Impact of intrapartum oxytocin administration on neonatal sucking behavior and breastfeeding

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A total of 64 pairs (29 in the group treated with intrapartum oxytocin and 35 in the control group) of normal infants within 24–48 h of birth and their mothers were recruited. Sucking ability was evaluated by measuring Non-Nutritive Sucking (NNS) for 5 min. Data on the rate of exclusive breastfeeding at 1 month postpartum were collected. In the adjusted multiple regression models, intrapartum oxytocin exposure was significantly associated with fewer total NNS bursts (95% confidence interval (CI), -6.811 to -0.311), longer pause times (95% CI, 0.320 to 9.223), and greater pause-time variability (95% CI, 4.453 to 62.738). Effects estimated using structural equation modeling revealed that intrapartum oxytocin exposure had a significant negative and direct effect on the practice of exclusive breastfeeding 1 month postpartum (β=-.238, p = 0.047). However, no NNS-mediated indirect effects were observed. This report demonstrates that infants born to mothers who receive intrapartum oxytocin may have impaired sucking ability for at least the first 48 h after birth, and breastfeeding support should be provided. Health sciences/Health care/Paediatrics/Neonatology Health sciences/Health care/Paediatrics/Paediatric research Figures Figure 1 Figure 2 Introduction The induction and augmentation of labor during delivery have been increasing worldwide. Reports have shown that 25% of all full-term infants born in developed countries were born after induction or augmentation of labor [ 1 – 3 ] . Additionally, in some areas of low- and middle-income countries, the use of oxytocin for labor induction or augmentation exceeded 50% of obstetric care facilities [ 4 ] . Oxytocin is a peptide hormone released from the posterior pituitary gland. During labor, endogenous oxytocin is released in pulses from the pituitary glands of women into the peripheral bloodstream to induce regular uterine contractions [ 5 ] . Maximum levels of endogenous oxytocin are achieved within 1 h of delivery in both maternal and infant brains. Maternal oxytocin release increases via skin-to-skin contact with the infant [ 6 , 7 ] . This hormone promotes uterine restoration in postpartum mothers and is an essential hormone released during breastfeeding that causes the breast milk ejection reflex [ 8 ] . In cases that require labor induction and augmentation, synthetic oxytocin is the most commonly used uterotonic agent. In contrast to the natural endogenous oxytocin secretion mechanism, the use of continuous intravenous administration of exogenous synthetic oxytocin preparations has been reported to have negative connotations. Specifically, it has been suggested that the administration of exogenous oxytocin disturbs the mechanism of physiological secretion, and the state of excess oxytocin in the mother causes negative feedback and suppresses endogenous oxytocin release [ 9 ] . As a result, not only is there a possibility of reduced endogenous oxytocin secretion, but also of suppressed oxytocin receptors [ 10 , 11 ] . Intrapartum oxytocin administration can also disrupt the balance of the endogenous oxytocin secretion in the fetus by allowing exogenous oxytocin to pass through the placental barrier and immature fetal blood–brain barrier, causing negative feedback and negatively affecting postnatal feeding and water metabolism [ 12 ] . Animal data have shown that perinatal manipulation of the oxytocin system has lasting effects on the feeding, attachment, sociability, and sexual behavior of children [ 13 ] . Oxytocin is an important hormone for breastfeeding, and there have been reports on the impact of intrapartum synthetic oxytocin administration on breastfeeding [ 14 ] . Current reports can be classified into two categories: those that survey the “impact on breastfeeding,” and those that survey the “impact on feeding behavior of infants.” The impact on breastfeeding has been reported to be associated with oxytocin administration, lower early postpartum breastfeeding initiation rates [ 15 , 16 ] , and lower long-term breastfeeding rates [ 17 – 19 ] . However, some reports [ 20 , 21 ] indicated no association with breastfeeding rates, and certain conclusions have not been reached. Impacts on the feeding behavior of infants have been reported in previous studies on the association between intrapartum oxytocin administration and lower expression of primitive neonatal reflexes [ 22 , 23 ] . Primitive reflexes associated with feeding refers to the instinctive behavior of newborns to seek, find, and begin to suck on the nipple of their mother. In previous studies, newborns were placed skin-to-skin on the breasts of their mothers, and their behavior leading up to spontaneous sucking was filmed using a study-specific scale to identify the primitive reflexes of the newborn, as well as to compare the number of primitive reflexes and the rate of eventual effective sucking with and without oxytocin administration. Reduced primitive reflexes associated with feeding have been observed in studies not only at 1 h after birth but also at 48 h after birth [ 19 , 24 ] . Although synthetic oxytocin preparations are fast falling in blood levels, it has been suggested that prolonged infusion of exogenous oxytocin at delivery may alter the neuroendocrine environment of the fetal brain and that the effect lasts for at least 48 h [ 19 , 24 ] . There are several methods for evaluating the feeding abilities of infants. In addition to observing the primitive reflex, the pressure and rhythm can also be measured during sucking movements. In previous studies, infant feeding behavior was evaluated by visual observation of primitive reflexes through videography. However, new findings are expected to be obtained by conducting studies with more objective parameters. The first method measured sucking during direct breastfeeding, in which infants are fed directly through their mother’s breasts. However, sucking measurements during direct breastfeeding result in differences in the lactation conditions between cases. Specifically, differences in the mother’s inexperience with lactation techniques, speed of breast milk flow into the infant’s oral cavity, and breast and nipple morphology make condition matching difficult. The next method involved measuring sucking during bottle feeding with formula or breast milk. However, bottle-feeding infants for research purposes may be a barrier to establishing breastfeeding. Therefore, in this study, we measured the infants’ Non-Nutritive Sucking (NNS) of empty artificial nipples with and without milk inflow using the same nipples and compared their sucking ability. Oxytocin affects the motor neurons associated with feeding and induces a rhythmic sucking reflex [ 25 ] . Therefore, measuring the infants’ sucking pressure and sucking rhythm, as well as analyzing the results, would be possible to provide an objective assessment of the effects of exogenous oxytocin exposure on feeding behavior. In this study, we hypothesized that intrapartum oxytocin exposure would weaken the infant’s ability to suck and negatively affect breastfeeding. This study aimed to determine the effects of intrapartum oxytocin administration on infants’ feeding behavior by measuring sucking pressure and rhythm, as well as to examine its effects on breastfeeding. Methods Participants This study was conducted in a Comprehensive Maternity and Perinatal Care Center in Fukuoka, Japan. The hospital was not accredited by the Baby Friendly Hospital Initiative, and if the mothers needed to supplement their breast milk, formula was used. A total of 86 normal newborns born between May 2022 and April 2023, as well as their mothers, were recruited within 24–48 h of birth. To determine the effects of fetal exposure to exogenous oxytocin, participants were limited to singleton neonates born via vaginal delivery. Infants with congenital abnormalities, preterm infants, infants admitted to the neonatal intensive care unit (NICU) and infants with an Apgar score of less than 7 at 5 min were excluded. In addition, mothers with postpartum abnormalities, those with contraindications to breastfeeding, and those who wished to feed exclusively with formula prior to delivery were excluded. Mothers who met the research eligibility criteria were informed about the study and voluntary participation via an explanatory document, and their written informed consent to participate was obtained. The study protocol was approved by the Institutional Review Boards and Ethics Committees of Kyushu University Hospital and Medical Institutions (ethics approval number: 21131-01). The study was conducted in accordance with the WMA Declaration of Helsinki, the hospital’s and government guidelines and regulations. Data collection Intrapartum oxytocin exposure status Intrapartum oxytocin was administered for medical indications to augment or induce labor; a vial of OXYTOCIN injection 5IU (JAN, INN) was mixed with 500-ml 5% glucose infusion. Intravenous infusion was started at 2 mU/min and increased by 1 mU/min at intervals of at least 30 min until effective labor was achieved. The maximum dose was 20 mU/min. During the third stage of labor, a customary dose of 10-IU oxytocin was administered intravenously to all patients and increased as needed. Data on the amount and duration of oxytocin administration and reasons for oxytocin use were collected from medical records. Variables related to breastfeeding and sucking ability The following mother–infant variables were collected from the medical records and questionnaires. Maternal characteristics included maternal age, history of childbirth, postpartum depression, complications, and smoking history. Delivery information: duration of labor, blood loss at delivery, instrumental delivery, and use of analgesia during labor. Infant characteristics included birth weight, umbilical cord arterial blood pH, Apgar score, gestational age at birth, and sex. Feeding for infants The mothers were asked about their breastfeeding intentions on the first postpartum day. Data on the details of actual feeding methods for babies (exclusive breastfeeding/mixed breastfeeding and formula/exclusive formula) at 1 month postpartum were collected. NNS NNS was evaluated by having infants aged 24–48 h suckle a pacifier nipple for 5 min at least 2 h after the last feeding. Nipples were supplied by Pigeon Co., Ltd. (Tokyo, Japan) and are routinely used in hospital nurseries. To ensure that the use of artificial nipple devices for measurement did not interfere with breastfeeding acquisition, attention was paid to avoid using artificial nipples on newborns who had never used them after birth. The nipple was modified to measure the intraoral negative pressure during sucking. A silicone tube with an inner diameter of 1 mm and a total length of 80 mm was attached to the hole punched in the center of the nipple. The other end of the tube was then connected to a micro-semiconductor pressure transducer (KEYENCE Co., Ltd., Osaka, Japan) and a data logger (Graphtec Co., Ltd., Yokohama, Japan). Infants underwent measurements while lying on the neonatal bed of the hospital. The infant’s arousal level was recorded before the start of the NNS measurement using a 3-point scale (0 = asleep, 1 = quietly awake, 2 = crying). The infants were gently stroked on the side of their lips with a Silicone Rubber Nipple to elicit a rooting response. The nipple was gently placed in the mouth, and the sucking pressure and rhythm were measured for 5 min after the infants initiated the sucking cycle. Readiness to start sucking was also recorded using a 4-point scale (3 = sucking started within 1 min; 2 = within 1 to 3 min; 1 = after 3 min; 0 = sucking did not start). Infants perform sucking movements in bursts (continuous sucking cycles) and pauses (periods of rest). NNS burst was defined as one burst containing two or more sucking amplitude cycles. A new next burst was defined as one in which the interval between sucking cycles was separated by more than 1000 milliseconds with no obvious connection to the previous cycle. All NNS data were graphed using the software program AcqKnowledge 5.0 (BIOPAC Systems, Inc., Goleta, CA), and the mean values of the following temporal parameters and pressure variables were calculated (Fig. 1 ). To design a protocol for measuring and analyzing NNS, we referenced previous studies that investigated NNS [ 26 – 35 ] . Total cycles (times): total number of sucking cycles per 5 min Total bursts (times): total number of bursts per 5 min Burst rate (%): percentage of total burst duration in 5 min Amplitude (mmHg): peak value of intraoral negative pressure in the sucking cycle Peak interval (s): interval between peak values of intraoral negative pressure Pause time (s): interval between bursts Burst duration (s): duration of each burst Cycles/burst (time): number of cycles within a burst Frequency (time): number of cycles per second within a burst Statistical analysis Participants were divided into two groups: the With OXT group that was administered intrapartum oxytocin in the first and second trimesters of delivery, and the Without OXT group that was not administered intrapartum oxytocin in the first and second trimesters of delivery. Descriptive statistics were calculated, and the differences in the distribution of maternal, infant, delivery, and breastfeeding characteristics between the two groups were determined. Multiple regression analysis was performed with NNS as the outcome variable and oxytocin exposure as the independent variable. As covariates, variables reported in previous studies as influencing factors of infant feeding behavior were entered into the model. To assess the effect of oxytocin exposure on breastfeeding achievement through reduced sucking performance in infants, structural equation modeling (SEM) was used to estimate the path diagram, with NNS as a mediating factor in the causal relationship between oxytocin exposure and breastfeeding attainment. To evaluate the mediating effect of NNS, the significance of the indirect effect was tested using the bootstrap method (bootstrap sample size: 2000, confidence interval [CI]: 95%), and the standardized indirect effect and bootstrapping bias-corrected confidence intervals were calculated using SPSS Amos version 21.0 (IBM Corp., Armonk, NY, USA). The outcome variable was a binary variable of “exclusive breastfeeding/other,” which indicated breastfeeding achievement. Since many factors influence breastfeeding, univariate logistic regression analysis was conducted with “exclusive breastfeeding /other” as the dependent variable, and variables that showed p <0.2 were extracted. In addition, representative variables that showed strong associations in previous studies were entered into the model diagram as control variables. All p -values were two-sided, and statistical significance was considered at p -values <0.05. Statistical analyses were performed using SPSS, version 27 (IBM Corp.) and SPSS Amos, version 21.0 (IBM Corp.). Results Participants A total of 86 full-term infants and their postpartum mothers were eligible for this study. After the survey was completed, the following participants were excluded from the analysis (4 infants transferred to the NICU after the survey, 1 mother who had severe postpartum depression that made a longitudinal study impossible, 1 infant who did not produce sucking bursts during measurement, and 16 cases with a significant decrease in the NNS pressure