Watson Jo, Hodnett Ellen, Armson B Anthony, Davies Barbara, Watt-Watson Judy
acute care nurse practitioner-adult, a certified lactation consultant, and the operations director for the Women and Babies Program, Sunnybrook Health Sciences Centre and adjunct faculty at the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada..
professor and Heather M. Reisman Chair in Perinatal Nursing Research, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
J Obstet Gynecol Neonatal Nurs. 2012 Jan;41(1):24-32. doi: 10.1111/j.1552-6909.2011.01321.x.
To determine the effect of conservative versus usual intrapartum intravenous (IV) fluid management for low-risk women receiving epidural analgesia on weight loss in breastfed newborns.
A randomized controlled trial.
A tertiary perinatal center in a large urban setting.
Women experiencing uncomplicated pregnancies who planned to have epidural analgesia and to breastfeed.
Healthy pregnant women were randomized to receive an IV epidural preload volume of <500 mLs continuing at an hourly rate of 75-100 mL/h (conservative care) or an epidural preload volume of ≥500 mLs and an hourly rate >125 mL/h (usual care). The primary study outcome was breastfed newborn weight loss >7% prior to hospital discharge. Secondary study outcomes included breastfeeding exclusivity, referral to outpatient breastfeeding clinic support, and delayed discharge. Other outcomes were admission to the neonatal intensive care unit and cord blood pH <7.25.
Two hundred women participated (100 in the conservative care and 100 in the usual care groups). Forty-eight of 100 infants in the usual care group and 44 of the 100 infants in the conservative care group lost >7% of their birth weight prior to discharge, p < 0.52 RR 0.92 [0.68-1.24].
A policy of restricted IV fluids did not affect newborn weight loss. Women and their care providers should be reassured that the volumes of IV fluid <2500 mLs are unlikely to have a clinically meaningful effect on breastfed newborn weight loss >7%. Exploratory analyses suggest that breastfed newborn weight loss increases when intrapartum volumes infused are >2500 mLs. Care providers are encouraged to consider volumes of IV fluid infused intrapartum as a factor that may have contributed to early newborn weight loss in the first 48 h of life.
确定接受硬膜外镇痛的低风险女性采用保守性与常规产时静脉输液管理对母乳喂养新生儿体重减轻的影响。
一项随机对照试验。
大城市环境中的三级围产期中心。
计划进行硬膜外镇痛并母乳喂养的无并发症妊娠女性。
健康孕妇被随机分为两组，一组接受静脉硬膜外预充量<500毫升，以每小时75 - 100毫升的速度持续输注（保守治疗），另一组接受硬膜外预充量≥500毫升且每小时输注速度>125毫升（常规治疗）。主要研究结局是出院前母乳喂养新生儿体重减轻>7%。次要研究结局包括纯母乳喂养、转至门诊母乳喂养诊所获得支持以及延迟出院。其他结局是入住新生儿重症监护病房和脐血pH<7.25。
200名女性参与研究（保守治疗组100名，常规治疗组100名）。常规治疗组100名婴儿中有48名、保守治疗组100名婴儿中有44名在出院前体重减轻超过出生体重的7%，p<0.52，相对危险度0.92[0.68 - 1.24]。
限制静脉输液的政策并未影响新生儿体重减轻。应让女性及其护理人员放心，静脉输液量<2500毫升不太可能对母乳喂养新生儿体重减轻>7%产生具有临床意义的影响。探索性分析表明，产时输注量>2500毫升时，母乳喂养新生儿体重减轻会增加。鼓励护理人员将产时静脉输液量视为可能导致新生儿出生后头48小时内体重早期减轻的一个因素。
