Department of Rehabilitation, Exercise, and Nutritional Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA.
Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Breastfeed Med. 2021 Mar;16(3):230-237. doi: 10.1089/bfm.2020.0280. Epub 2020 Dec 18.
Exclusive breastfeeding is recommended for most newborns. However, exclusively breastfed newborns sometimes experience excess weight loss (EWL, loss ≥10% of birth weight) while lactation is being established. Our primary objective was to evaluate the sensitivity and specificity of the Newborn Weight Loss Tool (NEWT) in early identification of exclusively breastfed newborns who develop EWL; and secondarily, identify breastfeeding variables associated with an at-risk NEWT trajectory. We conducted a secondary analysis of prospective data from mother-infant dyads screened for inclusion in the U.S. site of the WHO Growth Reference Study. We excluded records if: NEWT-specific criteria not met, missing key data, or >60 mL formula consumed. We defined NEWT "test-positive" based on an in-hospital weight at about 24 hours falling within the NEWT trajectory consistent with eventual EWL. We defined cases as true EWL based on weight measured at home on day of life 4 (DoL4). Of 280 original records, 60 were excluded ( = 27, NEWT-specific exclusion; = 15, missing data; = 18, >60 mL formula), resulting in 220 paired newborn weights measured in-hospital (17 ± 8 hours), and at DoL4 (84 ± 8 hours). NEWT status correctly identified 6/28 EWL cases (21% sensitivity [95% confidence interval, CI, 8-34%]), and 158/192 noncases (82% specificity [95% CI, 75-89%]). NEWT test-positive status was associated with greater weight loss, lower perceived breastfeeding support, and infant less often showing feeding cues on DoL4 ( < 0.05). Sensitivity in predicting EWL is low when applying NEWT at about 24 hours of life; however, early test-positive status is associated with indicators of breastfeeding difficulties on DoL4.
建议大多数新生儿进行纯母乳喂养。然而，在开始哺乳时，纯母乳喂养的新生儿有时会出现体重过度下降（EWL，体重下降≥出生体重的 10%）。我们的主要目标是评估新生儿体重下降工具（NEWT）在早期识别出现 EWL 的纯母乳喂养新生儿中的敏感性和特异性；其次，确定与高危 NEWT 轨迹相关的母乳喂养变量。我们对参加世界卫生组织生长参考研究美国站点的母婴对进行了前瞻性数据的二次分析。如果符合以下标准，我们将排除记录：未达到 NEWT 特定标准、关键数据缺失或摄入超过 60ml 配方奶。我们根据住院期间大约 24 小时的体重落在与最终 EWL 一致的 NEWT 轨迹内，将 NEWT“测试阳性”定义为。我们根据出生后第 4 天（DoL4）在家中测量的体重将病例定义为真正的 EWL。在最初的 280 份记录中，有 60 份被排除（ = 27，NEWT 特定排除； = 15，数据缺失； = 18，摄入超过 60ml 配方奶），因此有 220 对新生儿体重在住院期间（17 ± 8 小时）和 DoL4（84 ± 8 小时）进行了测量。NEWT 状态正确识别了 28 例 EWL 病例中的 6 例（21%的敏感性[95%置信区间，CI，8-34%]），192 例非病例中的 158 例（82%的特异性[95%CI，75-89%]）。NEWT 测试阳性状态与体重下降更大、感知到的母乳喂养支持更少以及婴儿在 DoL4 时较少出现喂养迹象有关（ < 0.05）。当在生命大约 24 小时应用 NEWT 时，预测 EWL 的敏感性较低；然而，早期的测试阳性状态与 DoL4 上母乳喂养困难的指标相关。
