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Weighing the Facts: A Systematic Review of Expected Patterns of Weight Loss in Full-Term, Breastfed Infants


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All breastfeeding infants lose some weight in the early days of life. Conventionally, 5% to 7% loss of birth weight has been accepted as the normal and expected amount of weight loss before infants begin to gain weight steadily. When infants lose more than 7% of their birth weight, breastfeeding adequacy is sometimes questioned and formula supplementation is often given. Despite the fact that 5% to 7% is well known and commonly cited, little reliable evidence exists that supports use of this figure as a guide to practice. A systematic review of studies that focused on infant weight loss was conducted. The main objective was to determine the mean amount of weight loss for healthy, full-term exclusively breastfed infants after birth. One previous review and 9 primary studies published since 2008 were examined. The reported mean infant weight loss ranged widely among studies from 3.79% to 8.6%. The point at which most infants have lost the most amount of weight occurs 2 to 4 days after birth. Close examination of the studies, however, revealed significant methodological flaws in the research. Study limitations commonly included gaps in data collection, lack of documented feeding type, sample groups that lacked adequate numbers of exclusively breastfed infants, and the exclusion of breastfed infants who lost the most weight. Well-designed clinical studies that address these limitations are needed. © The Author(s) 2015.
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Journal of Human Lactation
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DOI: 10.1177/0890334415597681
It is well established that some degree of early neonatal
weight loss is normal. For the first 2 days of life, breastfeed-
ing infants receive only small amounts of colostrum from the
breast. After lactogenesis stage II (secretory activation)
begins, usually on the third day of life, most infants will
begin to gain weight steadily. For a small percentage of
infants, too much weight loss may indicate a problem.
Potential problems may include poor breastfeeding manage-
ment, undiagnosed metabolic disorders, neurological disor-
ders, or other infant morbidities that cause poor feeding.1 A
serious outcome of unrecognized feeding problems and too
much weight loss can be hypernatremic dehydration.
Complications of hypernatremic dehydration may include
renal and liver failure, disseminated intravascular coagula-
tion, intracranial hemorrhage, seizure, and death.2
For many years, 5% to 7% loss of birth weight has been
considered the normal and expected amount of physiological
weight loss for breastfed infants.3-5 This figure is now being
challenged. Researchers are suggesting that little is actually
known about weight changes in term babies during the first 2
weeks of life.6,7 Until recently, the growth of breastfed babies
was judged by a standard that was derived from data col-
lected on children who had largely been artificially fed.6,8 It
was not until 2010 that updated growth charts were dissemi-
nated by the World Health Organization (WHO)9 and reflect
growth patterns among children predominantly breastfed.
Indeed, health differences between breastfed and formula-
fed infants have become increasingly clear. Breastfeeding is
positively associated with fewer respiratory, gastrointestinal,
and ear infections.10,11 Later in life, breastfed infants experi-
ence less Type I and II diabetes, heart disease, and obesity.12
There are several well-documented factors associated
with increased infant weight loss after birth. These factors
include higher weight at birth, female sex, advanced mater-
nal age and education, cesarean delivery, and jaundice.13,14
Delayed lactogenesis has also been demonstrated to correlate
strongly with increased weight loss.3 Recently, studies have
also shown that intravenous fluid given during the antepar-
tum period can affect the amount of weight loss in the neona-
tal period.1,15
597681JHLXXX10.1177/0890334415597681Journal of Human LactationThulier
1College of Nursing, University of Rhode Island, Wakefield, RI, USA
Date submitted: November 12, 2014; Date accepted: July 4, 2015.
Corresponding Author:
Diane Thulier, PhD, RN, University of Rhode Island College of Nursing,
39 Butterfield Rd, Kingston, RI 02881, USA.
Weighing the Facts: A Systematic Review
of Expected Patterns of Weight Loss in
Full-Term, Breastfed Infants
Diane Thulier, PhD, RN1
All breastfeeding infants lose some weight in the early days of life. Conventionally, 5% to 7% loss of birth weight has been
accepted as the normal and expected amount of weight loss before infants begin to gain weight steadily. When infants lose
more than 7% of their birth weight, breastfeeding adequacy is sometimes questioned and formula supplementation is often
given. Despite the fact that 5% to 7% is well known and commonly cited, little reliable evidence exists that supports use
of this figure as a guide to practice. A systematic review of studies that focused on infant weight loss was conducted. The
main objective was to determine the mean amount of weight loss for healthy, full-term exclusively breastfed infants after
birth. One previous review and 9 primary studies published since 2008 were examined. The reported mean infant weight
loss ranged widely among studies from 3.79% to 8.6%. The point at which most infants have lost the most amount of weight
occurs 2 to 4 days after birth. Close examination of the studies, however, revealed significant methodological flaws in the
research. Study limitations commonly included gaps in data collection, lack of documented feeding type, sample groups that
lacked adequate numbers of exclusively breastfed infants, and the exclusion of breastfed infants who lost the most weight.
Well-designed clinical studies that address these limitations are needed.
breastfeeding, infant, weight, weight loss
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2 Journal of Human Lactation
Currently, different opinions exist about what constitutes
normal infant weight loss and when this weight loss is con-
sidered to be excessive. Controversy also exists about when
interventions, such as formula supplementation, should be
initiated.1,7 The International Lactation Consultant
Association16 and the Academy of Breastfeeding Medicine17
both suggest that breastfeeding management should be eval-
uated in those infants who exceed a 7% loss. The 2012
American Academy of Pediatrics8 policy statement
“Breastfeeding and the Use of Human Milk” also notes that
breastfeeding infants should have a weight loss of no more
than 7%.
Some researchers use 7% as a marker for excessive
weight loss,18,19 whereas others use 10%.15,20,21 In a system-
atic review of infant physiological weight loss, Noel-Weiss
et al7 noted that the choice of 7% or 10% appears to be an
arbitrary demarcation of substantial weight loss. Despite
these differing professional opinions and lack of evidence,
the percentage of weight lost after birth remains 1 of the most
frequently used measures to assess infants’ well-being. What
is well known, however, is that administering supplemental
formula when not medically indicated interferes with the
establishment of effective breastfeeding.22 This is especially
true in the early days of life before lactogenesis is well estab-
lished. Therefore, to prevent unnecessary formula supple-
mentation, clinicians need to know the difference between
normal and abnormal weight loss.2
A systematic review of the literature was conducted to
answer 2 research questions: (1) What is the mean amount of
weight loss for healthy, full-term, exclusively breastfed
infants after birth? (2) When do most breastfed infants reach
their nadir or greatest point of weight loss after birth?
