dependent response - the more skin to skin, the higher the exclusive feeding rate.
There is a need to increase initial STS to 3 hours or more initially according to data.

Mikiel-Kostyra in 2002 found that just 20 minutes of uninterrupted STS increased exclusive BF. Mothers who had more than 20 breastfed 3 months longer than those who did not.
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Article: Morton, J, Hall, JY, Wong, RJ, et al. Combining Hand Techniques with Electric Pumping Increases Milk Production in Mothers of Preterm Infants. Journal of Perinatology 2009; 29:757-764. Presented by Jeannine Hoelsken, RN BSN IBCLC, Lactation Support Services at The Children’s Hospital, Anschutz Medical Campus

Important to review the hands-on pumping video and hand expression videos by Jane Morton. Can view in entirety at this link:
http://newborns.stanford.edu/Breastfeeding/HandExpression.html

Hand expression in first few days of life increase milk supply by up to a third!!! When combined with hand expression for mothers of preemies can double milk supply!