waveform at baseline). Finally, 64 pairs of infants and their mothers were analyzed. Normally, when infants perform sucking movements, the intraoral pressure values return to approximately the baseline values after the sucking cycle. In contrast, in cases where the baseline dropped, the negative intraoral pressure continued to increase for an unknown reason. These cases were excluded from the analysis because they could not be accurately measured. No background bias was observed in any of the excluded patients. Of the 64 pairs analyzed, there were 29 from the With OXT group and 35 from the Without OXT group. In the With OXT group, 21 patients underwent planned labor induction and 8 underwent labor augmentation. The intrapartum oxytocin exposure times and doses are shown in Table 1 . The objectives and indications for oxytocin administration are described in Supplementary Material 1 . Table 1 reports maternal and infant characteristics, feeding practices, and delivery information stratified by the With and Without OXT group. The proportion of mothers with complications was significantly higher in the With OXT group than in the Without OXT group ( p =0.048). Details of maternal complications are given in Supplementary Material 2 . The number of cases per complication was small. There were no patients in each group with a severe condition that interfered with breastfeeding. For each complication, no differences in NNS and breastfeeding practices were observed. All four cases in which epidural analgesia was used during delivery were in the With OXT group. Subgroup analysis by analgesia status showed no differences in NNS or breastfeeding practices. Since previous studies did not show sufficient evidence that delivery using epidural analgesia affects breastfeeding or infant feeding, they were included in the analysis. Supplementary Material 3 reports the information on the infants at the time of the NNS survey. There were no significant differences in arousal level and time required to start sucking between the With and Without OXT groups. Table 1 also reports the data on breastfeeding practices at 1 month postpartum, grouped into “Exclusive breastfeeding,” “Mixed breastfeeding and formula,” and “Exclusive formula.” The rate of the exclusively breastfeeding group at 1 month postpartum was significantly higher in the Without OXT group than in the With OXT group ( p =0.033). Impact of intrapartum oxytocin exposure on NNS Table 2 reports the results of the comparison of NNS measurements between the With and Without OXT groups. The With OXT group had significantly fewer total bursts ( p =0.041), significantly longer pause times ( p =0.044), and a significantly larger coefficient of variation (CV%) for pause times than the Without OXT group ( p =0.040). Table 3 reports the results of a multiple linear regression analysis of the impact of intrapartum oxytocin exposure on NNS. In the model adjusted for covariates, oxytocin exposure was significantly associated with fewer total bursts (95% CI, -6.811 to -0.311), longer pause time (95% CI, 0.320 to 9.223), and bigger CV% of pause time (95% CI, 4.453 to 62.738). Relationship between NNS-mediated intrapartum oxytocin exposure and breastfeeding Path models with the NNS variable as a mediator of the causal relationship between oxytocin exposure and feeding methods (exclusive breastfeeding/other) at 1 month postpartum are shown in Figure 2 . The standard errors and p -values for the direct effect estimates are presented in Supplementary Material 4. Factors influencing breastfeeding in addition to NNS were entered into the model diagram by considering variables based on previous studies and the results of a single regression analysis ( Supplementary Material 5 ). The standardized partial regression coefficients are the values of the direct effect coefficients. Significant negative effects (β=-0.288, p =0.017) from oxytocin exposure to total bursts and significant positive effects (β=0.235-, p =0.050) on pause-time length were observed. There was also a significant direct effect from intrapartum oxytocin exposure to the feeding methods at 1 month postpartum (β=-.238, p =0.047). However, there was no significant direct effect of total bursts on the feeding methods at 1 month postpartum (β=-0.040, p =0.734). Pause time to the feeding methods at 1 month postpartum (β=0.176, p =0.127) also indicated no significant direct effect. Breastfeeding intentions as a factor influencing breastfeeding were strongly associated with 1-month postpartum feeding methods (β=0.346, p =0.001). Table 4 presents the estimates of the indirect effects. There was no significant indirect effect of oxytocin exposure through the NNS burst on the breastfeeding method at 1 month postpartum (bootstrap bias-corrected 95% CI, -0.083 to 0.109). There was also no significant indirect effect of the NNS pause time (bootstrap bias-corrected 95% CI, -0.018 to 0.176). Discussion The components of infant feeding are the state of arousal, tactile and olfactory functional systems to find the mother’s nipple, routing reflex, rhythmic sucking, and swallowing [25] . This study objectively evaluated infant sucking ability, a part of the feeding behavior, using NNS measurements. Infants exposed to oxytocin in utero exhibited significantly fewer total bursts, longer pause times, and significantly larger variations in pause times than those not exposed to oxytocin. This is a new finding, as no previous studies have reported that oxytocin exposure affects NNS. This study examined the effects of fetal exposure to NNS. Previous studies have investigated the association between NNS and fetal exposure to substances other than oxytocin. Zimmerman et al. [29] examined the association between phthalate exposure during pregnancy and NNS. They reported a lower sucking frequency and higher amplitude in the exposed group of infants. It has been suggested that the amplitude may have increased to compensate for the slower sucking frequency. Additionally, higher maternal prenatal stress values were found to be associated with fewer infant NNS bursts/minute and longer burst duration [34] . An association between the administration of pethidine at delivery and lower sucking frequency has also been reported [36] . Although the mechanism by which the in-utero environment negatively affects the sucking ability of the child is not yet clear, these previous studies have described the possibility that the in-utero environment affects fetal neurodevelopment and reduces the generation of sucking patterns. Similar to reports of fetal cardiopulmonary function changes and decreases in fetal movement in the presence of stress in the prenatal environment [37] , NNS vitality may decrease as a self-soothing mechanism. Furthermore, similar to studies that showed the negative effects of the prenatal environment on postnatal NNS patterns, this study also found significant differences in sucking vitality characteristics: fewer bursts and longer, more varied pause times. Intrapartum oxytocin exposure may negatively influence infants’ sucking abilities. Additionally, the NNS of infants who developed sequelae later has been shown to have fewer sucking bursts per minute, slower sucking frequency, and greater variability in frequency and amplitude [32] . Compared to these results, the sucking ability of the With OXT group, which showed fewer bursts and longer, more variable pause times, was more similar to that of the sick infants and can be considered a weak sucking pattern. The mechanisms by which oxytocin exposure influences the NNS have been discussed. Endogenous oxytocin acts on motor neurons, induces sucking, and plays an important role in feeding [38] . The source of endogenous oxytocin in the fetus is produced by the fetus itself, while the maternal oxytocin passes through the immature blood–brain barrier of the fetus [39] . There are two barriers to oxytocin influx into the neonatal brain: the placental barrier and the cerebral blood barrier, which contains oxytocinase, an enzyme involved in the breakdown of oxytocin [5,39] . Although these barriers may inhibit the passage of peptides such as oxytocin, they are not fully mature and may be highly permeable during the fetal period [21] .Phaneuf et al. [40] observed that prolonged oxytocin exposure decreased oxytocin receptor utilization by decreasing OT receptor messenger RNA levels and caused desensitization. Fetal oxytocin exposure may cause downregulation of the innate oxytocin rhythm that acts on fetal sucking rhythm expression, resulting in a weakening of the sucking pattern. In addition, a meta-analysis of animal studies reported an association between exogenous oxytocin administration, suppression of food and water intake, and reduced mealtimes [41] .The mechanism is not fully understood; however, the few sucking expressions observed in this study may also be explained by an appetite-decreasing effect. However, there are differing views on whether exogenous oxytocin reaches the fetus at clinical doses. A review article [42] that measured maternal oxytocin levels, as well as umbilical cord arterial and venous oxytocin levels, reported that oxytocin levels in the cord blood did not differ with or without intrapartum synthetic oxytocin administration and may not cross from the mother to the fetus.However, the five studies reviewed were from small samples in the 1970s and the 1980s, and one of the studies reported lower umbilical artery oxytocin levels (24.6 pg/mL) in newborns whose mothers were administered synthetic oxytocin than in controls (116 pg/mL). Other large review articles [12] included studies that examined animal oxytocin levels and neonatal behavior after perinatal oxytocin manipulation, as well as studies that examined the possibility of placental transport of oxytocin. The study concluded that knowledge of the conditions under which peripheral oxytocin signaling reaches the fetus is incomplete, after suggesting that exposure to exogenous oxytocin may affect a variety of basic neural systems and behaviors, including protection against fetal hypoxia, initiation and regulation of neonatal feeding, and early social behavior. Further research is needed to provide evidence that clinical doses of exogenous oxytocin reach the fetus and disrupt the endogenous oxytocin rhythm. Although there was no difference in Apgar scores and cord blood pH levels with or without oxytocin exposure in this study, it is also possible that the induction and augmentation of delivery may indirectly affect the infant's ability to feed, as it has been reported that increased lactate levels in the amniotic fluid due to induction, augmentation [43] , and stress from enhanced strong uterine contractions harm infant health. [44] . Further studies are warranted to determine the mechanisms through which intrapartum oxytocin exposure affects infant feeding. To examine a hypothetical model in which intrapartum oxytocin exposure affects breastfeeding achievement mediated by NNS, the effect was estimated using SEM. The analysis showed that oxytocin exposure had a negative direct effect on NNS (total bursts and pauses), but no significant direct effect on feeding methods at 1 month postpartum from either total bursts or pauses. In addition, the estimates of indirect effects also showed no significant indirect effect of oxytocin exposure mediated through NNS (total bursts and pauses) on feeding methods at 1 month postpartum. These results suggested that the influence of the NNS pattern attenuated by oxytocin exposure was not strong enough to affect breastfeeding achievement. Breastfeeding is a mother–infant interaction, and the mother's endogenous oxytocin responds to effective sucking by the infant. Repeated and effective breastfeeding stimulates breast milk secretion, thereby facilitating breastfeeding. The sucking pattern of the With OXT group, which had fewer sucking bursts and longer pauses than the Without OXT group, predicted a weaker approach to maternal endogenous oxytocin and weaker breastfeeding achievement; however, the results of this study did not show this effect. The NNS patterns of infants were measured at a one time, 24–48 h after birth. Assuming that the negative effect of oxytocin on sucking was transient, it is possible that the later sucking ability did not differ between the two groups and did not affect breastfeeding achievement. Additionally, we did not observe in this study whether the infants reproduced the same sucking patterns at the time of the study during other feedings. However, further longitudinal studies are required to confirm this hypothesis. Some studies reported a negative association between intrapartum oxytocin exposure and breastfeeding practices, [15,16, 17–19] whereas others reported no such association [20,21] . In this study, a simple comparison between the two groups showed that the With OXT group was negatively associated with a significantly lower rate of exclusive breastfeeding methods at 1 month postpartum. Furthermore, effect estimates using SEM, including control variables in the model diagram, showed a significant negative direct effect of oxytocin exposure on feeding methods 1 month postpartum. Previous studies have discussed factors that negatively affect breastfeeding due to intrapartum oxytocin exposure, including interruption of breastfeeding initiation, decreased ejaculatory reflex due to downregulation of the endogenous oxytocin system [ 5] , and inhibition of lactation due to an enhanced stress response [45] . It has also been reported that mothers who receive intrapartum oxytocin secrete lower levels of endogenous oxytocin during postpartum breastfeeding [46] . In this study, we found no indirect effects on breastfeeding via attenuated NNS; however, we did find a direct and negative effect of oxytocin exposure on breastfeeding. This finding suggests that factors other than the infant's sucking ability may affect breastfeeding. This is the first study to evaluate the effect of intrapartum oxytocin on sucking movements using objective parameters. It is clear that a strategy of inducing labor at or beyond term is associated with fewer perinatal deaths and fewer cesarean sections [47,48] , and it is imperative in healthcare practice to induce and augment labor according to medical indications. However, breastfeeding should be supported while considering that infants born to mothers exposed to intrapartum oxytocin may have an attenuated feeding ability, at least until the second day after birth. Study strength and limitation The strength and originality of this study is that the impact of intrapartum oxytocin exposure on infant feeding behavior was objectively evaluated using a sucking measurement approach. This study was conducted at a university hospital that provided advanced medical care as the study field. Although all participants in the analysis met the eligibility criteria and none had lactation disabilities, there are limitations in generalizing the results. Conclusions This study investigated the effects of intrapartum oxytocin exposure on infant sucking ability (NNS) during the first 24–48 h after birth and breastfeeding at one month postpartum. In adjusted multiple regression models, intrapartum oxytocin exposure was significantly associated with fewer total NNS bursts, longer pause times, and greater pause-time variability. The effects estimated using SEM showed a significant, negative, and direct effect of intrapartum oxytocin exposure on the practice of exclusive breastfeeding 1 month postpartum; this is a novel finding. However, no indirect effects of NNS were found, rejecting the hypothesis that intrapartum oxytocin exposure attenuates infants' sucking ability and thus negatively affects breastfeeding. Since a policy of labor induction and augmentation is associated with fewer perinatal deaths and cesarean sections, treatment according to medical indications is essential for the provision of healthcare. However, it is necessary to consider that infants born to mothers who receive intrapartum oxytocin may have attenuated sucking ability for at least the first 48 h after birth, and breastfeeding support should be provided. Declarations Acknowledgments The authors would like to thank the infants and their families for their participation in this study. We would also like to thank the staff of Kyushu University Hospital for their cooperation in the data collection. This study was supported by RIKEN Healthcare and Medical Data Platform Project. Author contributions statement Study design: M.O., S.M., S.K., Y.O. Recruitment of study participants: M.O., S.M., S.K., and E.W. Data collection: M.O., and S.M. Statistical analyses: M.O., S.M., and K.O. Drafting of manuscript: M.O., and S.M. Critical revision of the manuscript: M. O., S. M., S. K., Y. O., and K. O. Supervision: All authors have reviewed and approved the final manuscript Additional information Competing interests: The authors declare that there are no competing interests. Data availability statement: Data supporting the findings of this study are available from the corresponding author upon request. Supplementary information are available . References Middleton, P., Shepherd, E., Morris, J., Crowther, C. A. & Gomersall, J. C. Induction of labour at or beyond 37 weeks’ gestation. Cochrane Database Syst Rev 7, (2020). Martin, J. A., Hamilton, B. E. & Osterman, M. Births in the United States, 2020. NCHS Data Brief 1–8 (2021). Blondel, B., Coulm, B., Bonnet, C., Goffinet, F. & Le Ray, C. Trends in perinatal health in metropolitan France from 1995 to 2016: Results from the French National Perinatal Surveys. J Gynecol Obstet Hum Reprod. 