To answer these questions, a database search was con-
ducted through the University of Rhode Island Library. Four
electronic databases were searched including the Cochrane
Database of Systematic Reviews, MEDLINE, CINAHL, and
PubMED. Primary keywords included breastfeeding, infant,
weight, and weight loss. Inclusion criteria were English-only
reviews and primary studies whose main objective was to
determine normal patterns of weight loss for healthy, full-
term infants. All research designs and all countries of origin
were considered for inclusion. The last systematic review of
the same topic was conducted in 2008,7 and therefore, the
search was limited to publications dated from 2008 to 2015.
In addition to the review by Noel-Weiss, 9 primary studies
were found that met these inclusion criteria.
In 2008, Noel-Weiss and colleagues7 completed a systematic
review on physiological weight loss in the breastfed neonate.
The objective of that review was to establish the reference
weight loss in the first 2 weeks of life for exclusively
breastfed neonates. Authors included in this review primary
research studies with weight loss data for healthy, full-term,
exclusively breastfed neonates. They found 11 studies that
met the criteria; 6 of the studies researched nonweight topics
but provided data about weight change patterns. The studies
consisted of works from several different cultures; the sam-
ple sizes varied from 21 to 937 with a median of 120 partici-
pants. Results indicated that mean weight loss for healthy
term infants ranged from 5.7% to 6.6%, with a standard devi-
ation around 2%. Days 2 and 3 following birth appeared to
be the days of maximum weight loss, and the majority of
infants regained their birth weight within the first 2 weeks
after birth.7 Since 2008, 9 primary studies with a focus on
determining normal patterns of infant weight loss in full-
term infants have been published (Table 1).
In 2008, Crossland and colleagues6 completed a prospec-
tive study to explore weight changes in 253 healthy, full-
term, singleton infants. Infants were born in the Sunderland
Royal Hospital in the United Kingdom and cared for by mid-
wifery teams that routinely practice skin-to-skin care after
birth and encouraged on-demand breastfeedings. Infants in
the study were born via vaginal and cesarean section (CS)
delivery. Weights were collected in the hospital and the
mothers weighed infants daily at home for 2 weeks or longer,
until the infant returned to birth weight. A total of 46 infants
were dropped from the study due to consecutive missing
weights. Among the breastfed infants who were dropped, 13
had switched to formula feeding. This resulted in a total of
111 exclusively breastfed infants and 142 formula-fed infants
in the study.6 Data showed that the mean weight loss for
exclusively breastfed infants was 6.4% (5.5%-7.3%). The
mean weight loss for formula-fed infants was 3.7% (2.7%-
4.7%). For both groups, the nadir of weight loss was day 3 of
life. A total of 85% of all infants regained their birth weight
by 2 weeks of age.
In 2010, Mulder and colleagues18 studied excessive
weight loss in 53 breastfed infants born at a midwestern
community hospital in the United States. A secondary analy-
sis of data from a psychometric study examining the Mother
Infant Breastfeeding Progress Tool was completed. This con-
venience sample included women who were “attempting” to
breastfeed and who delivered stable infants between 35 and
42 weeks gestation. A total of 31 (59.6%) infants in the study
were born via vaginal delivery and 20 (38.5%) were born via
CS. Infant weights were collected for 2 days. The reported
mean weight loss that occurred on days 1 to 2 was 3.79% ±
1.25%. The researchers also reported that 20.8% of infants
lost 7% of their birth weight by day 2 of life.18
Also in 2010, Flaherman and colleagues23 evaluated the
relationship between weight loss at < 24 hours and subse-
quent in-hospital weight loss > 10%. The authors described
how targeting infants at risk for greater weight loss could
allow for the provision of more supportive care. A retrospec-
tive analysis was completed that included 1050 term infants
born at the University of California, San Francisco.
Exclusively breastfed infants were categorized with mixed
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Thulier 3
feeding infants, and the reported mean weight loss was 6.1%
± 2.1% and the mean time to weight nadir was 38.7 ± 18.5
hours. The researchers were able to demonstrate that infants
who lost 4.5% birth weight at < 24 hours were at greater
risk for weight loss of 10%.23
A prospective study by Grossman et al24 sought to deter-
mine the weight-loss nadir among infants born at Boston
Medical Center, a Baby-Friendly hospital in Boston,
Massachusetts. The objective was to identify predictors of
weight loss in the first week of life. A total of 121 healthy,
term infants born via vaginal and CS were included in the
study. Hospital weights were recorded; in addition, research
assistants collected daily weights for 1 week following birth.
In this study, a total of 32 infants were exclusively breastfed
(received 100% breast milk), 66 infants were mainly breast-
fed (received 50% breast milk), 16 infants were mainly
formula fed (received > 50% formula), and 7 infants were
exclusively formula fed (received 100% formula). The
results indicated that the exclusively breastfed infants lost
5.5% ± 2.0%, the mainly breastfed infants lost 5.5% + 2.1%,
the mainly formula-fed infants lost 2.7% + 1.7%, and the
exclusively formula-fed infants lost 1.2% + 1.0% (P < .001).
The mean time to nadir was 2.5 days after birth and ranged
from 0 to 7 days. Feeding category, gestational age, and
insurance were the greatest predictors of percentage weight
In 2012, Preer and colleagues25 published a study of
200 infants also delivered at Boston Medical Center. The
objective of that study was to determine average weight
loss among exclusively breastfed infants delivered by CS
and to identify correlates of greater than expected weight
loss. Delivery by CS leads to longer length of stays and a
longer time frame to monitor weight loss. In this study, the
hospital staff was therefore able to collect daily weights
for 3 to 4 days. Researchers found that the mean weight
loss for full-term, exclusively breastfed infants delivered
Table 1. Neonatal Weight Loss Studies.
Study Sample No. Weights Results Limitations
Flaherman et al27
108 907 exclusively
breastfed, healthy infants
born via vaginal and
cesarean delivery, 36
weeks gestation
Daily weights × 1-4 days
until hospital discharge
Vaginal delivery: median
weight loss 4.2%, 7.1%,
and 6.4% at 24, 48, and
72 hours, respectively.
Cesarean delivery: 4.9%,
8.0%, 8.6%, and 5.8% at
24, 48, 72, and 96 hours,
72% of the sample had only 1
weight recorded in addition
to birth weight. Infants who
received formula due to
excessive weight loss were
Bertini et al20
1760 healthy, term
singletons born via vaginal
Weighed every 12 hours
until discharge 2-4 days
5.95% ± 1.73% mean weight
loss; time to nadir: 43.72 ±
11.6 hours
65% of sample had the
weight collected for less
than 48 hours. Type of
infant feeding was not
Fonseca et al13
1288 healthy, term
singletons born via vaginal
and cesarean delivery
One weight collected in
addition to birth weight
6.7% ± 2.3% mean weight
61% of sample had the weight
collected for less than 48
Grossman et al24
121 healthy, term singletons
born via vaginal and
cesarean delivery
Daily weights by research
assistant × 1 week
Exclusive breastfeeding
(n = 32) 5.5% ± 2.0%
mean weight loss; mainly
breastfed (n = 66) 5.5% ±
2.1% mean weight loss
74% of infants were fed
formula in varying amounts.
