出生早期の新生児における体温及び栄養管理が体重減少と黄疸発現に及ぼす影響

1)

2)

3)

4)

5)

6)

7)

8)

9)

10)

11)

12)

13)

14)

15)

16)

17)

18)

Victora CG, Bahl R, Barros AJ, Franca GVA, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC

and Lancet Breastfeeding Series Group : Breastfeeding in the 21st century : epidemiology, mechanisms, and

lifelong effect. Lancet. 387 : 475-490, 2016.

World Health Organization. Global Nutrition Targets 2025 : Breastfeeding Policy Brief (WHO/NMH/NHD/

14.7). 2014.

Oribe M, Lertxundi A, Basterrechea M, Begiristain H, Marina LS, Villar M, Dorronsoro M, Amiano P and

Ibarluzea J : [Prevalence of factors associated with the duration of exclusive breastfeeding during the first 6

months of life in the INMA birth cohort in Gipuzkoa]. Gaceta sanitaria. 29 : 4-9, 2015.

Cox K, Giglia R, Zhao Y and Binns CW : Factors associated with exclusive breastfeeding at hospital discharge

in rural Western Australia. Journal of human lactation. 30 : 488-497, 2014.

Centers for Diesease Control and Prevention. Breastfeeding Report Card. 2018.

厚生労働省．平成 27 年度 乳幼児栄養調査結果の概要．2016．

Flaherman V, Schaefer EW, Kuzniewicz MW, Li SX, Walsh EM and Paul IM : Health Care Utilization in the

First Month After Birth and Its Relationship to Newborn Weight Loss and Method of Feeding. Academic

pediatrics. 18 : 677-684, 2018.

Chen CF, Hsu MC, Shen CH, Wang CL, Chang SC, Wu KG, Wu SC and Chen SJ : Influence of breast-feeding on

weight loss, jaundice, and waste elimination in neonates. Pediatrics and neonatology. 52 : 85-92, 2011.

Macdonald PD, Ross SRM, Grant L and Young D : Neonatal weight loss in breast and formula fed infants.

Archives of disease in childhood. 88 : F472-476, 2003.

Martens PJ and Romphf L : Factors associated with newborn in-hospital weight loss : comparisons by feeding

method, demographics, and birthing procedures. Journal of human lactation. 23 : 233-241, 2007.

Fonseca MJ, Severo M, Barros H and Santos AC : Determinants of weight changes during the first 96 hours of

life in full-term newborns. Birth. 41 : 160-168, 2014.

久保田史郎：環境温度が赤ちゃんの体温調節機構に及ぼす影響について，臨床体温 23：20-34，2005．

Paul IM, Schaefer EW, Miller JR, Kuzniewicz, Li SX, Walsh EM and Flaherman VJ : Weight Change

Nomograms for the First Month After Birth. Pediatrics. 138 : e20162625, 2016.

Macdonald PD, Ross SRM, Grant L and Young D : Neonatal weight loss in breast and formula-fed infants.

Archives of disease in childhood. 472-477, 2003.

Unal S, Arhan E, Kara N, Uncu N and Aliefendioğlu D : Breast-feeding-associated hypernatremia : retrospective analysis of 169 term newborns. Pediatrics international. 50 : 29-34, 2008.

Koklu E, Gunes T, Ozturk MA, Kose M, Kurtoglu S and Yuksel F : A review of 116 cases of breastfeedingassociated hypernatremia in rural area of central Turkey. Journal of Tropical Pediatrics. 53 : 347-350, 2007.

Oddie SJ, Craven V, Deakin K, Westman J and Scally A : Severe neonatal hypernatraemia : a population based

study. Archives of disease in childhood. 98 : F384-387, 2013.

Lavagno CB, Camozzi P, Renzi S, Laba SAG, Simonetti GD, Bianchetti MG and Milani GP : reastfeeding-Associated Hypernatremia : A Systematic Review of the Literature. Journal of human lactation. 32 : 67-74, 2016.

10

久保田

ほか２名

19) Kubota S, Zaitsu M and Yoshihara T : Growth Patterns of Neonates Treated with Thermal Control in Neutral

Environment and Nutrition Regulation to Meet Basal Metabolism. Nutrients. 11 : 592, 2019.

20) Zaitsu M, Yoshihara T, Nakai H and Kubota S : Optimal Thermal Control with Sufficient Nutrition May

Reduce the Incidence of Neonatal Jaundice by Preventing Body-Weight Loss among Non-Low Birth Weight

Infants Not Admitted to Neonatal Intensive Care Unit. Neonatology. 114 : 348-354, 2018.

21) Flaherman VJ, Narayan NR, Hartigan-OʼConnor D, Cabana M, McCulloch CE and Paul IM : The Effect of

Early Limited Formula on Breastfeeding, Readmission, and Intestinal Microbiota : A Randomized Clinical

Trial. The Journal of pediatrics. 196 : 84-90, 2018.