46, 701–713 (2017). Kujabi, M. L. et al. 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Fernández-Cañadas Morillo, A. et al. Cessation of breastfeeding in association with oxytocin administration and type of birth. A prospective cohort study. Women and Birth. 32, e43-e48 (2019). Bell, A. F., White-Traut, R. & Rankin, K. Fetal exposure to synthetic oxytocin and the relationship with prefeeding cues within one hour postbirth. Early Hum Dev. 89, 137–143 (2013). Brimdyr, K. et al. The Association Between Common Labor Drugs and Suckling When Skin-to-Skin During the First Hour After Birth. Birth. 42, 319–328 (2015). Takahashi, Y. et al. Epidural Analgesia With or Without Oxytocin, but Not Oxytocin Alone, Administered During Birth Disturbs Infant Pre-feeding and Sucking Behaviors and Maternal Oxytocin Levels in Connection With a Breastfeed Two Days Later. Front Neurosci. 15, 673184 (2021). Muscatelli, F. & Bouret, S. G. Wired for eating: how is an active feeding circuitry established in the postnatal brain? Curr Opin Neurobiol. 52, 165–171 (2018). Wolff, P. H. THE SERIAL ORGANIZATION OF SUCKING IN THE YOUNG INFANT. Pediatrics. 42, 943–956 (1968). Hack, M., Estabrook, M. M. & Robertson, S. S. Development of sucking rhythm in preterm infants. Earb Human Development. 11, 133–140 (1985). Bingham, P. M., Ashikaga, T. & Abbasi, S. Prospective study of non-nutritive sucking and feeding skills in premature infants. Arch Dis Child Fetal Neonatal Ed. 95, 194–200 (2010). Zimmerman, E. et al. Associations of gestational phthalate exposure and non-nutritive suck among infants from the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) birth cohort study. Environ Int. 152, 106480 (2021). Pineda, R., Dewey, K., Jacobsen, A. & Smith, J. Non-Nutritive Sucking in the Preterm Infant. Am J Perinatol. 36, 268–276 (2019). Mizuno, K. & Ueda, A. Neonatal feeding performance as a predictor of neurodevelopmental outcome at 18 months. Dev Med Child Neurol. 47, 299–304 (2005). Hafström, M. & Kjellmer, I. Non-nutritive sucking in sick preterm infants. Early Hum Dev. 63, 37–52 (2001). Grassi, A. et al. Sensorized pacifier to evaluate non-nutritive sucking in newborns. Med Eng Phys. 38, 398–402 (2016). Zimmerman, E. et al. Examining the association between prenatal maternal stress and infant non-nutritive suck. Pediatr Res. 1–9 (2021) doi: 10.1038/s41390-021-01894-9 . Martens, A., Hines, M. & Zimmerman, E. Changes in non-nutritive suck between 3 and 12 months. Early Hum Dev. 149, 105141 (2020). Hafström, M. & Kjellmer, I. Non-nutritive sucking by infants exposed to pethidine in utero. Acta Paediatr. 89, 1196–1200 (2000). DiPietro, J. A., Costigan, K. A. & Gurewitsch, E. D. Fetal response to induced maternal stress. Early Hum Dev. 74, 125–138 (2003). Muscatelli, F., Matarazzo, V. & Chini, B. Neonatal oxytocin gives the tempo of social and feeding behaviors. Front Mol Neurosci. 15, 1071719 (2022). Malek, A., Blann, E. & Mattison, D. R. Human placental transport of oxytocin. J Matern Fetal Med. 5(5) 245–255 (1996). Phaneuf, S. et al. The desensitization of oxytocin receptors in human myometrial cells is accompanied by down-regulation of oxytocin receptor messenger RNA. Journal of Endocrinology. 154, 7–18 (1997). Skinner, J. A., Campbell, E. J., Dayas, C. V, Garg, M. L. & Burrows, T. L. The relationship between oxytocin, dietary intake and feeding: A systematic review and meta-analysis of studies in mice and rats. Front Neuroendocrinol. 65–78 (2019). Buckley, S. et al. Maternal and newborn plasma oxytocin levels in response to maternal synthetic oxytocin administration during labour, birth and postpartum - a systematic review with implications for the function of the oxytocinergic system. BMC Pregnancy Childbirth. 23, 137 (2023). Wiberg-Itzel, E. et al. Level of lactate in amniotic fluid and its relation to the use of oxytocin and adverse neonatal outcome. Acta Obstet Gynecol Scand. 93, 80–85 (2014). A M Bakker, P. C., J Kurver, P. H., Kuik, D. J. & Van Geijn, H. P. Elevated uterine activity increases the risk of fetal acidosis at birth. Am J Obstet Gynecol. 196, 313 (2007). Dewey, K. G. Maternal and fetal stress are associated with impaired lactogenesis in humans. J Nutr. 131, 3012S-5S (2001). Jonas, W. et al. Effects of intrapartum oxytocin administration and epidural analgesia on the concentration of plasma oxytocin and prolactin, in response to suckling during the second day postpartum. Breastfeeding Medicine. 4, 71–82 (2009). Middleton, P., Shepherd, E. & Crowther, C. A. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev. 5, CD004945 (2018). Nethery, E., Levy, B., McLean, K., Sitcov, K. & Souter, V. L. Effects of the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) Trial on Elective Induction and Obstetric Outcomes in Term Nulliparous Patients. Obstetrics & Gynecology. 142, 242–250 (2023). Tables Table 1. Basic characteristics of the With Oxytocin and Without Oxytocin groups Without OXT (n=35) With OXT (n=29) p- value Maternal characteristics Maternal age (years) 32.20±6.03 34.24±3.15 0.14 History of childbirth Primipara 14 (40.0) 15 (51.7) 0.451 Multipara 21 (60.0) 14 (48.3) Postpartum depression EPDS score at discharge 3.40±3.62 4.10±3.77 0.279 EPDS score at 1 month checkup 2.63±2.76 2.59±2.98 0.794 Maternal complications 0.048* Any 22 (62.9) 25 (86.2) None 13 (37.1) 4 (13.8) Smoking history, Yes 5 (14.3) 1 (3.4) 0.312 Nipple shape problems for breastfeeding 4 (11.4) 7 (24.1) 0.203 Breast and nipple troubles at discharge 14 (63.6) 8 (27.6) 0.428 Feeding for Infants Breastfeeding intentions (Method of feeding that mother desired) 0.138 Exclusive breastfeeding 9 (25.7) 3 (10.4) Mixed breastfeeding and formula 26 (74.3) 26 (89.4) Actual feeding method (1 month postpartum) 0.033* Exclusive breastfeeding 15（42.9） 5（17.2) Mixed breastfeeding and formula 18（51.4) 22（75.9) Exclusive formula 2 (5.7) 2 (6.9) Delivery information Duration of labor (minutes) 349.46±236.81 376.79±273.28 0.819 Blood loss at delivery (ml) 522.75±279.71 515.10±264.52 0.356 Instrumental delivery 2 (5.7) 6 (20.7) 0.127 Use of epidural analgesia in labor 0 (0.0) 4 (13.8) 0.037* Intrapartum Oxytocin use Oxytocin administration dose (IU) ― 3.45±5.28 Oxytocin administration time (minutes) ― 354.38±428.53 Infant characteristics Birth weight (g) 3152.66±407.90 3035.97±377.32 0.272 Umbilical cord arterial blood pH value 7.309±0.051 7.316±0.092 0.691 APGAR score 1minute 8.09±0.387 8.12±0.485 0.847 5minutes 9.02±0.218 9.09±0.412 0.094 Gestational age at birth (weeks) 39.3±0.9 38.6±1.0 0.077 Infant sex 0.451 Male 11 (40.0) 15 (51.7) Female 21 (60.0) 14 (48.3) Time since birth 34.80±7.39 38.93±8.42 0.052 The data shown are mean±SD or number of people (%). The p -values were estimated from the Mann–Whitney U test or chi-squared test; * p < 0.05, ** p < 0.01, *** p < 0.000 0.001 0.001 Abbreviations: SD, standard deviation; EPDS, Edinburgh postnatal depression scale. Table 2. NNS measurements of the With Oxytocin and Without Oxytocin groups Without OXT (n=35) With OXT (n=29) p- value Mean SD Median IQR Mean SD Median IQR Total cycles 209.94 (93.82) 219.00 (173.00) 182.03 (92.31) 181.00 (151.00) 0.252 Total bursts 17.74 (6.40) 18.00 (7.00) 14.38 (5.94) 14.00 (7.50) 0.041* Burst rate 40.17 (21.01) 42.94 (36.26) 36.06 (19.51) 31.63 (25.92) 0.557 Amplitude -189.23 (35.26) -184.70 (42.45) -193.61 (37.62) -192.82 (57.10) 0.415 CV%† 19.08 (7.28) 19.08 (11.40) 19.80 (6.73) 18.17 (7.40) 0.531 Peak interval 0.62 (0.08) 0.60 (0.14) 0.64 (0.08) 0.63 (0.10) 0.171 CV%† 19.40 (3.33) 19.60 (4.01) 19.44 (3.54) 19.44 (4.29) 0.887 Pause time 11.01 (6.40) 8.52 (5.07) 14.88 (9.79) 12.27 (6.64) 0.044* CV%† 78.28 (49.68) 69.16 (75.96) 104.47 (54.99) 84.97 (109.49) 0.040* Burst duration 7.94 (7.37) 6.67 (5.97) 7.79 (4.04) 7.79 (7.62) 0.446 CV%† 70.39 (27.04) 66.52 (43.48) 69.24 (28.47) 67.49 (34.22) 0.772 Cycles/burst 13.24 (9.53) 11.35 (9.06) 12.94 (5.73) 12.86 (8.90) 0.496 CV%† 61.35 (26.42) 58.84 (33.91) 59.67 (26.41) 55.10 (28.20) 0.681 Frequency 2.04 (0.36) 1.98 (0.49) 1.94 (0.37) 1.88 (0.50) 0.243 CV%† 19.28 (10.59) 17.28 (12.05) 17.83 (9.43) 17.56 (14.92) 0.731 The p -values were estimated from the Mann–Whitney U test; * p <0.05, ** p <0.01, *** p <0.001 †CV%=(SD/Mean×100) Abbreviations: SD, standard deviation; CV, coefficient of variation. Table 3. Impact of intrapartum oxytocin exposure on NNS Simple linear Regression model† Multiple linear Regression model‡ Outcomes B SE β p - value 95% CI B SE β p -value 95% CI Total bursts -3.66 1.53 -0.29 0.021* [-6.68 to -0.57] -3.60 1.64 -0.29 0.032* [-6.81 to -0.31] Pause time 3.87 2.04 0.24 0.062 [-0.20–7.94] 4.77 2.22 0.29 0.036* [0.32–9.22] Pause time CV% 26.20 13.09 0.25 0.050* [0.02–52.37] 33.60 14.55 0.32 0.025* [4.45–62.74] Multiple regression analysis with oxytocin exposure as the independent variable for NNS outcomes with significant differences between the two groups with and without oxytocin. † Only oxytocin exposure was entered as an independent variable. ‡ Infant's birth weight, infant's gestational age at birth, infant's sex, maternal age, and duration of labor were entered as covariates. Abbreviations: B, partial regression coefficient; SE, standard error; β, standardized partial regression coefficient; CI, confidence interval; NNS, Non-Nutritive Sucking. Table 4. Multiple Mediation Model: Indirect effects of oxytocin on 1-month postpartum feeding methods through NNS. Indirect effect (products of coefficients) Bootstrapping bias-corrected 95％ CI Relationship B SE β p -value 95% CI Oxytocin → Total bursts → Exclusive breastfeeding/Other 0.01 0.05 0.01 0.726 [-0.08–0.11] Oxytocin → pause time → Exclusive breastfeeding/Other 0.04 0.05 0.04 0.209 [-0.02–0.18] Bootstrap sample size=2,000 Abbreviations: B, partial regression coefficient; SE, standard error; β, standardized partial regression coefficient; CI, confidence interval; NNS, Non-Nutritive Sucking. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3383044","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":237127479,"identity":"2a5e68cb-1109-4fc3-b57c-79bdf3f13786","order_by":0,"name":"Machiko Omaru","email":"data:image/png;base64,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","orcid":"","institution":"Kyushu University","correspondingAuthor":true,"prefix":"","firstName":"Machiko","middleName":"","lastName":"Omaru","suffix":""},{"id":237127480,"identity":"74ba9855-1f6b-46e5-be07-3eb42093fb5a","order_by":1,"name":"Setsu Kajiwara","email":"","orcid":"","institution":"Kyushu University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Setsu","middleName":"","lastName":"Kajiwara","suffix":""},{"id":237127481,"identity":"601ad6f0-ecac-4471-b9a4-c649b41fb205","order_by":2,"name":"Eri Wakamatsu","email":"","orcid":"","institution":"Kyushu University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Eri","middleName":"","lastName":"Wakamatsu","suffix":""},{"id":237127483,"identity":"41337a27-6f3b-476b-afe8-1ad7c2db7850","order_by":3,"name":"Sumiko Kuroishi","email":"","orcid":"","institution":"Pigeon Corporation","correspondingAuthor":false,"prefix":"","firstName":"Sumiko","middleName":"","lastName":"Kuroishi","suffix":""},{"id":237127485,"identity":"734402f0-193f-4107-8b2a-6322295df6bf","order_by":4,"name":"Yukifumi Ochiai","email":"","orcid":"","institution":"Pigeon Corporation","correspondingAuthor":false,"prefix":"","firstName":"Yukifumi","middleName":"","lastName":"Ochiai","suffix":""},{"id":237127489,"identity":"325467c3-d190-42b8-910c-602e02025c00","order_by":5,"name":"Kentaro Oniki","email":"","orcid":"","institution":"Kumamoto University","correspondingAuthor":false,"prefix":"","firstName":"Kentaro","middleName":"","lastName":"Oniki","suffix":""},{"id":237127491,"identity":"0408a4cb-a863-47a4-808c-978e455017e2","order_by":6,"name":"Seiichi Morokuma","email":"","orcid":"","institution":"Kyushu University","correspondingAuthor":false,"prefix":"","firstName":"Seiichi","middleName":"","lastName":"Morokuma","suffix":""}],"badges":[],"createdAt":"2023-09-25 04:44:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3383044/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3383044/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-024-56635-9","type":"published","date":"2024-03-11T15:01:18+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":44206534,"identity":"e9bab1d6-b6be-45f5-9e7c-a8927e0591f4","added_by":"auto","created_at":"2023-10-06 20:21:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":227754,"visible":true,"origin":"","legend":"\u003cp\u003eNNS measurements\u003c/p\u003e\n\u003cp\u003eAbbreviation: NNS, Non-Nutritive Sucking\u003c/p\u003e\n\u003cp\u003e(a) Example NNS graph. Two bursts with a pause in between were observed in about 30 seconds. (b) Zoom of Burst 1. Amplitude means the peak value of intraoral negative pressure (mmHg). Peak interval means the length between the peak values of the intraoral negative pressure. (c) Left: Modified nipple used for NNS measurements. Right: An infant undergoing NNS measurement.