University of California, Davis, Medical Center, Department of Pediatrics, 2516 Stockton Blvd, Sacramento, CA 95817, USA.
Pediatrics. 2011 Jan;127(1):e171-9. doi: 10.1542/peds.2009-2663. Epub 2010 Dec 20.
The objectives were to describe weight loss in a multiethnic population of first-born, predominantly breastfed, term infants and to identify potentially modifiable risk factors for excess weight loss (EWL).
Data on prenatal breastfeeding intentions, demographic characteristics, labor and delivery interventions and outcomes, breastfeeding behaviors, formula and pacifier use, onset of lactogenesis, and nipple type and pain were collected prospectively. Logistic regression analyses identified independent predictors of EWL (≥10% of birth weight) by using a preplanned theoretical model.
EWL occurred for 18% of infants who received no or minimal (≤60 mL total since birth) formula (n = 229), including 19% of exclusively breastfed infants (n = 134) and 16% of infants who received minimal formula (n = 95). In bivariate analyses, EWL was associated (P < .05) with higher maternal age, education, and income levels, hourly intrapartum fluid balance, postpartum edema, delayed lactogenesis (>72 hours), fewer infant stools, and infant birth weight. In multivariate logistic regression analysis, only 2 variables predicted EWL significantly, namely, intrapartum fluid balance (adjusted relative risk for EWL of 3.18 [95% confidence interval [CI]: 1.35-13.29] and 2.80 [95% CI: 1.17-11.68] with net intrapartum fluid balance of >200 and 100-200 mL/hour, respectively, compared with <100 mL/hour) and delayed lactogenesis (adjusted relative risk: 3.35 [95% CI: 1.74-8.10]).
EWL was more common in this population than reported previously and was independently related to intrapartum fluid balance. This suggests that intrapartum fluid administration can cause fetal volume expansion and greater fluid loss after birth, although other mechanisms are possible.
描述以多民族、初产、主要母乳喂养、足月婴儿为研究对象的体重减轻情况，并确定超重体重减轻（EWL）的潜在可改变危险因素。
前瞻性收集关于产前母乳喂养意向、人口统计学特征、分娩干预和结局、母乳喂养行为、配方奶和奶嘴使用、泌乳启动、乳头类型和疼痛的数据。使用预先计划的理论模型，通过逻辑回归分析确定 EWL（出生体重的 10%以上）的独立预测因素。
在接受无配方奶或最低配方奶（出生后总摄入量≤60 毫升）的婴儿中，有 18%（n=229）出现 EWL，其中包括 19%的纯母乳喂养婴儿（n=134）和 16%接受最低配方奶的婴儿（n=95）。在单变量分析中，EWL 与较高的产妇年龄、教育程度和收入水平、分娩期间每小时液体平衡、产后水肿、泌乳延迟（>72 小时）、婴儿粪便减少和婴儿出生体重相关（P<0.05）。多元逻辑回归分析表明，只有 2 个变量显著预测 EWL，即分娩期间的液体平衡（EWL 的调整相对风险分别为 3.18（95%置信区间[CI]：1.35-13.29）和 2.80（95%CI：1.17-11.68），与每小时净液体平衡>200 和 100-200 毫升/小时相比，<100 毫升/小时）和泌乳延迟（调整相对风险：3.35（95%CI：1.74-8.10））。
与先前报道的相比，该人群中 EWL 更为常见，且与分娩期间的液体平衡独立相关。这表明分娩期间的液体给药可能导致胎儿体积膨胀，并在出生后导致更大的液体丢失，尽管可能存在其他机制。