22) Güemes M, Rahman SA and Hussain K : What is a normal blood glucose? Archives of Disease in Childhood.

101 : 569-574, 2016.

23) Samayam P, Ranganathan PK, Kotari UD and Balasundaram R : Study of Asymptomatic Hypoglycemia in Full

Term Exclusively Breastfed Neonates in First 48 Hours of Life. Journal of clinical and diagnostic research. 9 :

SC07-10, 2015.

24) 長谷川泰延，田中敏章，神崎晋，杉原茂孝，横谷進，田中弘之，原田正平，藤枝憲二：高インスリン血性低血

糖症の診断と治療ガイドライン．日本小児科学会雑誌．110：1471-1474，2006．

25) 久保田史郎：環境温度が赤ちゃんの体温調節機構に及ぼす影響について，鹿児島県母性衛生学会誌 13：1-9，

2008．

26) Fukuda I, Matsuda H, Sugahara S and Kazama T : The effect of intravenous glucose solutions on neonatal

blood glucose levels after cesarean delivery. Journal of Anesthesia. 27 : 180-185, 2013.

27) Louvigne M, Rouleau S, Caldagues E, Souto I, Montcho Y, Bouvagnet AM, Baud O, Carel JC and Gascoin G :

Association of maternal nutrition with transient neonatal hyperinsulinism. PloS one. 13 : e0195383, 2018.

28) Oettlé GJ, Emmett PM and Heaton KW : Glucose and insulin responses to manufactured and whole-food

snacks. The American journal of clinical nutrition. 45 : 86-91, 1987.

29) Tey SL, Salleh NB, Henry J and Forde CG : Effects of aspartame-, monk fruit-, stevia- and sucrose-sweetened

beverages on postprandial glucose, insulin and energy intake. International journal of obesity. 41 : 450-457,

2017.

30) Soll RF : Heat loss prevention in neonates. Journal of perinatology. 28 Suppl 1 : S57-S59, 2008.

31) Stern L : The newborn infant and his thermal environment. Current problems in pediatrics. 1 : 1-29, 1970.

32) Stern L, Lees MH and Leduc J : Environmental temperature, oxygen consumption, and catecholamine

excretion in newborn infants. Pediatrics. 36 : 367-373, 1965.

33) 林時仲：母乳不足感を訴える母親への対応，周産期医学．42：209-212，2012．

34) de Carvalho M, Hall M and Harvey D : Effects of water supplementation on physiological jaundice in breastfed babies. Archives of disease in childhood. 56 : 568-569, 1981.

35) Hey EN and Katz G : The Optimum Thermal Environment for Naked Babies. Archives of disease in childhood.

45 : 328-334, 1970.

36) Kubota S, Koyanagi T, Hori E, Hara K, Shimokawa H and Nakano H : Homeothermal adjustment in the

immediate postdelivered infant monitored by continuous and simultaneous measurement of core and

peripheral body temperatures. Biology of the neonate. 54 : 79-85, 1988.

37) Yoshimura T, Tsukimori K, Wake N and Nakano H : The influence of thermal environment on pulmonary

hemodynamic acclimation to extrauterine life in normal full-term neonates. Journal of Perinatal Medicine. 35 :

236-240, 2007.

38) Sato H, Uchida T, Toyota K, Kanno M, Hashimoto T, Watanabe M, Nakamura T, Tamiya G, Aoki K and

Hayasaka K : Association of breast-fed neonatal hyperbilirubinemia with UGT1A1 polymorphisms : 211G ＞

A (G71R) mutation becomes a risk factor under inadequate feeding. Journal of human genetics. 58 : 7-10, 2013.

39) Itoh S, Kondo M, Kusaka T, Isobe K and Onishi S : Differences in transcutaneous bilirubin readings in Japanese

term infants according to feeding method. Pediatrics international. 43 : 12-15, 2001.

40) Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 129 : e827-841, 2012.

41) Dancis J, OʼConnell JR and Holt LE : A grid for recording the weight of premature infants. The Journal of

pediatrics. 33 : 570-572, 1948.

42) Brosius KK, Ritter DA and Kenny JD : Postnatal growth curve of the infant with extremely low birth weight

who was fed enterally. Pediatrics. 74 : 778-782, 1984.

43) Itabashi K, Takeuchi T, Okuyama K, Kuriya N and Ohtani Y : Postnatal growth curves of very low birth

weight Japanese infants. Acta paediatrica Japonica. 34 : 648-655, 1992.

新生児の体温と栄養管理

44)

45)

46)

47)

48)

49)

50)

51)

52)

53)

54)

11

Itabashi K, Takeuchi T, Hayashi T, Okuyama K, Kuriya N and Otani Y : Postnatal reference growth curves for

very low birth weight infants. Early human development. 37 : 151-160, 1994.