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-3383044/v1/b5877506747ced45035db59e.png"},{"id":44206535,"identity":"ad6a21aa-54a0-4afa-9324-9ca524f8c38c","added_by":"auto","created_at":"2023-10-06 20:21:01","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":84554,"visible":true,"origin":"","legend":"\u003cp\u003ePath Diagram―Impact of oxytocin exposure and NNS on feeding methods at 1 month postpartum\u003c/p\u003e\n\u003cp\u003eAbbreviations: β, standardized partial regression coefficient; EPDS, Edinburgh postnatal depression scale\u003c/p\u003e\n\u003cp\u003eExclusive breastfeeding: 1/Other: 0\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-3383044/v1/2b4da3b34775c1ba5b5aa201.png"},{"id":52907597,"identity":"63f8ac4d-7d3a-4622-b2f2-2c55c3cff81f","added_by":"auto","created_at":"2024-03-18 15:13:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":763668,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3383044/v1/73755c63-2c25-46d8-bfa6-37ec5efaca55.pdf"},{"id":44206537,"identity":"2176821b-bfa4-4fe0-8721-3c64e5efb48f","added_by":"auto","created_at":"2023-10-06 20:21:01","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":270137,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterialomaru.20230925.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3383044/v1/d5f4b528706f74160d2d0e02.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of intrapartum oxytocin administration on neonatal sucking behavior and breastfeeding","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe induction and augmentation of labor during delivery have been increasing worldwide. Reports have shown that 25% of all full-term infants born in developed countries were born after induction or augmentation of labor \u003csup\u003e[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Additionally, in some areas of low- and middle-income countries, the use of oxytocin for labor induction or augmentation exceeded 50% of obstetric care facilities \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Oxytocin is a peptide hormone released from the posterior pituitary gland. During labor, endogenous oxytocin is released in pulses from the pituitary glands of women into the peripheral bloodstream to induce regular uterine contractions \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Maximum levels of endogenous oxytocin are achieved within 1 h of delivery in both maternal and infant brains. Maternal oxytocin release increases via skin-to-skin contact with the infant \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. This hormone promotes uterine restoration in postpartum mothers and is an essential hormone released during breastfeeding that causes the breast milk ejection reflex \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn cases that require labor induction and augmentation, synthetic oxytocin is the most commonly used uterotonic agent. In contrast to the natural endogenous oxytocin secretion mechanism, the use of continuous intravenous administration of exogenous synthetic oxytocin preparations has been reported to have negative connotations. Specifically, it has been suggested that the administration of exogenous oxytocin disturbs the mechanism of physiological secretion, and the state of excess oxytocin in the mother causes negative feedback and suppresses endogenous oxytocin release \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. As a result, not only is there a possibility of reduced endogenous oxytocin secretion, but also of suppressed oxytocin receptors \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Intrapartum oxytocin administration can also disrupt the balance of the endogenous oxytocin secretion in the fetus by allowing exogenous oxytocin to pass through the placental barrier and immature fetal blood\u0026ndash;brain barrier, causing negative feedback and negatively affecting postnatal feeding and water metabolism \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Animal data have shown that perinatal manipulation of the oxytocin system has lasting effects on the feeding, attachment, sociability, and sexual behavior of children \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOxytocin is an important hormone for breastfeeding, and there have been reports on the impact of intrapartum synthetic oxytocin administration on breastfeeding \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Current reports can be classified into two categories: those that survey the \u0026ldquo;impact on breastfeeding,\u0026rdquo; and those that survey the \u0026ldquo;impact on feeding behavior of infants.\u0026rdquo; The impact on breastfeeding has been reported to be associated with oxytocin administration, lower early postpartum breastfeeding initiation rates \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e, and lower long-term breastfeeding rates \u003csup\u003e[\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. However, some reports \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e indicated no association with breastfeeding rates, and certain conclusions have not been reached. Impacts on the feeding behavior of infants have been reported in previous studies on the association between intrapartum oxytocin administration and lower expression of primitive neonatal reflexes \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. Primitive reflexes associated with feeding refers to the instinctive behavior of newborns to seek, find, and begin to suck on the nipple of their mother. In previous studies, newborns were placed skin-to-skin on the breasts of their mothers, and their behavior leading up to spontaneous sucking was filmed using a study-specific scale to identify the primitive reflexes of the newborn, as well as to compare the number of primitive reflexes and the rate of eventual effective sucking with and without oxytocin administration. Reduced primitive reflexes associated with feeding have been observed in studies not only at 1 h after birth but also at 48 h after birth \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. Although synthetic oxytocin preparations are fast falling in blood levels, it has been suggested that prolonged infusion of exogenous oxytocin at delivery may alter the neuroendocrine environment of the fetal brain and that the effect lasts for at least 48 h \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThere are several methods for evaluating the feeding abilities of infants. In addition to observing the primitive reflex, the pressure and rhythm can also be measured during sucking movements. In previous studies, infant feeding behavior was evaluated by visual observation of primitive reflexes through videography. However, new findings are expected to be obtained by conducting studies with more objective parameters. The first method measured sucking during direct breastfeeding, in which infants are fed directly through their mother\u0026rsquo;s breasts. However, sucking measurements during direct breastfeeding result in differences in the lactation conditions between cases. Specifically, differences in the mother\u0026rsquo;s inexperience with lactation techniques, speed of breast milk flow into the infant\u0026rsquo;s oral cavity, and breast and nipple morphology make condition matching difficult. The next method involved measuring sucking during bottle feeding with formula or breast milk. However, bottle-feeding infants for research purposes may be a barrier to establishing breastfeeding. Therefore, in this study, we measured the infants\u0026rsquo; Non-Nutritive Sucking (NNS) of empty artificial nipples with and without milk inflow using the same nipples and compared their sucking ability. Oxytocin affects the motor neurons associated with feeding and induces a rhythmic sucking reflex \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. Therefore, measuring the infants\u0026rsquo; sucking pressure and sucking rhythm, as well as analyzing the results, would be possible to provide an objective assessment of the effects of exogenous oxytocin exposure on feeding behavior.\u003c/p\u003e \u003cp\u003eIn this study, we hypothesized that intrapartum oxytocin exposure would weaken the infant\u0026rsquo;s ability to suck and negatively affect breastfeeding. This study aimed to determine the effects of intrapartum oxytocin administration on infants\u0026rsquo; feeding behavior by measuring sucking pressure and rhythm, as well as to examine its effects on breastfeeding.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003e This study was conducted in a Comprehensive Maternity and Perinatal Care Center in Fukuoka, Japan. The hospital was not accredited by the Baby Friendly Hospital Initiative, and if the mothers needed to supplement their breast milk, formula was used. A total of 86 normal newborns born between May 2022 and April 2023, as well as their mothers, were recruited within 24\u0026ndash;48 h of birth. To determine the effects of fetal exposure to exogenous oxytocin, participants were limited to singleton neonates born via vaginal delivery. Infants with congenital abnormalities, preterm infants, infants admitted to the neonatal intensive care unit (NICU) and infants with an Apgar score of less than 7 at 5 min were excluded. In addition, mothers with postpartum abnormalities, those with contraindications to breastfeeding, and those who wished to feed exclusively with formula prior to delivery were excluded. Mothers who met the research eligibility criteria were informed about the study and voluntary participation via an explanatory document, and their written informed consent to participate was obtained. The study protocol was approved by the Institutional Review Boards and Ethics Committees of Kyushu University Hospital and Medical Institutions (ethics approval number: 21131-01). The study was conducted in accordance with the WMA Declaration of Helsinki, the hospital\u0026rsquo;s and government guidelines and regulations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003eIntrapartum oxytocin exposure status\u003c/h2\u003e \u003cp\u003eIntrapartum oxytocin was administered for medical indications to augment or induce labor; a vial of OXYTOCIN injection 5IU (JAN, INN) was mixed with 500-ml 5% glucose infusion. Intravenous infusion was started at 2 mU/min and increased by 1 mU/min at intervals of at least 30 min until effective labor was achieved. The maximum dose was 20 mU/min. During the third stage of labor, a customary dose of 10-IU oxytocin was administered intravenously to all patients and increased as needed. Data on the amount and duration of oxytocin administration and reasons for oxytocin use were collected from medical records.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eVariables related to breastfeeding and sucking ability\u003c/h2\u003e \u003cp\u003eThe following mother\u0026ndash;infant variables were collected from the medical records and questionnaires. Maternal characteristics included maternal age, history of childbirth, postpartum depression, complications, and smoking history. Delivery information: duration of labor, blood loss at delivery, instrumental delivery, and use of analgesia during labor. Infant characteristics included birth weight, umbilical cord arterial blood pH, Apgar score, gestational age at birth, and sex.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eFeeding for infants\u003c/h2\u003e \u003cp\u003eThe mothers were asked about their breastfeeding intentions on the first postpartum day. Data on the details of actual feeding methods for babies (exclusive breastfeeding/mixed breastfeeding and formula/exclusive formula) at 1 month postpartum were collected.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eNNS\u003c/h2\u003e \u003cp\u003eNNS was evaluated by having infants aged 24\u0026ndash;48 h suckle a pacifier nipple for 5 min at least 2 h after the last feeding. Nipples were supplied by Pigeon Co., Ltd. (Tokyo, Japan) and are routinely used in hospital nurseries. To ensure that the use of artificial nipple devices for measurement did not interfere with breastfeeding acquisition, attention was paid to avoid using artificial nipples on newborns who had never used them after birth. The nipple was modified to measure the intraoral negative pressure during sucking. A silicone tube with an inner diameter of 1 mm and a total length of 80 mm was attached to the hole punched in the center of the nipple. The other end of the tube was then connected to a micro-semiconductor pressure transducer (KEYENCE Co., Ltd., Osaka, Japan) and a data logger (Graphtec Co., Ltd., Yokohama, Japan).\u003c/p\u003e \u003cp\u003eInfants underwent measurements while lying on the neonatal bed of the hospital. The infant\u0026rsquo;s arousal level was recorded before the start of the NNS measurement using a 3-point scale (0\u0026thinsp;=\u0026thinsp;asleep, 1\u0026thinsp;=\u0026thinsp;quietly awake, 2\u0026thinsp;=\u0026thinsp;crying). The infants were gently stroked on the side of their lips with a Silicone Rubber Nipple to elicit a rooting response. The nipple was gently placed in the mouth, and the sucking pressure and rhythm were measured for 5 min after the infants initiated the sucking cycle. Readiness to start sucking was also recorded using a 4-point scale (3\u0026thinsp;=\u0026thinsp;sucking started within 1 min; 2\u0026thinsp;=\u0026thinsp;within 1 to 3 min; 1\u0026thinsp;=\u0026thinsp;after 3 min; 0\u0026thinsp;=\u0026thinsp;sucking did not start).\u003c/p\u003e \u003cp\u003eInfants perform sucking movements in bursts (continuous sucking cycles) and pauses (periods of rest). NNS burst was defined as one burst containing two or more sucking amplitude cycles. A new next burst was defined as one in which the interval between sucking cycles was separated by more than 1000 milliseconds with no obvious connection to the previous cycle. All NNS data were graphed using the software program AcqKnowledge 5.0 (BIOPAC Systems, Inc., Goleta, CA), and the mean values of the following temporal parameters and pressure variables were calculated (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). To design a protocol for measuring and analyzing NNS, we referenced previous studies that investigated NNS \u003csup\u003e[\u003cspan additionalcitationids=\"CR27 CR28 CR29 CR30 CR31 CR32 CR33 CR34\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTotal cycles (times): total number of sucking cycles per 5 min\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTotal bursts (times): total number of bursts per 5 min\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eBurst rate (%): percentage of total burst duration in 5 min\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAmplitude (mmHg): peak value of intraoral negative pressure in the sucking cycle\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePeak interval (s): interval between peak values of intraoral negative pressure\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePause time (s): interval between bursts\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eBurst duration (s): duration of each burst\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCycles/burst (time): number of cycles within a burst\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eFrequency (time): number of cycles per second within a burst\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were divided into two groups: the With OXT group that was administered intrapartum oxytocin in the first and second trimesters of delivery, and the Without OXT group that was not administered intrapartum oxytocin in the first and second trimesters of delivery.\u003c/p\u003e\n\u003cp\u003eDescriptive statistics were calculated, and the differences in the distribution of maternal, infant, delivery, and breastfeeding characteristics between the two groups were determined. Multiple regression analysis was performed with NNS as the outcome variable and oxytocin exposure as the independent variable. As covariates, variables reported in previous studies as influencing factors of infant feeding behavior were entered into the model.