The effect of maternal pre-cesarean oral carbohydrate supplementation on neonatal jaundice: a randomized, double-blind clinical trial
Background: lack of breastfeeding initiation in the first hours after birth is an influencing factor in the incidence of jaundice, and breastfeeding problems in the first week of birth are common. Given the effectiveness of oral carbohydrate before the cesarean section on maternal breastfeeding in the first days of birth, this study was conducted to investigate the effectiveness of oral carbohydrate on the incidence of neonatal jaundice.
Methods: In this randomized, double-blind clinical trial study, a total of 91 women scheduled for elective cesarean surgery were randomly divided into intervention (oral carbohydrate before surgery, N=45) and placebo (flavored water before surgery, N=46) groups. The intervention group received 400 + 800 ml of a carbohydrate solution before surgery. Until the end of the first week of birth, subjects were followed-up for neonatal jaundice incidence through the information contained in the medical records.
Results: In the intervention group, 6 infants developed jaundice. All these cases were infants with blood group of A or B from mothers with blood group of O. In contrast, in the placebo group, 25 infants developed jaundice, of them, 5 cases were infants with blood group of A or B from mothers with blood group of O. The number of infants with jaundice was significantly lower in the group receiving oral carbohydrate than in the group receiving placebo (n = 25 (54.3%) VS. n = 6 (13.3%), P 0.001).
Conclusion: Regardless of the type of blood group, pre-cesarean oral carbohydrate intake was observed to reduce the incidence of neonatal jaundice. These findings suggest that carbohydrate could be used as a preventive dietary supplement against neonatal jaundice, which occurs due to the lack of breastfeeding. However, further clinical trials are warranted to confirm our results and to investigate the role of other influencing factors on jaundice such as G6PD deficiency status.
2. El-Beshbishi, S.N., et al., Hyperbilirubinemia and transcutaneous bilirubinometry. Clinical chemistry, 2009. 55(7): p. 1280-1287.
3. Weng, Y.H. and Y.-W. Chiu, Spectrum and outcome analysis of marked neonatal hyperbilirubinemia with blood group incompatibility. Chang Gung Med J, 2009. 32(4): p. 400-408.
4. Fay, D.L., K.G. Schellhase, and G.K. Suresh, Bilirubin screening for normal newborns: a critique of the hour-specific bilirubin nomogram. Pediatrics, 2009. 124(4): p. 1203-1205.
5. Bhutani, V.K., For a safer outcome with newborn jaundice. Indian pediatrics, 2004. 41(4): p. 321-326.
6. Moritz, M.L., et al., Breastfeeding-associated hypernatremia: are we missing the diagnosis? Pediatrics, 2005. 116(3): p. e343-e347.
7. Tarcan, A., et al., Weight loss and hypernatremia in breast‐fed babies: Frequency in neonates with non‐hemolytic jaundice. Journal of paediatrics and child health, 2005. 41(9‐10): p. 484-487.
8. Boskabadi, H., et al., Neonatal hypernatremia and dehydration in infants receiving inadequate breastfeeding. Asia Pacific journal of clinical nutrition, 2010. 19(3): p. 301-307.
9. Boskabadi, H., G. Maamouri, and S. Mafinejad, The effect of traditional remedies (camel's thorn, flixweed and sugar water) on idiopathic neonatal jaundice. Iranian journal of pediatrics, 2011. 21(3): p. 325-330.
10. Schneider, A.P., Breast milk jaundice in the newborn: a real entity. JAMA, 1986. 255(23): p. 3270-3274.
11. Kaplan, M., et al., Neonatal jaundice and liver disease. Neonatal-perinatal medicine, 2011: p. 1443-1496.
12. Dewey, K.G., et al., Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics, 2003. 112(3): p. 607-619.
13. Lemay, D.G., et al., RNA sequencing of the human milk fat layer transcriptome reveals distinct gene expression profiles at three stages of lactation. PloS one, 2013. 8(7): p. e67531.
14. Hausel, J., et al., A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients. Anesthesia & Analgesia, 2001. 93(5): p. 1344-1350.
15. Bisgaard, T., et al., Randomized clinical trial comparing an oral carbohydrate beverage with placebo before laparoscopic cholecystectomy. British journal of surgery, 2004. 91(2): p. 151-158.
16. Hausel, J., et al., Randomized clinical trial of the effects of oral preoperative carbohydrates on postoperative nausea and vomiting after laparoscopic cholecystectomy. British journal of surgery, 2005. 92(4): p. 415-421.
17. Yuill, K., et al., The administration of an oral carbohydrate-containing fluid prior to major elective upper-gastrointestinal surgery preserves skeletal muscle mass postoperatively—a randomised clinical trial. Clinical Nutrition, 2005. 24(1): p. 32-37.
18. Soop, M., et al., Preoperative oral carbohydrate treatment attenuates endogenous glucose release 3 days after surgery. Clinical Nutrition, 2004. 23(4): p. 733-741.
19. Nygren, J., et al., Preoperative oral carbohydrate administration reduces postoperative insulin resistance. Clinical nutrition, 1998. 17(2): p. 65-71.
20. Thorell, A., J. Nygren, and O. Ljungqvist, Insulin resistance: a marker of surgical stress. Current Opinion in Clinical Nutrition & Metabolic Care, 1999. 2(1): p. 69-78.
21. Salas, A.A., et al., Significant weight loss in breastfed term infants readmitted for hyperbilirubinemia. BMC pediatrics, 2009. 9(1): p. 1.
|Issue||Vol 2, No 2 (Spring 2016)|
|Neonatal jaundice Cesarean surgery Oral carbohydrate Breastfeeding|
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