Preer et al25
200 exclusively breastfed,
healthy, term singletons,
born via cesarean only
Daily weights × 3-4 days
until discharge
7.2% ± 2.1% mean weight
Infants who received formula
due to weight loss were
excluded from the study.
Flaherman et al23
1049 term, healthy infants
born via vaginal and
cesarean delivery
Daily weights × 1-4 days
until hospital discharge
6.1% ± 2.1% mean weight
loss; time to nadir: 38.7 ±
18.5 hours
Combined exclusive
breastfeeding and mixed
feeding infants
Mulder et al18
53 stable infants born via
vaginal and cesarean
delivery, 35-42 weeks
Weights × 2 days 3.79% ± 1.25% mean weight
Formula supplementation
not recorded; included late
preterm infants
Crossland et al6
253 healthy, term singletons
born via vaginal and
cesarean delivery
Daily weights × 2 weeks or
longer until a return to
birth weight was achieved
Exclusive breastfeeding 6.4%
(5.5%-7.3%) mean weight
Breastfed infants who
switched to formula were
not included.
Davanzo et al14
1003 healthy, term
singletons born via vaginal
and cesarean delivery
Daily weights × 2-4 days
until hospital discharge
Breastfed group: 6.3% ±
2.0% mean weight loss
If neonatal weight loss was
8%, infants were often given
supplemental feedings.
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4 Journal of Human Lactation
by CS was 7.2% ± 2.1%. A total of 75% of the infants
reached their nadir of weight loss prior to discharge (day
3 or 4). In addition, absence of labor prior to CS
(P = .0004), lower gestational age (P = .0004), and higher
birth weight (P < .0001) were all associated with greater
than expected weight loss.25
A retrospective chart review was completed by Davanzo
and colleagues.14 Researchers studied 1003 full-term infants
who had been admitted to the regular newborn nursery of the
Institute of Maternal and Child Health in Trieste, Italy. This
is a level III maternity hospital where rooming-in is prac-
ticed. The objective was to assess the extent of neonatal
weight loss and its association with selected clinical vari-
ables. Infants were weighed daily until discharge on days 2
to 4; infants born via vaginal and CS were included. A mean
percentage weight loss of 6.3% ± 2.0% for the breastfed
group and 7.5% ± 2.4% for the formula-fed group was
reported. For all infants, the weight loss during hospitaliza-
tion ranged from 0% to 13.2%. Any formula feeding, CS, hot
season, and jaundice were independently associated with
neonatal weight loss 8%.14
Fonseca and colleagues13 also examined the determinants
of weight changes for infants during the first 96 hours of life.
They prospectively sampled 1288 full-term infants born in 5
different metropolitan hospitals in Porto, Portugal. Infants
were weighed twice—once at birth and then again before
discharge—to determine total weight loss. For 61% of the
total sample (n = 1288), this second weight was collected at
or prior to 48 hours of life. Exclusively breastfed infants
made up the breastfed category (n = 291, 52.2%); all other
infants were part of the formula/mixed-feeding group. The
mean weight loss for all infants was 6.7% SD ± 2.32; weight
loss ranged between 0% and 18.2%. Excessive weight loss
(defined as 9.4%) was positively associated with maternal
age > 40 years, maternal education, cesarean delivery, and
phototherapy-treated jaundice.13
In 2014, Bertini and colleagues20 published a retrospec-
tive chart review of data from 1760 infants. All healthy, full-
term, singleton infants born via vaginal delivery at the
Margherita Birth Center at the University Hospital in
Florence, Italy, were enrolled. The infant feeding policies
and procedures at this hospital complied with the WHO’s Ten
Steps to Successful Breastfeeding.26 The objective of the
study was to construct a percentile chart of neonatal weight
loss. Weight was recorded at birth and every 12 hours until
discharge, which usually occurred between 48 and 72 hours
of life. Results showed a mean weight loss of 5.95% ± 1.73%
(range, 0.0%-9.9%). No infants in this study lost > 10% of
their birth weight. The mean time to nadir was 43.72 ± 11.6
hours after birth and ranged from 12 to 72 hours.20
Most recently, Flaherman et al27 introduced early weight
loss nomograms for exclusively breastfed newborns based
on delivery mode. The researchers retrospectively extracted
recorded weights from the charts of 108 907 singleton infants
born 36 weeks gestation at Northern Kaiser Permanente
hospitals. The authors found that differences in weight loss
by delivery method became evident 6 hours after delivery
and persisted over time. For infants delivered vaginally, the
median weight loss was 4.2%, 7.1%, and 6.4% at 24, 48, and
72 hours of age, respectively. For infants born via CS, the
median percentage weight loss was 4.9%, 8.0%, 8.6%, and
5.8% at 24, 48, 72, and 96 hours after delivery, respectively.
Hour-by-hour nomograms were created to assist in early
identification of infants who might be on a trajectory for
excessive weight loss and associated adverse outcomes.27
Five of the primary studies presented in this review were
conducted in the United States and 4 were completed in
Europe. Two of the US studies took place in a Massachusetts
hospital that had been designated as Baby-Friendly.24,25 The
Baby-Friendly Hospital Initiative is a global program sup-
ported by the WHO and the United Nations Children’s Fund
that recognizes hospitals and birth centers that give optimal
breastfeeding support. Many Baby-Friendly policies and
practices affect the likelihood that a breastfed infant will not
receive formula in the first 2 days of life.28 Among the
European studies, 3 of the authors described routine prac-
tices such as rooming-in and skin-to-skin care, which are
also known to improve breastfeeding outcomes.6,14,20
The sample sizes in the 9 studies in this review ranged
from 53 to 108 907 participants. The mean infant weight loss
ranged from a low18 of 3.79% ± 1.25% to a high25 of 7.2% ±
2.1%. When reported in hours, time to nadir ranged from a
low23 of 38.7 ± 18.5 hours to a high20 of 43.72 ± 11.6 hours.