\u003c/p\u003e\n\u003cp\u003eTo assess the effect of oxytocin exposure on breastfeeding achievement through reduced sucking performance in infants, structural equation modeling (SEM) was used to estimate the path diagram, with NNS as a mediating factor in the causal relationship between oxytocin exposure and breastfeeding attainment. To evaluate the mediating effect of NNS, the significance of the indirect effect was tested using the bootstrap method (bootstrap sample size: 2000, confidence interval [CI]: 95%), and the standardized indirect effect and bootstrapping bias-corrected confidence intervals were calculated using SPSS Amos version 21.0 (IBM Corp., Armonk, NY, USA). The outcome variable was a binary variable of \u0026ldquo;exclusive breastfeeding/other,\u0026rdquo; which indicated breastfeeding achievement. Since many factors influence breastfeeding, univariate logistic regression analysis was conducted with \u0026ldquo;exclusive breastfeeding /other\u0026rdquo; as the dependent variable, and variables that showed \u003cem\u003ep\u003c/em\u003e\u0026lt;0.2 were extracted. In addition, representative variables that showed strong associations in previous studies were entered into the model diagram as control variables.\u003c/p\u003e\n\u003cp\u003eAll \u003cem\u003ep\u003c/em\u003e-values were two-sided, and statistical significance was considered at \u003cem\u003ep\u003c/em\u003e-values \u0026lt;0.05. Statistical analyses were performed using SPSS, version 27 (IBM Corp.) and SPSS Amos, version 21.0 (IBM Corp.).\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003eParticipants\u003c/h2\u003e\n\u003cp\u003eA total of 86 full-term infants and their postpartum mothers were eligible for this study. After the survey was completed, the following participants were excluded from the analysis (4 infants transferred to the NICU after the survey, 1 mother who had severe postpartum depression that made a longitudinal study impossible, 1 infant who did not produce sucking bursts during measurement, and 16 cases with a significant decrease in\u0026nbsp;the NNS pressure waveform at baseline). Finally, 64 pairs of infants and their mothers were analyzed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNormally, when infants perform sucking movements,\u0026nbsp;the intraoral pressure values return to approximately the baseline values after\u0026nbsp;the sucking cycle. In contrast, in cases where the baseline dropped, the negative intraoral pressure continued to increase for an unknown reason. These cases were excluded from the analysis because they could not be accurately measured. No background bias was observed in any of the excluded patients.\u003c/p\u003e\n\u003cp\u003eOf the 64 pairs analyzed, there were 29\u0026nbsp;from the With OXT group\u0026nbsp;and 35 from the Without OXT group. In the With OXT group, 21 patients underwent planned labor induction and 8 underwent labor augmentation. The intrapartum\u0026nbsp;oxytocin exposure times and doses are shown in \u003cstrong\u003eTable 1\u003c/strong\u003e. The objectives and indications for oxytocin administration are described in \u003cstrong\u003eSupplementary Material 1\u003c/strong\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003ereports maternal and infant characteristics, feeding practices, and delivery information stratified by the With and Without OXT group. The proportion of mothers with complications was significantly higher in the With OXT group than in the Without OXT group (\u003cem\u003ep\u003c/em\u003e=0.048). Details of maternal complications are given in\u003cstrong\u003e\u0026nbsp;Supplementary Material 2\u003c/strong\u003e. The number of cases per complication was small. There were no patients in each group with a severe condition that interfered with breastfeeding. For each complication, no differences in NNS and breastfeeding practices were observed. All four cases in which epidural analgesia was used during delivery were in the With OXT group. Subgroup analysis by analgesia status showed no differences in NNS or breastfeeding practices. Since previous studies did not show sufficient evidence that delivery using epidural analgesia affects breastfeeding or infant feeding, they were included in the analysis. \u003cstrong\u003eSupplementary Material 3\u003c/strong\u003e reports the information on the infants at the time of the NNS survey. There were no significant differences in arousal level and time required to start sucking between the With and Without OXT groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e also reports the data on breastfeeding practices at 1 month postpartum, grouped into \u0026ldquo;Exclusive breastfeeding,\u0026rdquo; \u0026ldquo;Mixed breastfeeding and formula,\u0026rdquo; and \u0026ldquo;Exclusive formula.\u0026rdquo; The rate of the exclusively breastfeeding group at 1 month postpartum was significantly higher in the Without OXT group than in the With OXT group (\u003cem\u003ep\u003c/em\u003e=0.033).\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eImpact of intrapartum oxytocin exposure on NNS\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e reports the results of the comparison of NNS measurements between the With and Without OXT groups. The With OXT group had significantly fewer total bursts (\u003cem\u003ep\u003c/em\u003e=0.041), significantly longer pause times (\u003cem\u003ep\u003c/em\u003e=0.044), and a significantly larger coefficient of variation (CV%) for pause times than the Without OXT group (\u003cem\u003ep\u003c/em\u003e=0.040).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e reports the results of a multiple linear regression analysis of the impact of intrapartum oxytocin exposure on NNS. In the model adjusted for covariates, oxytocin exposure was significantly associated with fewer total bursts (95% CI, -6.811 to -0.311), longer pause time (95% CI, 0.320 to 9.223), and bigger CV% of pause time (95% CI, 4.453 to 62.738).\u003c/p\u003e\n\u003ch2\u003eRelationship between NNS-mediated intrapartum oxytocin exposure and breastfeeding\u003c/h2\u003e\n\u003cp\u003ePath models with the NNS variable as a mediator of the causal relationship between oxytocin exposure and feeding methods (exclusive breastfeeding/other) at 1 month postpartum are shown in\u003cstrong\u003e\u0026nbsp;Figure 2\u003c/strong\u003e. The standard errors and \u003cem\u003ep\u003c/em\u003e-values for\u0026nbsp;the direct effect estimates are\u0026nbsp;presented in\u003cstrong\u003e\u0026nbsp;Supplementary Material 4.\u003c/strong\u003e Factors influencing breastfeeding\u0026nbsp;in addition to NNS were entered into the model diagram by considering variables based on\u0026nbsp;previous studies and the results of a single regression analysis (\u003cstrong\u003eSupplementary Material 5\u003c/strong\u003e). The standardized partial regression coefficients are the values of\u0026nbsp;the direct effect coefficients.\u0026nbsp;Significant negative effects (\u0026beta;=-0.288, \u003cem\u003ep\u003c/em\u003e=0.017) from oxytocin exposure to total bursts and significant positive effects (\u0026beta;=0.235-,\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=0.050) on pause-time length were observed. There was also a significant direct effect from intrapartum oxytocin exposure to the feeding methods at 1 month postpartum (\u0026beta;=-.238, \u003cem\u003ep\u003c/em\u003e=0.047). However, there was no significant direct effect of total bursts on the feeding methods at 1 month postpartum (\u0026beta;=-0.040, \u003cem\u003ep\u003c/em\u003e=0.734). Pause time to the feeding methods at 1 month postpartum (\u0026beta;=0.176, \u003cem\u003ep\u003c/em\u003e=0.127) also indicated no significant direct effect. Breastfeeding intentions as a factor influencing breastfeeding were strongly associated with 1-month postpartum feeding methods (\u0026beta;=0.346, \u003cem\u003ep\u003c/em\u003e=0.001). \u003cstrong\u003eTable 4\u0026nbsp;\u003c/strong\u003epresents the estimates of\u0026nbsp;the indirect effects.\u0026nbsp;There was no significant indirect effect of oxytocin exposure through\u0026nbsp;the NNS burst on the\u0026nbsp;breastfeeding method at 1 month postpartum (bootstrap bias-corrected 95% CI, -0.083 to 0.109). There was also no significant indirect effect of\u0026nbsp;the NNS pause time (bootstrap bias-corrected 95% CI, -0.018 to 0.176).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe components of infant feeding are\u0026nbsp;the state of arousal, tactile and olfactory functional systems to find the mother\u0026rsquo;s nipple, routing reflex, rhythmic sucking, and swallowing\u003csup\u003e\u0026nbsp;[25]\u003c/sup\u003e.\u0026nbsp;This study objectively evaluated infant sucking ability, a part of\u0026nbsp;the feeding behavior, using\u0026nbsp;NNS measurements.\u0026nbsp;Infants exposed to oxytocin in utero exhibited significantly fewer total bursts, longer pause times, and significantly larger variations\u0026nbsp;in pause times than those not exposed to oxytocin. This is\u0026nbsp;a new finding, as no previous studies have reported that oxytocin exposure affects\u0026nbsp;NNS.\u003c/p\u003e\n\u003cp\u003eThis study examined the effects of fetal exposure to NNS. Previous studies have investigated the association between NNS and fetal exposure\u0026nbsp;to substances other than oxytocin.\u0026nbsp;Zimmerman et al.\u003csup\u003e\u0026nbsp;[29]\u003c/sup\u003e examined the association between phthalate exposure during pregnancy and NNS. They reported\u0026nbsp;a lower sucking frequency and higher amplitude in\u0026nbsp;the exposed group of infants.\u0026nbsp;It has been suggested that the amplitude may have increased to compensate for the slower sucking frequency.\u0026nbsp;Additionally, higher maternal prenatal stress values were found to be associated with fewer infant NNS bursts/minute and longer burst duration\u003csup\u003e\u0026nbsp;[34]\u003c/sup\u003e.\u0026nbsp;An association between the administration of pethidine at delivery and lower sucking frequency has also been reported \u003csup\u003e[36]\u003c/sup\u003e. Although the mechanism by which the in-utero environment negatively affects the sucking ability of the child is not yet clear,\u0026nbsp;these previous studies have described the possibility that the in-utero environment affects fetal neurodevelopment and reduces the generation of sucking patterns.\u0026nbsp;Similar to reports of fetal cardiopulmonary function changes and\u0026nbsp;decreases in fetal movement\u0026nbsp;in the presence of stress in the prenatal environment\u003csup\u003e\u0026nbsp;[37]\u003c/sup\u003e, NNS vitality may decrease as a self-soothing mechanism. Furthermore, similar to studies that showed\u0026nbsp;the negative effects of the prenatal environment on\u0026nbsp;postnatal NNS patterns, this study also found significant differences in sucking vitality characteristics: fewer bursts and longer, more varied pause times. Intrapartum oxytocin exposure may negatively influence infants\u0026rsquo; sucking abilities.\u0026nbsp;Additionally, the NNS of infants who developed sequelae later has been shown to have fewer sucking bursts per minute, slower sucking frequency, and greater variability in frequency and amplitude\u003csup\u003e\u0026nbsp;[32]\u003c/sup\u003e.\u0026nbsp;Compared to these results, the sucking ability of\u0026nbsp;the\u0026nbsp;With OXT group, which showed fewer bursts and longer, more variable pause times, was more similar to that of\u0026nbsp;the sick infants and can be considered a weak\u0026nbsp;sucking pattern.\u003c/p\u003e\n\u003cp\u003eThe mechanisms\u0026nbsp;by\u0026nbsp;which oxytocin exposure influences\u0026nbsp;the NNS\u0026nbsp;have been discussed. Endogenous oxytocin acts on motor neurons, induces sucking, and plays an important role in feeding\u003csup\u003e\u0026nbsp;[38]\u003c/sup\u003e. The source of endogenous oxytocin in\u0026nbsp;the fetus is produced by the fetus itself, while the maternal oxytocin\u0026nbsp;passes through the immature blood\u0026ndash;brain barrier of the fetus\u003csup\u003e\u0026nbsp;[39]\u003c/sup\u003e.\u0026nbsp;There are two barriers to oxytocin influx into the neonatal brain: the placental barrier and the cerebral blood barrier, which contains oxytocinase, an enzyme involved in the breakdown of oxytocin\u003csup\u003e\u0026nbsp;[5,39]\u003c/sup\u003e. Although these barriers may inhibit the passage of peptides such as oxytocin, they are not fully mature and may be highly permeable during the fetal period\u003csup\u003e\u0026nbsp;[21]\u003c/sup\u003e.Phaneuf et al.\u003csup\u003e\u0026nbsp;[40]\u0026nbsp;\u003c/sup\u003eobserved that prolonged oxytocin exposure decreased oxytocin receptor utilization by decreasing OT receptor messenger RNA\u0026nbsp;levels and caused desensitization.\u0026nbsp;Fetal oxytocin exposure may cause downregulation of the innate oxytocin rhythm that acts on fetal sucking rhythm expression, resulting in a weakening of the sucking pattern. In addition, a meta-analysis of animal studies reported an association between exogenous oxytocin administration, suppression of food and water intake, and reduced mealtimes\u003csup\u003e\u0026nbsp;[41]\u003c/sup\u003e.The mechanism is not fully understood; however, the few sucking expressions observed in this study may also be explained\u0026nbsp;by an appetite-decreasing effect.\u0026nbsp;However, there are differing views on whether exogenous oxytocin reaches the fetus\u0026nbsp;at clinical doses.\u0026nbsp;A review article\u003csup\u003e\u0026nbsp;[42]\u003c/sup\u003e that measured maternal oxytocin levels, as well as umbilical cord arterial and venous oxytocin levels, reported that oxytocin levels in\u0026nbsp;the cord blood did not differ with or without intrapartum synthetic oxytocin administration and may not cross from the mother to the fetus.However, the five studies reviewed were from small samples in the 1970s and\u0026nbsp;the 1980s, and\u0026nbsp;one of the studies reported lower umbilical artery oxytocin levels (24.6 pg/mL) in newborns whose mothers were administered synthetic oxytocin than in controls (116 pg/mL). Other large review articles\u003csup\u003e\u0026nbsp;[12]\u003c/sup\u003e included studies that examined animal oxytocin levels and neonatal behavior after perinatal oxytocin manipulation, as well as studies that examined the possibility of placental transport of oxytocin. The study concluded that knowledge of the conditions under which peripheral oxytocin signaling reaches the fetus is incomplete, after suggesting that exposure to exogenous oxytocin may affect a variety of basic neural systems and behaviors, including protection against fetal hypoxia, initiation and regulation of neonatal feeding, and early social behavior. Further research is needed to provide evidence that clinical doses of exogenous oxytocin reach the fetus and disrupt the endogenous oxytocin rhythm.\u0026nbsp;Although there was no difference in Apgar scores and cord blood pH levels with or without oxytocin exposure in this study, it is also possible that\u0026nbsp;the induction and augmentation of delivery may indirectly affect the infant\u0026apos;s ability to feed, as it has been reported that increased lactate levels in the amniotic fluid due to induction, augmentation\u003csup\u003e\u0026nbsp;[43]\u003c/sup\u003e,\u0026nbsp;and stress from enhanced strong uterine contractions harm infant health.\u003csup\u003e\u0026nbsp;[44]\u003c/sup\u003e. Further studies are warranted to determine the mechanisms\u0026nbsp;through which intrapartum oxytocin exposure affects infant feeding.