Newborn Weight Loss as a Predictor of Persistence of Exclusive Breastfeeding up to 6 Months.

Objectives: To investigate the association between neonatal weight loss and persistence of exclusive breastfeeding up to 6 months. Study Design: An observational cohort study in the setting of a Baby Friendly Hospital, enrolling 1,260 healthy term dyads. Neonatal percentage of weight loss was collected between 48 and 72 h from birth. Using a questionnaire, all mothers were asked on the phone what the infant's mode of feeding at 10 days, 42 days and 6 months (≥183 days) from birth were. The persistence of exclusive breastfeeding up to 6 months and the occurrence of each event that led to the interruption of exclusive breastfeeding were verified through a logistic analysis that included 40 confounders. Results: Infants with a weight loss ≥7% were exclusively breastfed at 6 months in a significantly lower percentage of cases than infants with a weight loss <7% (95% CI 0.563 to 0.734, p < 0.001). Weight loss ≥7% significantly increases the occurrence of either sporadic integration with formula milk (95% CI 0.589 to 0.836, p < 0.001), complementary feeding (95% CI 0.460 to 0.713, p < 0.001), exclusive formula feeding (95% CI 0.587 to 0.967, p < 0.001) or weaning (95% CI 0.692 to 0.912, p = 0.02) through the first 6 months of life. Conclusions: With the limitations of a single-center study, a weight loss ≥7% in the first 72 h after birth appears to be a predictor of an early interruption of exclusive breastfeeding before the recommended 6 months in healthy term exclusively breastfed newborns.

A priori choice of neuraxial labour analgesia and breastfeeding initiation success: a community-based cohort study in an Italian baby-friendly hospital.

OBJECTIVE: To investigate whether the nature of the decision about receiving neuraxial labour analgesia is associated with breastfeeding initiation success (BIS), defined as exclusive breastfeeding until discharge associated with postnatal weight loss <7% at 60 hours from birth. DESIGN: Single-centre community-based cohort study. SETTING: An Italian baby-friendly hospital, from 1 July 2011 to 22 September 2015. PARTICIPANTS: Inclusion criteria: women vaginally delivering singleton cephalic newborns and willing to breastfeed. EXCLUSION CRITERIA: women who delivered in uterus-dead fetuses, were single or requested but did not receive neuraxial analgesia. Overall, 775 out of the 3628 enrolled women received neuraxial analgesia. RESULTS: Compared with women who tried to cope with labour pain, those who decided a priori to receive neuraxial analgesia had less BIS (planned vaginal birth: 2121/3421 (62.0%), vs 102/207 (49.3%; p<0.001; risk difference (RD), 12.7%); actual vaginal birth: 1924/2994 (64.3%), vs 93/189 (49.2%; p<0.001; RD, 15.1%)). Multivariable analyses with antelabour-only confounders confirmed both associations (planned vaginal birth: relative risk (RR), 0.65; 95% CI, 0.48 to 0.87; actual vaginal birth: RR, 0.59; 95% CI, 0.43 to 0.80). Although women who requested analgesia as a last resort had less BIS than did those successfully coping with labour pain in the bivariable analyses (planned vaginal birth: 1804/2853 (63.2%), vs 317/568 (55.8%; p=0.001; RD, 7.4%); actual vaginal birth: 1665/2546 (65.4%), vs 259/448 (57.8%; p=0.002; RD, 7.6%)), multivariable analyses with either antelabour-only or peripartum confounders did not confirm these associations (planned vaginal birth: RR, 0.99; 95% CI, 0.80 to 1.23; actual vaginal birth: RR, 0.90; 95% CI, 0.69 to 1.16). CONCLUSIONS: Compared with trying to cope with labour pain, a priori choice of neuraxial analgesia is negatively associated with BIS. Conversely, compared with having successfully coped with pain, requesting neuraxial analgesia as a last resort is not negatively associated with BIS.

Use of recombinant activated factor VII in severe post-partum haemorrhage: data from the Italian Registry: a multicentric observational retrospective study.

PURPOSE: To report the Italian real experience in clinical practice about recombinant factor VII activated (rFVIIa) in Post-Partum Haemorrhage (PPH) treatment. METHODS: An Italian retrospective survey of severe primary PPH cases treated with rFVIIa was performed. Anamnestic, clinical and haemostatic data about thirty-five patients with PPH, from 2005 to 2007, were collected. Coagulative parameters and transfusion requirements before and after rFVIIa treatment were compared. RESULTS: After rFVIIa administration INR was significantly decreased, while fibrinogen levels were markedly increased. Median of packed red blood cells units, platelets units, fresh frozen plasma, crystalloids and colloids needed, before and after rFVIIa administration, were respectively 6 and 2 units (p<1.2exp-6), 1.5 and 0 units (p=0.001), 1250 and 0 mL (p<4.4exp-5), 3000 and 1250 mL (p<0,0042). Twenty-nine of 35 patients needed surgical intervention before rFVIIa administration, 9/35 after treatment. Hysterectomies have been performed respectively in 10/35 cases before and in 6/35 cases after rFVIIa infusion. No maternal deaths have been reported. No adverse events or thromboembolic complications were observed. CONCLUSIONS: Our clinical and haemostatic data suggest that recombinant activated factor VII may be a safe and helpful adjunctive therapy in the PPH management.