Other researchers reported that the time to reach nadir was
longer, taking on average 3 to 4 days.6,25 Overall, as com-
pared to the findings in the review by Noel-Weiss et al, there
is a slightly greater amount of reported weight loss and a
slightly longer time to nadir. Close examination of these 9
studies, however, reveals several reasons that there is still
insufficient evidence to determine normal physiological
weight loss and time to nadir for breastfed infants.
In 2008, Noel-Weiss and colleagues7 reported consistent
problems with methodology in the breastfeeding studies
included in their review; specifically, there were major gaps
in data collection. In most of the studies, infant weights were
not measured daily after discharge. Lack of measurements
made determining the lowest weight and normal patterns of
weight loss impossible. Another limitation was a lack of clar-
ity among feeding groups. Most of the studies in the 2008
review did not identify when infants received supplemental
formula feedings. This is an important consideration as new-
born infants who consume formula lose less weight com-
pared to infants who are breastfed.
It is unfortunate that these same problems continue to be
present in the current literature. Specifically, the gap in daily
weight collections is a major limitation. In several of the
studies, researchers reported that weights were measured for
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Thulier 5
2 to 4 days after birth. Yet, the majority of infants in all of
these studies had hospital weights collected for only 2 days
or less.13,14,20,25,27 Most of the infants were vaginally deliv-
ered and so were discharged from the hospital by the first or
second day of life. In the largest study, published by
Flaherman et al,27 a total of 83 433 (76.6%) infants were
born vaginally and 25 474 (23.4%) were delivered by CS. In
this study, 72% of the vaginally delivered infants had only 1
weight recorded in addition to their birth weight. In addition,
75% of the infants delivered by CS had 2 weights recorded
prior to discharge.27 It is interesting that in the work by
Mulder et al,18 weights on all infants were collected for only
2 days no matter the type of delivery. It is not surprising that
this study generated the lowest mean percentage of weight
loss (3.79% + 1.25%).18 The majority of infants in that study
had probably not reached their nadir of weight loss before
data collection ceased.
Lack of measurements also affects the reported time to
nadir. The only way to accurately determine time to nadir is
to weigh infants daily until they begin to gain weight.
Crossland et al6 demonstrated this very strategy and weighed
infants daily for a minimum of 14 days after birth. These
authors found that most infants reached the nadir of weight
on day 3, later than was reported by Bertini et al20 and
Flaherman et al.27 If weights are not recorded daily until the
time when infants begin to gain, researchers are left making
best guesses as to when the maximum amount of weight loss
has occurred.
Problems with the clear identification of infant feeding
groups also continue to be prevalent in the literature. Mulder
et al18 included women who were “attempting” to breastfeed
their infants. They did not indicate if breastfeeding was suc-
cessful or if formula was given. Similarly, in the large study
(n = 1760) done by Bertini et al,20 researchers described how
the infant feeding policies and procedures at the hospital
complied with the WHO’s Ten Steps to Successful
Breastfeeding.26 They suggested that all infants in this study
were exclusively breastfed, but they did not collect data
regarding feeding type. It is unfortunate that birth in an envi-
ronment supportive of breastfeeding is not an assurance that
the infants born there are actually breastfed. It is very likely
that many infants in both of these studies consumed formula
in varying amounts.
Other researchers recorded infant feeding type but com-
bined feeding groups for data analysis. Flaherman et al23
sampled 1050 infants; 853 (86%) were exclusively breast-
feeding, 144 (14%) were given mixed feedings, and 53 (5%)
were given formula. For data analysis, they collapsed the
exclusive and mixed-feeding infants, which resulted in a
mean weight loss of 6.1% ± 2.1%. It is possible that the
inclusion of infants who consumed supplemental formula
decreased the total amount of weight loss. The study by
Davanzo et al14 used a similar approach. The authors used
the WHO breastfeeding definitions29 but combined exclusive
and predominant breastfeeding infants into 1 category. They
also combined complementary breastfed infants together
with formula-fed infants. It is interesting that this was the
only study that has ever reported a greater percentage of
mean weight loss among formula-fed versus breastfed infants
(7.5% ± 2.4% vs 6.3% ± 2.0%, P .001).14 The combination
of complementary (mixed) breastfed infants together with
infants who were formula fed may have affected the results.
Some of the complementary breastfed infants were likely
given formula due to excessive weight loss, which may have
increased the total weight loss for that group.
Lack of clarity among infant feeding groups is a challeng-
ing problem, particularly for studies focused on infant
weight. At first glance, the solution may appear simple;
researchers must carefully control their sample and include
adequate numbers of exclusively breastfed infants. This
seemingly simple solution, however, presents a complex set
of challenges. If breastfed infants lose too much weight, they
are often given formula supplementation. Yet, to determine
patterns of weight loss among the exclusively breastfed,
infants fed formula must be excluded from the sample group.
After excluding supplemented infants, the end result may be
a sample that is biased as it contains only those infants who
did not lose much weight. This exact scenario was demon-
strated in several of the studies.14,25,27
Preer et al25 described how breastfeeding infants with
excessive weight loss were given formula supplementation
and excluded from their study. As described by the authors,
this resulted in a sample that was not representative of the
true population of breastfed infants.25 Similarly, Davanzo
et al14 noted that when neonatal weight loss was 8%, sup-
plemental feedings were often given. In the largest study,
Flaherman et al27 also described how 16 871 breastfed infants
(15.4%) received formula supplementation and were
removed from the study. In this study, formula was frequently
given to treat excessive weight loss. As a result, the amount
of weight loss in the exclusively breastfed population may
have been underestimated. Flaherman et al27 coped with this
limitation by implementing a sensitivity analysis that
matched censored to uncensored infants. The nomograms
were recreated based on this matching strategy and the
results indicated that removing these infants from the sample
group did not create a substantial source of bias. No other
published studies have used this matching strategy. In the
end, it may not be possible to create large sample groups in
which all infants are exclusively breastfed. Therefore,
researchers must do the next best thing. Sample groups must
be created that more accurately report what infants are
In 2008, Noel-Weiss et al7 determined that the normal and
expected amounts of infant weight loss after birth could not be
accurately determined. In most of the 11 studies in their
review, infant weights were not measured daily after discharge
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6 Journal of Human Lactation
and infants were not clearly categorized into feeding groups.
At the time, these 2 methodological flaws in the research made
it impossible to determine a mean for normal physiological
weight loss in term breastfed infants.
The systematic review presented by this author was com-
pleted to determine if, since 2008, more scientific evidence
has become available. Specifically, this author sought to
determine the mean amount of weight loss for healthy, full-
term, exclusively breastfed infants after birth. In addition, a
second objective of this review was to determine when
infants reach their nadir of lost birth weight. It is unfortunate
that the current literature still does not provide enough evi-
dence to accurately answer these questions.