\u003c/p\u003e\n\u003cp\u003eTo examine a hypothetical model in which intrapartum oxytocin exposure affects breastfeeding achievement mediated by NNS, the effect was estimated using SEM. The analysis showed that oxytocin exposure had a negative direct effect on NNS (total bursts and pauses), but no significant direct effect on feeding methods at 1 month postpartum from either total bursts or pauses. In addition,\u0026nbsp;the estimates of indirect effects also showed no significant indirect effect of oxytocin exposure mediated through NNS (total bursts and pauses) on\u0026nbsp;feeding methods at 1 month postpartum. These results suggested that the influence of the NNS pattern attenuated by oxytocin exposure was not strong enough to affect breastfeeding achievement.\u0026nbsp;Breastfeeding is a mother\u0026ndash;infant interaction, and the mother\u0026apos;s endogenous oxytocin responds to effective sucking by the infant. Repeated and effective breastfeeding stimulates breast milk secretion, thereby facilitating breastfeeding. The sucking pattern of the With OXT group,\u0026nbsp;which had fewer sucking bursts and longer pauses than the Without OXT group, predicted a weaker approach to maternal endogenous oxytocin and weaker breastfeeding achievement; however, the results of this study did not show this effect. The NNS patterns of infants\u0026nbsp;were measured at a one time, 24\u0026ndash;48 h after birth.\u0026nbsp;Assuming that the negative effect of oxytocin on sucking was transient, it is possible that the later sucking ability did not differ between the two groups and did not affect breastfeeding achievement. Additionally, we did not observe in this study whether the infants reproduced the same sucking patterns at the time of the study during other feedings. However, further longitudinal studies are required to confirm this hypothesis.\u003c/p\u003e\n\u003cp\u003eSome studies reported a negative association between intrapartum oxytocin exposure and breastfeeding practices,\u003csup\u003e[15,16, 17\u0026ndash;19]\u003c/sup\u003e whereas others reported no\u0026nbsp;such association\u0026nbsp;\u003csup\u003e[20,21]\u003c/sup\u003e. In this study, a simple comparison between the two groups showed that the With OXT group was negatively associated with\u0026nbsp;a significantly\u0026nbsp;lower rate of exclusive breastfeeding methods at 1 month postpartum. Furthermore, effect estimates using SEM,\u0026nbsp;including control variables in the model diagram,\u0026nbsp;showed\u0026nbsp;a significant\u0026nbsp;negative direct effect of oxytocin exposure on feeding methods 1 month postpartum. Previous studies\u0026nbsp;have discussed factors that negatively affect breastfeeding due to intrapartum oxytocin exposure, including interruption of breastfeeding initiation, decreased ejaculatory reflex due to downregulation of the endogenous oxytocin system\u003csup\u003e\u0026nbsp;[\u003c/sup\u003e\u003csup\u003e5]\u003c/sup\u003e, and inhibition of lactation due to\u0026nbsp;an enhanced stress response\u0026nbsp;\u003csup\u003e[45]\u003c/sup\u003e.\u0026nbsp;It has also been reported that mothers who receive intrapartum oxytocin secrete lower levels of endogenous oxytocin during postpartum breastfeeding\u0026nbsp;\u003csup\u003e[46]\u003c/sup\u003e. In this study, we found no indirect effects on breastfeeding via attenuated NNS; however, we did find a\u0026nbsp;direct and negative\u0026nbsp;effect of oxytocin exposure on breastfeeding. This\u0026nbsp;finding suggests that\u0026nbsp;factors other than the infant\u0026apos;s sucking ability may affect breastfeeding.\u003c/p\u003e\n\u003cp\u003eThis is the first study to evaluate the effect of intrapartum oxytocin on sucking movements using objective parameters. It is clear that a strategy of inducing labor at or beyond term is associated with fewer perinatal deaths and fewer cesarean sections \u003csup\u003e[47,48]\u003c/sup\u003e, and it is imperative in healthcare practice to induce and augment labor according to medical indications.\u0026nbsp;However, breastfeeding should be supported while considering that infants born to mothers exposed to intrapartum oxytocin may have\u0026nbsp;an attenuated feeding ability, at least until the second day after birth.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy strength and limitation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe strength and originality of this study is that the impact of intrapartum oxytocin exposure on infant feeding behavior was objectively evaluated using a sucking measurement approach. This study was conducted at a university hospital that provided advanced medical care as the study field. Although all participants in the analysis met the eligibility criteria and none had lactation disabilities, there are limitations in generalizing the results.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study investigated the effects of intrapartum oxytocin exposure on infant sucking ability (NNS) during the first 24\u0026ndash;48 h after birth and breastfeeding at one month postpartum. In adjusted multiple regression models, intrapartum oxytocin exposure was significantly associated with fewer total NNS bursts, longer pause times, and greater pause-time variability. The effects estimated using SEM showed a significant, negative, and direct effect of intrapartum oxytocin exposure on the practice of exclusive breastfeeding 1 month postpartum; this is a novel finding. However, no indirect effects of NNS were found, rejecting the hypothesis that intrapartum oxytocin exposure attenuates infants\u0026apos; sucking ability and thus negatively affects breastfeeding. Since a policy of labor induction and augmentation is associated with fewer perinatal deaths and cesarean sections, treatment according to medical indications is essential for the provision of healthcare. However, it is necessary to consider that infants born to mothers who receive intrapartum oxytocin may have attenuated sucking ability for at least the first 48 h after birth, and breastfeeding support should be provided.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgments\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the infants and their families for\u0026nbsp;their\u0026nbsp;participation in this study. We would also like to thank\u0026nbsp;the\u0026nbsp;staff of Kyushu University Hospital for their cooperation in\u0026nbsp;the data collection.\u0026nbsp;This study was supported by RIKEN Healthcare and Medical Data Platform Project.\u003c/p\u003e\n\u003cp\u003eAuthor contributions statement\u003c/p\u003e\n\u003cp\u003eStudy design: M.O., S.M., S.K., Y.O.\u003c/p\u003e\n\u003cp\u003eRecruitment of study participants: M.O., S.M., S.K., and E.W.\u003c/p\u003e\n\u003cp\u003eData collection: M.O., and S.M.\u003c/p\u003e\n\u003cp\u003eStatistical analyses: M.O., S.M., and K.O.\u003c/p\u003e\n\u003cp\u003eDrafting of manuscript: M.O., and S.M.\u003c/p\u003e\n\u003cp\u003eCritical revision of the manuscript: M.\u0026nbsp;O., S. M., S. K., Y. O.,\u0026nbsp;and K.\u0026nbsp;O.\u003c/p\u003e\n\u003cp\u003eSupervision: All authors have reviewed and approved the final manuscript\u003c/p\u003e\n\u003cp\u003eAdditional information\u003c/p\u003e\n\u003cp\u003eCompeting interests: The authors declare that there are no competing interests.\u003c/p\u003e\n\u003cp\u003eData availability statement:\u0026nbsp;Data supporting the findings of this study are available from the corresponding author upon\u0026nbsp;request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupplementary information are available\u003c/strong\u003e.\u003cbr\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMiddleton, P., Shepherd, E., Morris, J., Crowther, C. A. \u0026amp; Gomersall, J. C. Induction of labour at or beyond 37 weeks\u0026rsquo; gestation. Cochrane Database Syst Rev 7, (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartin, J. A., Hamilton, B. 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Effects of the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) Trial on Elective Induction and Obstetric Outcomes in Term Nulliparous Patients. Obstetrics \u0026amp; Gynecology. 142, 242\u0026ndash;250 (2023).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Basic characteristics of the With Oxytocin and Without Oxytocin groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.75346687211094%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.112480739599384%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithout OXT (n=35)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.10939907550077%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWith OXT (n=29)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.477657935285054%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep-\u003c/em\u003evalue\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.61538461538461%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.769230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.61538461538461%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMaternal age (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e32.20\u0026plusmn;6.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.769230769230769%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e34.24\u0026plusmn;3.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.61538461538461%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eHistory of childbirth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.076923076923077%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"2.769230769230769%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.076923076923077%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.461538461538462%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"39.75346687211094%\" valign=\"top\"\u003e\n \u003cp\u003ePrimipara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.112480739599384%\" valign=\"top\"\u003e\n \u003cp\u003e14 (40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.10939907550077%\" valign=\"top\"\u003e\n \u003cp\u003e15 (51.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.477657935285054%\" valign=\"top\"\u003e\n \u003cp\u003e0.451\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"39.75346687211094%\" valign=\"top\"\u003e\n \u003cp\u003eMultipara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.112480739599384%\" valign=\"top\"\u003e\n \u003cp\u003e21 (60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.10939907550077%\" valign=\"top\"\u003e\n \u003cp\u003e14 (48.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.477657935285054%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.61538461538461%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePostpartum depression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.076923076923077%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"2.769230769230769%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.076923076923077%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.461538461538462%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"39.75346687211094%\" valign=\"top\"\u003e\n \u003cp\u003eEPDS score at discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.112480739599384%\" valign=\"top\"\u003e\n \u003cp\u003e3.40\u0026plusmn;3.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.10939907550077%\" valign=\"top\"\u003e\n \u003cp\u003e4.10\u0026plusmn;3.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.477657935285054%\" valign=\"top\"\u003e\n \u003cp\u003e0.279\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"39.75346687211094%\" valign=\"top\"\u003e\n \u003cp\u003eEPDS score at 1 month checkup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.112480739599384%\" valign=\"top\"\u003e\n \u003cp\u003e2.63\u0026plusmn;2.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.10939907550077%\" valign=\"top\"\u003e\n \u003cp\u003e2.59\u0026plusmn;2.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.477657935285054%\" valign=\"top\"\u003e\n \u003cp\u003e0.794\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.61538461538461%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMaternal complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.076923076923077%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"2.769230769230769%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.076923076923077%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e0.048*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"39.75346687211094%\" valign=\"top\"\u003e\n \u003cp\u003eAny\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.112480739599384%\" valign=\"top\"\u003e\n \u003cp\u003e22 (62.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.10939907550077%\" valign=\"top\"\u003e\n \u003cp\u003e25 (86.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.477657935285054%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"39.75346687211094%\" valign=\"top\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.112480739599384%\" valign=\"top\"\u003e\n \u003cp\u003e13 (37.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.10939907550077%\" valign=\"top\"\u003e\n \u003cp\u003e4 (13.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.477657935285054%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.61538461538461%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSmoking history, Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e5 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.769230769230769%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e1 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e0.312\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.61538461538461%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNipple shape problems for breastfeeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e4 (11.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.769230769230769%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e7 (24.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e0.203\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.61538461538461%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eBreast and nipple troubles at discharge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e14 (63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.769230769230769%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e8 (27.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e0.428\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.61538461538461%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFeeding for Infants\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.076923076923077%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"2.769230769230769%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.076923076923077%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.461538461538462%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.63944530046226%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eBreastfeeding intentions (Method of feeding that mother desired)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.10939907550077%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.477657935285054%\" valign=\"top\"\u003e\n \u003cp\u003e0.138\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"39.75346687211094%\" valign=\"top\"\u003e\n \u003cp\u003eExclusive breastfeeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.112480739599384%\" valign=\"top\"\u003e\n \u003cp\u003e9 (25.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.10939907550077%\" valign=\"top\"\u003e\n \u003cp\u003e3 (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.477657935285054%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"39.75346687211094%\" valign=\"top\"\u003e\n \u003cp\u003eMixed breastfeeding and formula\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.112480739599384%\" valign=\"top\"\u003e\n \u003cp\u003e26 (74.