Diekmann M, Genzel-Boroviczény O, Zoppelli L and Von Poblotzki M : Postnatal growth curves for extremely

low birth weight infants with early enteral nutrition. European Journal of Pediatrics. 164 : 714-723, 2005.

Chen YJ, Chen WC and Chen CM : Risk factors for hyperbilirubinemia in breastfed term neonates. European

journal of pediatrics. 171 : 167-171, 2012.

Sato H, Uchida T, Toyota K, Kakamura T, Tamiya G, Kanno M, Hashimoto T, Watanabe M, Aoki K and

Hayasaka K : Association of neonatal hyperbilirubinemia in breast-fed infants with UGT1A1 or SLCOs

polymorphisms. Journal of Human Genetics. 60 : 35-40, 2014.

Huang MJ, Kua KE, Teng HC, Tang KS, Weng HW and Huang CS : Risk factors for severe hyperbilirubinemia

in neonates. Pediatric Research. 56 : 682-689, 2004.

Aoshima N, Fujie Y, Itoh T, Tukey RH and Fujiwara R : Glucose induces intestinal human UDP-glucuronosyltransferase (UGT) 1A1 to prevent neonatal hyperbilirubinemia. Scientific Reports. 4 : 6343, 2014.

Suresh GK and Clark RE : Cost-effectiveness of strategies that are intended to prevent kernicterus in

newborn infants. Pediatrics. 114 : 917-924, 2004.

Maisels MJ and McDonagh AF : Phototherapy for neonatal jaundice. The New England journal of medicine.

358 : 920-928, 2008.

Olusanya BO, Osibanjo FB and Slusher TM : Risk factors for severe neonatal hyperbilirubinemia in low and

middle-income countries : a systematic review and meta-analysis. PloS one. 10 : e0117229, 2015.

Sedlak TW and Snyder SH : Bilirubin benefits : cellular protection by a biliverdin reductase antioxidant cycle.

Pediatrics. 113 : 1776-1782, 2004.

McLaren L, McIntyre L and Kirkpatrick S : Roseʼs population strategy of prevention need not increase social

inequalities in health. International journal of epidemiology. 39 : 372-377, 2010.

(Received for publication November 9, 2019)

（特に重要な文献については，番号をゴシック体で表記している．

12

久保田

ほか２名

Neonatal Management of Body Temperature and Nutrition

on Body Weight Loss and Neonatal Jaundice

Shiro KUBOTA1)2), Masayoshi ZAITSU3), Tatsuya YOSHIHARA2)4)

1)

Kubota Life Science Laboratory Co., Ltd., Saga, Japan

2)

Kubota Maternity Clinic, Fukuoka, Japan

3)

Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

4)

Clinical Research Center, Fukuoka Mirai Hospital, Fukuoka, Japan

After birth, the environment of infants suddenly changes from inside to outside of the uterus.

Therefore, infants should immediately adapt to the new environment. However, their cardiopulmonary

abilities are yet immature and vulnerable to the sudden change.

The room temperature of delivery rooms (around 25℃) is likely to be low for infants. Due to the

immature abilities to produce and maintain heat, infants thus have a considerable risk of hypothermia,

which can cause unstable circulatory status.

Breast milk is an excellent nutritional source for infants, and breastfeeding is currently

recommended worldwide. However, in some instances, breastfeeding may not sufficiently meet the

basal metabolism of infants for the first several days after birth in Japan. In general, the maximum

body-weight loss is more significant in breastfed infants compared with bottle-fed infants. Excessive

body-weight loss is known to increase the risks of hypoglycemia, hypernatremia, and hyperbilirubinemia. These critical neonatal situations can lead to permanent central nervous damages.

In our hospital, we applied a combination method of thermal control and nutritional regulation to

meet the basal metabolism (50 kcal/kg/day). In this method, neonates were maintained in the neutral

environment temperature (32-34℃) for more than 1-2 hours after birth. This thermal control stabilizes

the autonomic nerve system, which has benefits on bowel movement, early initiation of oral intake, and

rapid excretion of meconium. Neonates were also fed with 5％ glucose solution (10 mL/kg) at 1 hour

after birth, breastfed every 3 hours, and the formula was added (if applicable) to meet basal

metabolism. We have reported the results of this combination method, with very low incidence rates

for excessive body-weight loss (1.9％) and neonatal jaundice required phototherapy (0.3％).

Here, we review and discuss the influence of the neonatal management of body temperature and

nutrition after birth on infantsʼ clinical outcomes.

Key words : Breastfeeding, physiological body-weight loss, thermal control, neonatal jaundice, neonatal

hypoglycemia

...