The same methodological flaws reported in 2008 con-
tinue to be found in the current literature. A limited number
of infant weights have been collected, feeding methods have
not always been well documented, and infant feeding groups
have been combined for data analysis. In addition, breastfed
infants who lost the most amount of weight have been
excluded from sample groups. As a result of these method-
ological flaws, an accurate mean percentage of infant weight
loss and the time to nadir remain elusive. In fact, given that
infants who received formula have been included whereas
infants who lost the most have at times been excluded from
sample groups, it is likely that the mean amount of infant
weight loss for breastfeeding infants is higher than has ever
been reported.
Professional guidance and care in the early weeks of life
can enhance breastfeeding duration.30 Alternatively, inaccu-
rate information and ill-founded advice can easily derail
breastfeeding efforts. Clinicians require accurate data to
make sound decisions. Well-designed clinical studies are
needed to determine the normal and expected patterns of
weight loss for the breastfed infant. It is only when clinicians
have this information that they can provide the best guidance
and care to promote, protect, and support breastfeeding
Many thanks to Dr Debra Erickson-Owens, PhD, CNM, RN, for her
unwavering support of this work.
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
The author received no financial support for the research, author-
ship, and/or publication of this article.
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... Previous studies on early life weight changes 13,14 reported a wide range of weight loss, with nadirs ranging from 3.8 to 8.6% occurring from the second to fourth day postpartum. 14 A recent review pointed out that some newborns may lose ≥10%. ...
... 10,17,27 Ethnic diversity may also partially explain the differences, as previous studies were conducted outside Africa. 3,13,14 The type of feeding is pivotal for weight trajectories but is not always documented systematically. 3 Formula-fed newborns tend to lose less weight than breastfed newborns. ...
... did not include full reports on feeding type but included a large proportion of formula-fed newborns. 3,10,13,14,28 However, we observed a nadir as early as day 2, despite our study population being exclusively breastfed. One possible explanation is that our study used a robust methodology, thereby minimizing potential bias compared with previous studies. ...
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Introduction: Identification of low birthweight and small for gestational age is pivotal in clinical management and many research studies, but in low-income countries, birthweight is often unavailable within 24 h of birth. Newborn weights measured within days after birth and knowledge of the growth patterns in the first week of life can help estimate the weight at birth retrospectively. This study aimed to generate sex-specific prediction maps and weight reference charts for the retrospective estimation of birthweight for exclusively breastfed newborns in a low-resource setting. Material and methods: This was a prospective cohort study nested in a clinical trial of intermittent preventive treatment in pregnancy for malaria with either dihydroartemisinin-piperaquine with/without azithromycin or sulfadoxine-pyrimethamine in Korogwe District, north-eastern Tanzania ( NCT03208179). Newborns were weighed at birth or in the immediate hours after birth and then daily for 1 week. Reference charts, nadir, time to regain weight, and prediction maps were generated using nonlinear mixed-effects models fitted to the longitudinal data, incorporating interindividual variation as random effects. Predictions and prediction standard deviations were computed using a linear approximation approach. Results: Between March and December 2019, 513 live newborns with birthweights measured within 24 h of delivery were weighed daily for 1 week. Complete datasets were available from 476 exclusively breastfed newborns. There was a rapid decline in weight shortly after delivery. The average weight loss, time of nadir, and time to regain weight were 4.3% (95% confidence interval [CI] 3.8-4.9) at 27 h (95% CI 24-30) and 105 h (95% CI 91-120) in boys and 4.9% (95% CI 4.2-5.6) at 28 h (95% CI 23-33) and 114 h (95% CI 93-136) in girls, respectively. The data were used to generate prediction maps with 1-h time intervals and 0.05 kg weight increments showing the predicted birthweights and weight-for-age and weight-change-for-age reference charts depicting variation in weight loss from <1 to >10%. Conclusions: The prediction maps and reference charts can be used by researchers in low-resource settings to retrospectively estimate birthweights using weights collected up to 168 h after delivery, thereby maximizing data utilization. Clinical practitioners can also use the prediction maps to retrospectively classify newborns as low birthweight or small for gestational age.
... It is important the evaluation of body weight during the first 24 hrs that should be lower than 5%. [2] The newborns start the rooming in the delivery room to promote exclusively breastfeeding. [3] Furthermore, if a newborn loses more than 10% of body weight or more than 5% of body weight in a day, a dehydration state might occur. ...
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Background : Body weight loss is physiological when is lower than 8-10% in the first days of life. Low birth body weight is correlated to up regulation of hypothalamus-pituitary-adrenal axis function. The aim was to test the hypothesis that weight loss from 24 to 48 hours of life is associated with high levels of salivary cortisol in healthy term newborns. Methods : a prospective clinical study was performed enrolling healthy term newborns who started the rooming-in in the delivery room to improve skin to skin and breastfeeding. Salivary cortisol levels were measured at 24 and 48 hours of life, using Salimetrics Salivary Cortisol Enzyme Immunoassay Kit. Weight loss/gain was recorded every 24 hours starting from birth. Results : A significant positive correlation was found between salivary cortisol levels and body weight loss at 48 hours of life (n= 57, r=0,393; p=0,006). At 48 hours of life, salivary cortisol levels were significantly higher in newborns that lost body weight 1,7 times more than body weight loss at 24 hours of life compared to newborns who maintained a more stable body weight between 24 and 48 hours of life Conclusions : The swift body weight loss from 24 to 48 hours of life increases salivary cortisol levels in term newborns. Data suggest the need to protect exclusive breast fed newborns with human milk donor in term newborns, in case of temporary breast milk lack, to reduce cortisol exposure early in life.
... Currently, conclusions in the literature are contradictory: each depends on the influence and relationship of several extrinsic and intrinsic factors, both in the mother and the newborn, that directly affect the percentage of weight loss expected individually 9 . For example, the Academy of Breastfeeding Medicine (ABM) considers excessive weight loss to be > 10% 10 , while the American Academy of Pediatrics refers to extreme weight loss as > 7% 11 . ...
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As health professionals, we have memorized that “newborns can lose up to 10% of their birth weight during the first week of life and should regain it by two weeks of age”. However, this statement, which appears so accurate, comes from studies conducted in the 1960s, when medical knowledge and how newborns were fed were utterly different from what it is today. Currently, multiple factors contribute to the percentage of weight loss at birth and the rate at which this weight is regained. There are nomograms for exclusively breastfed and formula-fed newborns and those by vaginal or cesarean delivery. To meet the World Health Organization’s goal of exclusively breastfeeding newborns, it is essential to recognize that “loss of more than 10% of birth weight” does not represent the need for formula supplementation. When assessing these cases, we must consider several factors that influence the percentage of weight loss in newborns. Therefore, diagnostic decisions should always be individualized in favor of breastfeeding.