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.10939907550077%\" valign=\"top\"\u003e\n \u003cp\u003e26 (89.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.477657935285054%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.63944530046226%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eActual feeding method (1 month postpartum)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.10939907550077%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.477657935285054%\" valign=\"top\"\u003e\n \u003cp\u003e0.033*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"39.75346687211094%\" valign=\"top\"\u003e\n \u003cp\u003eExclusive breastfeeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.112480739599384%\" valign=\"top\"\u003e\n \u003cp\u003e15（42.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.10939907550077%\" valign=\"top\"\u003e\n \u003cp\u003e5（17.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.477657935285054%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"39.75346687211094%\" valign=\"top\"\u003e\n \u003cp\u003eMixed breastfeeding and formula\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.112480739599384%\" valign=\"top\"\u003e\n \u003cp\u003e18（51.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.10939907550077%\" valign=\"top\"\u003e\n \u003cp\u003e22（75.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.477657935285054%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.75346687211094%\" valign=\"top\"\u003e\n \u003cp\u003eExclusive formula\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.112480739599384%\" valign=\"top\"\u003e\n \u003cp\u003e2 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.10939907550077%\" valign=\"top\"\u003e\n \u003cp\u003e2 (6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.477657935285054%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.61538461538461%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDelivery information\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.769230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.461538461538462%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.61538461538461%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDuration of labor (minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e349.46\u0026plusmn;236.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.769230769230769%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e376.79\u0026plusmn;273.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e0.819\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.61538461538461%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eBlood loss at delivery (ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e522.75\u0026plusmn;279.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.769230769230769%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e515.10\u0026plusmn;264.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e0.356\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.61538461538461%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eInstrumental\u0026nbsp;delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e2 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.769230769230769%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e6 (20.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e0.127\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.61538461538461%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eUse of epidural analgesia in labor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.769230769230769%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e4 (13.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e0.037*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.61538461538461%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eIntrapartum Oxytocin use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.076923076923077%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"2.769230769230769%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.076923076923077%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.461538461538462%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"39.75346687211094%\" valign=\"top\"\u003e\n \u003cp\u003eOxytocin administration dose (IU)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.112480739599384%\" valign=\"top\"\u003e\n \u003cp\u003e―\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.10939907550077%\" valign=\"top\"\u003e\n \u003cp\u003e3.45\u0026plusmn;5.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.477657935285054%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.75346687211094%\" valign=\"top\"\u003e\n \u003cp\u003eOxytocin administration time (minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.112480739599384%\" valign=\"top\"\u003e\n \u003cp\u003e―\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.10939907550077%\" valign=\"top\"\u003e\n \u003cp\u003e354.38\u0026plusmn;428.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.477657935285054%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.61538461538461%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfant characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.769230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.461538461538462%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.61538461538461%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eBirth weight (g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e3152.66\u0026plusmn;407.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.769230769230769%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e3035.97\u0026plusmn;377.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e0.272\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.61538461538461%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eUmbilical\u0026nbsp;cord\u0026nbsp;arterial\u0026nbsp;blood\u0026nbsp;pH\u0026nbsp;value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e7.309\u0026plusmn;0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.769230769230769%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e7.316\u0026plusmn;0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e0.691\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.61538461538461%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eAPGAR score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.076923076923077%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"2.769230769230769%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.076923076923077%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.461538461538462%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"39.75346687211094%\" valign=\"top\"\u003e\n \u003cp\u003e1minute\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.112480739599384%\" valign=\"top\"\u003e\n \u003cp\u003e8.09\u0026plusmn;0.387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.10939907550077%\" valign=\"top\"\u003e\n \u003cp\u003e8.12\u0026plusmn;0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.477657935285054%\" valign=\"top\"\u003e\n \u003cp\u003e0.847\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"39.75346687211094%\" valign=\"top\"\u003e\n \u003cp\u003e5minutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.112480739599384%\" valign=\"top\"\u003e\n \u003cp\u003e9.02\u0026plusmn;0.218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.10939907550077%\" valign=\"top\"\u003e\n \u003cp\u003e9.09\u0026plusmn;0.412\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.477657935285054%\" valign=\"top\"\u003e\n \u003cp\u003e0.094\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.61538461538461%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eGestational age at birth (weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e39.3\u0026plusmn;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.769230769230769%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e38.6\u0026plusmn;1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.61538461538461%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eInfant sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.076923076923077%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"2.769230769230769%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.076923076923077%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e0.451\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"39.75346687211094%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.112480739599384%\" valign=\"top\"\u003e\n \u003cp\u003e11 (40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.10939907550077%\" valign=\"top\"\u003e\n \u003cp\u003e15 (51.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.477657935285054%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.75346687211094%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.112480739599384%\" valign=\"top\"\u003e\n \u003cp\u003e21 (60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.10939907550077%\" valign=\"top\"\u003e\n \u003cp\u003e14 (48.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.477657935285054%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.61538461538461%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTime since birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e34.80\u0026plusmn;7.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.769230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.076923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e38.93\u0026plusmn;8.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.63944530046226%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eThe data shown are mean\u0026plusmn;SD or number of people (%).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.773497688751926%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.10939907550077%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.477657935285054%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003eThe \u003cem\u003ep\u003c/em\u003e-values were estimated from the Mann\u0026ndash;Whitney\u003cem\u003e\u0026nbsp;U\u0026nbsp;\u003c/em\u003etest or\u003cem\u003e\u0026nbsp;\u003c/em\u003echi-squared test; *\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05, **\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01, ***\u003cem\u003ep\u003c/em\u003e \u0026lt;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 0.000 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"89.52234206471495%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.477657935285054%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"89.52234206471495%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eAbbreviations: SD, standard deviation; EPDS, Edinburgh postnatal depression scale.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.477657935285054%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. NNS measurements of the With Oxytocin and Without Oxytocin groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithout OXT (n=35)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWith OXT (n=29)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep-\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003evalue\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIQR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIQR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTotal cycles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e209.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(93.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e219.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(173.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e182.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(92.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e181.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(151.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.252\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal bursts\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e17.74\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e(6.40)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e18.00\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e(7.00)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e14.38\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e(5.94)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e14.00\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e(7.50)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.041*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBurst rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(21.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e42.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(36.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e36.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(19.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e31.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(25.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.557\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAmplitude\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-189.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(35.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-184.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(42.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-193.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(37.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-192.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(57.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.415\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCV%\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(7.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(11.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(6.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(7.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.531\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePeak interval\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.171\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCV%\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(3.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(4.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(3.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(4.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.887\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePause time\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e11.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e(6.40)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e8.52\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e(5.07)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e14.88\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e(9.79)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e12.27\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e(6.64)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.044*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCV%\u0026dagger;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e78.28\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e(49.68)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e69.16\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e(75.96)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e104.47\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e(54.99)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e84.97\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e(109.49)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.040*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBurst duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(7.