1237 An audit into the management of excessive weight loss in the neonatal period and the impact of the Covid-19 pandemic

• Published in: Archives of disease in childhood Vol. 106; no. Suppl 1; p. A287
• Main Authors: Stead, Joshua, Kale, Ajinkya
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01-10-2021; BMJ Publishing Group LTD
• Subjects: Abstracts; Birth weight; Body Weight; Breast feeding; Breast milk; Breastfeeding & lactation; Colostrum; Coronaviruses; COVID-19; Dehydration; Diuresis; Management; National Standards; Neonatal care; Neonates; Newborn babies; Pandemics; Pediatrics; Pregnancy; Supplements
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2021-rcpch.499

BackgroundIt is accepted that healthy neonates can lose weight in the first days of life due a negative fluid balance caused by diuresis of extra fluid and breast feeding only supplying small amounts of colostrum. In breastfed neonates there is a an average weight loss of 6.6% from their birth weight in the first days of life. Weight loss of greater than 10% can be associated with underlying pathology such as Neonatal Hypernatremic Dehydration (NHD). Weighing of neonates on day five and ten of life as recommended by NICE, has been shown to lead to earlier identifications of feeding difficulties, NHD and abnormal weight loss.ObjectivesTo review local management of neonates presenting with significant weight loss in the first 3 weeks of life.To compare the management of neonates presenting with significant weight loss in the first 3 weeks of life prior to and during the Covid-19 pandemic.MethodsCases were identified from admissions coded as ‘Feeding Problems’ during two separate six month periods, prior to and during the Covid-19 pandemic. From these, cases meeting the inclusion criteria were identified manually. The circumstances of the admission and the management of the neonate was assessed and described using descriptive statistics. A comparison between the cases and their management prior to and during the Covid-19 pandemic was performed using paired T-Testing.Resultsn=16 cases met the inclusion criteria. n=12 of these cases were admitted in the six months prior to the Covid-19 pandemic. n=4 cases were admitted during the Covid-19 pandemic.The neonates admitted with weight loss had a mean gestation of 39 +0 weeks and a mean birthweight of 3480g. 56% were born by Caesarean Section. The mean maternal age was 34 years. n=10 of the neonates were born to primiparous mothers. The mean weight loss was 13.9%. These factors were not statistically different in the pre-pandemic and pandemic groups.n=15 neonates were breast fed on admission. Of these n=2 were discharged fully formula fed, n=10 were breastfed (with or without expressed breast milk top ups) and n=3 were mixed feeding. There was no difference in the discharge feeding plans between the pandemic and pre-pandemic group.The length of hospital stay was significantly less in the neonates admitted during the pandemic (mean= 0.75 days) compared to prior to the pandemic (2.5 days) p=0.041.ConclusionsInfants that were admitted with weight loss in this audit were more likely to be born to primiparous mothers, breastfed and born via caesarean section.Fewer neonates presented during the Covid-19 pandemic compared to before the pandemic. The length of stay in hospital was shorter during the Covid-19 pandemic.Despite local and national guidelines to encourage ongoing breast feeding and supplementation with expressed milk, neonates presenting with weight loss are often discharged either exclusively formula fed or mixed feeding.