... Normal weight loss in term infants is suggested to be about 4% to 7% and the nadir is seen 48 to 72 hours after birth. (20) (21) The degree of contraction is inversely proportional to the gestational age. (22) Preterm infants can experience nearly double the weight loss during the first week after birth. ...
Understanding physiologic water balance and homeostasis mechanisms in the neonate is critical for clinicians in the NICU as pathologic fluid accumulation increases the risk for morbidity and mortality. In addition, once this process occurs, treatment is limited. In this review, we will cover fluid homeostasis in the neonate, explain the implications of prematurity on this process, discuss the complexity of fluid accumulation and the development of fluid overload, identify mitigation strategies, and review treatment options.
Background: A nurse led a team of providers in a quality improvement (QI) project to positively impact inpatient care and outcomes for infants with neonatal abstinence syndrome (NAS). The Eat Sleep Console (ESC) model was implemented to promote rooming-in and family-centered care as part of a nonpharmacological treatment approach. Purpose: To compare the ESC model with the traditional Finnegan treatment approach to describe differences in infants' pharmacotherapy use (morphine), length of stay (LOS), weight loss, consumption of mother's own milk by any feeding method within 24 hours of discharge, Neonatal Intensive Care Unit (NICU) use, and Pediatric Unit utilization. Methods: The QI project was conducted at a single hospital site with more than 1700 deliveries per year in the Midwestern United States. A comparative effectiveness study design was used to evaluate the ESC model. Results: The ESC model impacted care and outcomes for infants with NAS, contributing to a significant reduction in morphine treatment, decrease in LOS among morphine-treated infants, increase in weight loss in infants who did not require morphine treatment, less NICU use, and greater Pediatric Unit utilization. A nonsignificant increase was found in the number of infants who consumed their mother's own milk by any feeding method in the 24-hour period prior to discharge. Implications for practice and research: Results may be helpful for hospitals striving to optimize care for infants exposed to opioids, using assessments of eating, sleeping, and consoling to guide individualized treatment decisions and to reduce morphine use.
Recent literature has demonstrated that pregnancy and early childhood represent a critical time window for human development and future health. In this scenario, maternal and infant nutrition are part of an intergenerational cycle which can affect an infant’s growth and body composition. Epigenetics play a crucial role in explaining how growth trajectories can influence later health outcomes, such as the risk of developing non-communicable diseases. This chapter focuses on early nutritional determinants and their effects on infants’ growth and body composition, taking into account the specific characteristics of both term and preterm infants. The influence of maternal nutritional status and lifestyle on infants’ growth and future health is also described. Although much progress has been made in this field, future research is needed in order to focus on the specific mechanisms underlying the association between early nutrition and later disease risk. These new findings will enable targeted public health interventions.
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Introduction Cancer patients often suffer from both chronic and acute pain related to their disease [1-3], which may be caused by the disease itself or be the side effect of oncological treatment [4]. Therefore, pain management is an essential part of modern anti-cancer treatment [3]. The level of pain control has an impact on patients’ quality of life [3, 4] and their attitude towards further treatment, such as chemotherapy or radiotherapy [3]. Aim The aim of the study was to assess the quality of pain therapy received by cancer patients, to investigate their satisfaction with pain management and to determine factors affecting their perception of pain related to cancer. Methods An original questionnaire was distributed among 194 patients (63,7±10,8 years, 54% females) treated in two oncological departments of Medical University of Silesia, Katowice, Poland. The questionnaire was anonymous, designed in paper format, and was approved by the chairs of both oncological departments. Each of the patients of the departments at the time of the study was kindly invited to fill out the form. Patients willing to participate returned it to the research team member after finishing the survey. The questionnaire contained a statement on the lack of questions requiring confidential data and both open and closed questions regarding patients' medical history, their perception of pain and its severity in the Numerical Rating Scale (NRS) as well as demographic questions. Statistical analysis was performed using Statistica 13.3 software. Results 39.9% of patients confirmed the feeling of cancer-related pain, without any statistically significant differences in the incidence or severity of pain for gender or tumor location. Most frequently (51.4%), the pain was mild (NRS scores 0-3), but patients reported also moderate (NRS 4-6; 27%) and severe pain (NRS 7-10; 21,6%). Among patients declaring the presence of pain, 81.4% received pain therapy, mostly (95.6%) pharmacotherapy, usually prescribed by oncologist (69.1%), less often by family doctor (14.7%) and palliative care specialist (10.3%). The majority (73.9%) of treated patients agreed that they received optimal care. However, in group of patients receiving pain therapy, 63% declared that they wished to make changes in current pain treatment. 67.9% of patients linked their pain sensation to mood deterioration, more frequently in patients describing their pain as severe (p=0.0001), and moderate and severe pain impaired their daily living more often (p=0.0001). Gender did not affect the perception of pain or mood lowering (p>0.05). Conclusions In our pilot study, patients received therapy for acute and chronic pain, which they declared to be optimal. However, the results suggest that some patients remained undertreated. The perception of cancer-related pain cancer patients may be related to their mood deterioration. References 1. Dalal S, Bruera E. Pain Management for Patients With Advanced Cancer in the Opioid Epidemic Era. American Society of Clinical Oncology Educational Book. 2019;(39):24-35. 2. Brant J, Eaton L, Irwin M. Cancer-Related Pain: Assessment and Management With Putting Evidence Into Practice Interventions. Clinical Journal of Oncology Nursing. 2017;21(3):4-7. 3. Neufeld N, Elnahal S, Alvarez R. Cancer pain: a review of epidemiology, clinical quality and value impact. Future Oncology. 2017;13(9):833-841. 4. Yoon S, Oh J. Neuropathic cancer pain: prevalence, pathophysiology, and management. The Korean Journal of Internal Medicine. 2018;33(6):1058-1069.
