The Effect of Intrapartum Intravenous Fluid Management on Breastfed Newborn Weight Loss
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- Describe the risks associated with intrapartum fluid overload.
- Identify patterns of newborn weight loss.
- Describe recommendations for intrapartum delivery of IV fluids.
Design: a single site randomized controlled trial.
Setting: a regional perinatal centre supporting 4000 annual births
Patients/Participants: Women with a history of a healthy pregnancy, planning to breastfeed and requesting an epidural in early labor participated in this trial
Methods: Women were randomized to receive an intravenous epidural preload volume of < 500 mL continuing at an hourly rate of 110 mL/h (conservative care) or an epidural preload volume of ≥ 500 mL and an hourly rate of >125 mL/h (usual care). The primary study outcome was breastfed newborn weight loss >7% prior to discharge. A sample size of 184 was necessary to have 80% power to detect a 28% reduction in the primary outcome, assuming a two sided, 5% type 1 error.
Results: A total of 200 women participated in the trial (100 in the usual care and 100 in the conservative care groups) and outcome data was collected on 200 babies. Forty-eight infants in the usual care group and 44 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].
Conclusion/Implications for nursing practice: Restricting IV fluids in labor to an epidural preload < 500 mLs and an hourly infusion rate of 110 mLs, compared to a more liberal policy of delivering an epidural preload of > 500 mLs and an hourly infusion rate of >125 mLs per hour, has no known benefits related to breastfed newborn weight loss prior to discharge.
Keywords: intravenous, intrapartum, breastfeeding, newborn weight loss