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(5.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(4.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(7.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.446\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCV%\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e70.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(27.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(43.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e69.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(28.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e67.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(34.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.772\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCycles/burst\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(9.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(9.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(5.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(8.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.496\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCV%\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e61.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(26.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e58.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(33.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e59.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(26.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(28.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.681\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.243\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCV%\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(10.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(12.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(9.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(14.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.731\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"11\" valign=\"top\"\u003e\n \u003cp\u003eThe \u003cem\u003ep\u003c/em\u003e-values were estimated from the Mann\u0026ndash;Whitney U test; *\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05, **\u003cem\u003ep\u003c/em\u003e\u0026lt;0.01, ***\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"11\" valign=\"top\"\u003e\n \u003cp\u003e\u0026dagger;CV%=(SD/Mean\u0026times;100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"11\" valign=\"top\"\u003e\n \u003cp\u003eAbbreviations: SD, standard deviation; CV, coefficient of variation.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 3. Impact of intrapartum oxytocin exposure on NNS\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"714\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.764705882352942%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"42.857142857142854%\" colspan=\"5\" valign=\"top\" style=\"width: 42.7182%;\"\u003e\n \u003cp\u003eSimple linear Regression model\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.2408963585434174%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\" colspan=\"5\" valign=\"top\" style=\"width: 43.1361%;\"\u003e\n \u003cp\u003eMultiple linear Regression model\u0026Dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.781206171107995%\"\u003e\n \u003cp\u003eOutcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.5918653576437585%\" style=\"width: 6.5837%;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.5918653576437585%\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.451612903225806%\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.433380084151473%\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-\u003c/p\u003e\n \u003cp\u003evalue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.708274894810659%\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.244039270687237%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.5918653576437585%\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.5918653576437585%\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.872370266479663%\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.433380084151473%\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.708274894810659%\" style=\"width: 15.6852%;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.781206171107995%\" valign=\"top\"\u003e\n \u003cp\u003eTotal bursts\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.5918653576437585%\" style=\"width: 6.5837%;\"\u003e\n \u003cp\u003e-3.66\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.5918653576437585%\"\u003e\n \u003cp\u003e1.53\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.451612903225806%\"\u003e\n \u003cp\u003e-0.29\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.433380084151473%\" valign=\"top\"\u003e\n \u003cp\u003e0.021*\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.708274894810659%\" valign=\"top\"\u003e\n \u003cp\u003e[-6.68 to -0.57]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.244039270687237%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.5918653576437585%\"\u003e\n \u003cp\u003e-3.60\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.5918653576437585%\"\u003e\n \u003cp\u003e1.64\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.872370266479663%\" valign=\"top\"\u003e\n \u003cp\u003e-0.29\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.433380084151473%\" valign=\"top\"\u003e\n \u003cp\u003e0.032*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.708274894810659%\" valign=\"top\" style=\"width: 15.6852%;\"\u003e\n \u003cp\u003e[-6.81 to -0.31]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.781206171107995%\" valign=\"top\"\u003e\n \u003cp\u003ePause time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.5918653576437585%\" style=\"width: 6.5837%;\"\u003e\n \u003cp\u003e3.87\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.5918653576437585%\"\u003e\n \u003cp\u003e2.04\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.451612903225806%\"\u003e\n \u003cp\u003e0.24\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.433380084151473%\" valign=\"top\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.708274894810659%\" valign=\"top\"\u003e\n \u003cp\u003e[-0.20\u0026ndash;7.94]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.244039270687237%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.5918653576437585%\"\u003e\n \u003cp\u003e4.77\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.5918653576437585%\"\u003e\n \u003cp\u003e2.22\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.872370266479663%\" valign=\"top\"\u003e\n \u003cp\u003e0.29\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.433380084151473%\" valign=\"top\"\u003e\n \u003cp\u003e0.036*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.708274894810659%\" valign=\"top\" style=\"width: 15.6852%;\"\u003e\n \u003cp\u003e[0.32\u0026ndash;9.22]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.781206171107995%\" valign=\"top\"\u003e\n \u003cp\u003ePause time\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCV%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.5918653576437585%\" style=\"width: 6.5837%;\"\u003e\n \u003cp\u003e26.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.5918653576437585%\"\u003e\n \u003cp\u003e13.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.451612903225806%\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.433380084151473%\"\u003e\n \u003cp\u003e0.050*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.708274894810659%\"\u003e\n \u003cp\u003e[0.02\u0026ndash;52.37]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.244039270687237%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.5918653576437585%\"\u003e\n \u003cp\u003e33.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.5918653576437585%\"\u003e\n \u003cp\u003e14.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.872370266479663%\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.433380084151473%\"\u003e\n \u003cp\u003e0.025*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.708274894810659%\" style=\"width: 15.6852%;\"\u003e\n \u003cp\u003e[4.45\u0026ndash;62.74]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"12\" valign=\"top\"\u003e\n \u003cp\u003eMultiple regression analysis with oxytocin exposure as the independent variable for NNS outcomes with significant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"12\" valign=\"top\"\u003e\n \u003cp\u003edifferences between the two groups with and without oxytocin.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"12\" valign=\"top\"\u003e\n \u003cp\u003e\u0026dagger; Only oxytocin exposure was entered as an independent variable.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"12\" valign=\"top\"\u003e\n \u003cp\u003e\u0026Dagger; Infant\u0026apos;s birth weight, infant\u0026apos;s gestational age at birth, infant\u0026apos;s sex, maternal age, and duration of labor were entered as covariates.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"12\" valign=\"top\"\u003e\n \u003cp\u003eAbbreviations: B, partial regression coefficient; SE, standard error; \u0026beta;, standardized partial regression coefficient; CI, confidence interval; NNS, Non-Nutritive Sucking.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 4. Multiple Mediation Model: Indirect effects of oxytocin on 1-month postpartum feeding methods through NNS.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"681\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.71659324522761%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.22173274596182%\" colspan=\"4\" rowspan=\"2\"\u003e\n \u003cp\u003eIndirect effect\u003cbr\u003e\u0026nbsp; (products of coefficients)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.061674008810574%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eBootstrapping\u003cbr\u003e\u0026nbsp;bias-corrected 95％ CI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.794117647058826%\"\u003e\n \u003cp\u003eRelationship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.029411764705882%\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.882352941176471%\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.882352941176471%\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.323529411764707%\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.08823529411765%\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.794117647058826%\"\u003e\n \u003cp\u003eOxytocin\u0026nbsp;\u0026rarr;\u0026nbsp;Total bursts\u0026nbsp;\u0026rarr;\u0026nbsp;Exclusive breastfeeding/Other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.029411764705882%\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.882352941176471%\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.882352941176471%\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.323529411764707%\"\u003e\n \u003cp\u003e0.726\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.08823529411765%\"\u003e\n \u003cp\u003e[-0.08\u0026ndash;0.11]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.794117647058826%\"\u003e\n \u003cp\u003eOxytocin \u0026rarr; pause time \u0026rarr; Exclusive breastfeeding/Other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.029411764705882%\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.882352941176471%\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.882352941176471%\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.323529411764707%\"\u003e\n \u003cp\u003e0.209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.08823529411765%\"\u003e\n \u003cp\u003e[-0.02\u0026ndash;0.18]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003eBootstrap sample size=2,000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003eAbbreviations: B, partial regression coefficient; SE, standard error; \u0026beta;, standardized partial regression coefficient; CI, confidence interval; NNS, Non-Nutritive Sucking.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-3383044/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3383044/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study aimed to examine the effect of intrapartum oxytocin administration on neonatal sucking behavior and breastfeeding. A total of 64 pairs (29 in the group treated with intrapartum oxytocin and 35 in the control group) of normal infants within 24\u0026ndash;48 h of birth and their mothers were recruited. Sucking ability was evaluated by measuring Non-Nutritive Sucking (NNS) for 5 min. Data on the rate of exclusive breastfeeding at 1 month postpartum were collected. In the adjusted multiple regression models, intrapartum oxytocin exposure was significantly associated with fewer total NNS bursts (95% confidence interval (CI), -6.811 to -0.311), longer pause times (95% CI, 0.320 to 9.223), and greater pause-time variability (95% CI, 4.453 to 62.738). Effects estimated using structural equation modeling revealed that intrapartum oxytocin exposure had a significant negative and direct effect on the practice of exclusive breastfeeding 1 month postpartum (β=-.238, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.047). However, no NNS-mediated indirect effects were observed. This report demonstrates that infants born to mothers who receive intrapartum oxytocin may have impaired sucking ability for at least the first 48 h after birth, and breastfeeding support should be provided.\u003c/p\u003e","manuscriptTitle":"Impact of intrapartum oxytocin administration on neonatal sucking behavior and breastfeeding","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-10-06 20:20:56","doi":"10.21203/rs.3.rs-3383044/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-01-11T08:21:38+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-11-13T18:44:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4050e552-7c94-4faf-8190-d8b462f5e66c","date":"2023-10-25T14:35:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-10-25T10:01:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5714d8bd-c312-4071-b663-0d983631d874","date":"2023-10-17T13:12:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-10-09T17:44:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-10-09T06:02:15+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2023-10-01T03:33:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-10-01T03:21:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2023-09-25T04:42:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d777da93-1a10-4806-a411-5d28246cdb32","owner":[],"postedDate":"October 6th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":25103501,"name":"Health sciences/Health care/Paediatrics/Neonatology"},{"id":25103502,"name":"Health sciences/Health care/Paediatrics/Paediatric research"}],"tags":[],"updatedAt":"2024-03-18T15:09:26+00:00","versionOfRecord":{"articleIdentity":"rs-3383044","link":"https://doi.org/10.1038/s41598-024-56635-9","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2024-03-11 15:01:18","publishedOnDateReadable":"March 11th, 2024"},"versionCreatedAt":"2023-10-06 20:20:56","video":"","vorDoi":"10.1038/s41598-024-56635-9","vorDoiUrl":"https://doi.org/10.1038/s41598-024-56635-9","workflowStages":[]},"version":"v1","identity":"rs-3383044","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3383044","identity":"rs-3383044","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}