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Introduction: COVID-19 is a disease caused by the SARS-CoV-2 coronavirus, whose dangerous feature is its high transmission rate combined with a higher risk of death. Patients hospitalized with COVID-19 had a mortality risk that was nearly 3.5 times higher than those hospitalized with influenza. In a significant proportion of COVID-19 patients requiring hospitalization, diabetes was a primary risk factor. Aim: The aim of the study is to show that the presence of diabetes in COVID-19 patients is a risk factor for increased mortality among these people. Methods: The analyzed data is based on a systematic review from 2020-2021 on PubMed platform. The following key words were used: type 2 diabetes, COVID-19, SARS-CoV-2, mortality risk. The articles most relevant to the topic of the work were selected. The overall number of reviewed articles was 9. Results: The results of a study in China that was published in BMJ Open Diabetes Res Care showed that patients with severe COVID-19 and diabetes mellitus were significantly more likely to require intensive care unit (ICU) treatment with mechanical ventilation compared to those without diabetes. In Italy the Istituto Superiore di Sanità published a report according to which diabetes was the second most common comorbidity after hypertension in those who died from COVID-19. In 2021, The American Journal of Medicine published the results of a retrospective cohort study that was conducted in Wuhan on a group of 584 COVID-19 patients, in which 84 patients had diabetes comorbidity. It was noted that there were more critically ill patients in the diabetic group, suggesting that this group was more likely to progress to severe disease following SARS-CoV-2 infection. Compared with patients without diabetes, patients with diabetes had higher levels of neutrophils, troponin I, CRP, procalcitonin and D-dimers. The results also showed that people with diabetes were more likely to receive intravenous immunoglobulin and mechanical ventilation. This group also had a higher rate of complications such as respiratory failure and acute heart injury. Looking at the research results, the question arises - how does diabetes contribute to the deterioration of COVID-19. Study published in Cell Metabolism shows that in human monocytes, elevated glucose levels increase SARS-CoV-2 replication, and glycolysis sustains virus replication due to the production of mitochondrial reactive oxygen species. High stress on 69 inflammatory cells can also affect the function of skeletal muscles and the liver, the organs responsible for most of the insulin-mediated glucose uptake. Conclusions: Study results show that diabetes is one of the predictors of more severe course of COVID-19. The course of the disease in this group of patients is characterized by higher values of inflammatory markers and more advanced treatment. In conclusion, patients with COVID-19 and coexisting diabetes require special attention because more often than in non-diabetic patients, severe complications can be observed.
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Introduction: Diabetic foot syndrome (DFS) is one of the chronic complications of diabetes mellitus, causing significant morbidity and mortality. Damage to the vascular and nervous systems of the foot affects the blood supply to tissues and metabolic processes, and thus increases their susceptibility to infections and gangrene development. It is estimated that the annual incidence of diabetic foot ulcers (DFU) or necrosis in patients with diabetes is 2-5%. The lifetime risk of developing the condition is 25%. In addition to conventional basic therapy, there are adjuvant therapy methods such as hyperbaric oxygen therapy (HBOT)Aim: The aim of the study is to present the current state of knowledge on the use of hyperbaric oxygen therapy in the treatment of diabetic foot syndrome. Methods: The analyzed data is based on a systematic review from 2011-2021 on the PubMed platform with the following key words combination: (hyperbaric oxygen therapy) AND (diabetic foot). The search criteria were: clinical trial and randomized controlled trial publications. The most appropriate articles regarding the topic of this work have been chosen. The overall number of reviewed articles was 8. Results: Analysed studies assessed the efficacy of adjuvant, systemic HBOT in healing of diabetic foot ulcers and also in the risk of amputation of the affected limb. Wound size reduction in the HBOT groups was greater than in the control groups and in each study varied from 30% to 42.4% versus 18,1% ± 6.5% in the control. The amputation rate was 5% for the HBOT group and 11% for the routine care group. However, Fedorko’s study did not demonstrate an advantage of HBOT combined with wound care compared with wound care alone in reducing indications for amputations. Another randomized controlled trial showed that HBOT, supplemented with either lipoic acid or its R+ enantiomer had a better healing effect than HBOT alone in the treatment of chronic leg wound. Additionally, Irawan’s team study proved that patients with DFU Wagner 3-4 may benefit from this therapy by decreasing HbA1c levels and leukocyte count. Another study showed no significant relationship between HBOT and improved health-related quality of life. However, in the same study HBOT was related to fewer participants reporting mobility problems, pain or discomfort. Conclusions: Diabetic foot syndrome is a major health concern for the growing population of diabetic patients worldwide. The use of HBOT as a form of adjuvant treatment in the combined therapy of the DFU appears as safe and effective method in wound healing. Additionally, this therapy also reduces the risk of amputation of the affected limb and improves the hematological and biochemical conditions by reducing glycemic and inflammatory levels. HBOT plays an important role in the enhancement of wound healing for diabetic foot ulcers.
Background Maternal worry about infant weight has inconsistently been reported as a breastfeeding barrier. Weight monitoring is a critical tool to assess adequacy of infant feeding. Yet, little is known about the intensity of maternal worry about infant weight or associated breastfeeding outcomes. Research aims To examine (1) the frequency and intensity of maternal worry about infant weight; (2) the relationship between worry about weight and use of artificial milk; and 3) the relationship between worry about weight and breastfeeding cessation. Methods A prospective cross-sectional design was used. A questionnaire was completed by women in the United States ( N = 287) from 12 web-based maternal support groups. Results Sixty-three percent of women ( n = 182) had some worry about infant weight. Participants breastfeeding for the first time had more worry ( p = .035). Participants still breastfeeding had less worry about weight compared to those who had stopped (67%, n = 147 vs. 41%, n = 28). Exclusive breastfeeding participants had less worry ( p < .001) compared to those who supplemented with artificial milk. Increased worry was associated with the use of artificial milk within 1 week of birth ( p < .001) and early breastfeeding cessation ( p < .001). Conclusions Worry about weight is a significant breastfeeding barrier. It is associated with first time breastfeeding, less exclusive breastfeeding, use of artificial milk, and earlier breastfeeding cessation. Lactating mothers need anticipatory guidance about expected neonatal weight changes and interventions to help relieve worry about infant weight.
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The majority of newborns are exclusively breastfed during the birth hospitalization, and weight loss is nearly universal for these neonates. The amount of weight lost varies substantially among newborns with higher amounts of weight loss increasing risk for morbidity. No hour-by-hour newborn weight loss nomogram exists to assist in early identification of those on a trajectory for adverse outcomes. For 161 471 term, singleton neonates born at ≥36 weeks' gestation at Northern California Kaiser Permanente hospitals in 2009-2013, data were extracted from the birth hospitalization regarding delivery mode, race/ethnicity, feeding type, and weights from electronic records. Quantile regression was used to create nomograms stratified by delivery mode that estimated percentiles of weight loss as a function of time among exclusively breastfed neonates. Weights measured subsequent to any nonbreastmilk feeding were excluded. Among this sample, 108 907 newborns had weights recorded while exclusively breastfeeding with 83 433 delivered vaginally and 25 474 delivered by cesarean. Differential weight loss by delivery mode was evident 6 hours after delivery and persisted over time. Almost 5% of vaginally delivered newborns and >10% of those delivered by cesarean had lost ≥10% of their birth weight 48 hours after delivery. By 72 hours, >25% of newborns delivered by cesarean had lost ≥10% of their birth weight. These newborn weight loss nomograms demonstrate percentiles for weight loss by delivery mode for those who are exclusively breastfed. The nomograms can be used for early identification of neonates on a trajectory for greater weight loss and related morbidities. Copyright © 2015 by the American Academy of Pediatrics.
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AimHealthy, full-term, exclusively breastfed infants are expected to lose weight in the first days after birth, but experts disagree about what constitutes a physiological neonatal weight loss and there is a lack of evidence-based data. Our study aimed to construct a centile chart of neonatal weight loss in a healthy population of exclusively breastfed term neonates.Methods We prospectively studied all infants born at an Italian centre that focused on natural childbirth from April 2007 to December 2012 and who complied with World Health Organization guidance on infant feeding. The infants’ weight loss was recorded after 12, 24, 36, 48, 60 and 72 hours of life.ResultsWe included 1,760 healthy, full-term, singleton babies born by vaginal delivery. Their mean weight loss was 5.95±1.73 grams, 72.2% had maximal weight loss before discharge, only 3.9% lost more than 9% of their birth weight and no infant lost more than 10%. We measured the percentage weight change from birth and each time the infant was examined, summarising how their weight varied in the first 72 hours of life.Conclusion Our normative chart of physiological weight loss provided an important instrument for identifying high-risk infants who required breastfeeding support.This article is protected by copyright. All rights reserved.
Inadequate nutrition and acute lower respiratory infection (ALRI) are overlapping and interrelated health problems affecting children in developing countries. Based on a critical review of randomized trials of the effect of nutritional interventions on ALRI morbidity and mortality, we concluded that: (1) zinc supplementation in zinc-deficient populations prevents about one-quarter of episodes of ALRI, which may translate into a modest reduction in ALRI mortality; (2) breastfeeding promotion reduces ALRI morbidity; (3) iron supplementation alone does not reduce ALRI incidence; and (4) vitamin A supplementation beyond the neonatal period does not reduce ALRI incidence or mortality. There was insufficient evidence regarding other potentially beneficial nutritional interventions. For strategies with a strong theoretical rationale and probable operational feasibility, rigorous trials with active clinical case-finding and adequate sample sizes should be undertaken. At present, a reduction in the burden of ALRI can be expected from the continued promotion of breastfeeding and scale-up of zinc supplementation or fortification strategies in target populations.
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
Breastfeeding and human milk are the normative standards for infant feeding and nutrition. Given the documented short-and long-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice. The American Academy of Pediatrics reaffirms its recommendation of exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant. Medical contraindications to breastfeeding are rare. Infant growth should be monitored with the World Health Organization (WHO) Growth Curve Standards to avoid mislabeling infants as underweight or failing to thrive. Hospital routines to encourage and support the initiation and sustaining of exclusive breastfeeding should be based on the American Academy of Pediatrics-endorsed WHO/UNICEF "Ten Steps to Successful Breastfeeding." National strategies supported by the US Surgeon General's Call to Action, the Centers for Disease Control and Prevention, and The Joint Commission are involved to facilitate breastfeeding practices in US hospitals and communities. Pediatricians play a critical role in their practices and communities as advocates of breastfeeding and thus should be knowledgeable about the health risks of not breastfeeding, the economic benefits to society of breastfeeding, and the techniques for managing and supporting the breastfeeding dyad. The "Business Case for Breastfeeding" details how mothers can maintain lactation in the workplace and the benefits to employers who facilitate this practice. Pediatrics 2012; 129:e827-e841
All infants lose weight after they are born, no matter what or how they are fed. However, there are conflicting opinions about what constitutes a normal newborn weight loss, especially in exclusively-breastfed infants, and about when interventions, such as supplemental feedings, should be considered. This review will: Present evidence for the amount and timing of initial weight loss and timing of birth weight recovery. Explain the normal physiology of the newborn infant in the early days of life. Determine whether intrapartum intravenous (IV) fluids cause excessive weight loss in some newborn infants. Present information which should allow health professionals to make an informed assessment of what is contributing to an individual newborn infant's weight loss.
Most breast-fed newborns get the milk they need. However, very rarely milk intake is insufficient mostly as a result of poor breastfeeding techniques. Dramatic weight loss and hypernatremic dehydration may occur. Our aim was to construct charts for weight loss. A case-control study was performed. Charts with standard deviation score (SDS) lines for weight loss in the first month were constructed for 2,359 healthy breast-fed term newborns and 271 cases with breastfeeding-associated hypernatremic dehydration with serum sodium level > 149 mEq/L. Day 0 was defined as the day of birth. Many cases with (or who will develop) hypernatremic dehydration (84%; +1 SDS line) fell below the -1 SDS line at day 3, the -2 SDS line at day 4, and the -2.5 SDS line at day 5 in the chart of the healthy breast-fed newborns. Weight loss of cases with permanent residual symptoms was far below the -2.5 SDS. Already at an early age, weight loss differs between healthy breast-fed newborns and those with hypernatremic dehydration. Charts for weight loss are, therefore, useful tools to detect early, or prevent newborns from developing, breastfeeding-associated hypernatremic dehydration, and also to prevent unnecessary formula supplementing.
Background Newborn weight loss (NWL) in the first 3 days of life is around 6 percent of birthweight (BW). We aim to describe the determinants of an excessive and insufficient NWL in the first 96 hours of life.MethodsA sample of 1,288 full-term singletons without congenital abnormality belonging to Generation XXI birth cohort was selected. Newborns were recruited in 2005–2006 at all public units providing obstetrical and neonatal care in Porto, Portugal. Information was collected by face-to-face interview and additionally abstracted from clinical records. Anthropometrics were obtained by trained examiners and newborn weight change (NWC) was estimated as (weight–BW)/BW × 100. We categorized NWL as excessive (below 10th percentile of the sample distribution of NWC: ≤−9.4% of BW), normal (between 10th and 90th percentiles: −9.3 to −4.2%) and insufficient (above 90th percentile: ≥ −4.1%). Adjusted odds ratios (OR) and 95 percent confidence intervals (CI) were calculated using multinomial regression models.ResultsExcessive NWL was positively associated with maternal age ≥40 years (OR = 3.32, 95%CI 1.19–9.25), maternal education (OR = 1.04, 95% CI 1.00–1.09), cesarean delivery (OR = 2.42, 95% CI 1.12–5.23), and phototherapy-treated jaundice (OR = 1.69, 95% CI 1.00–2.87). Insufficient NWL was positively associated with low BW (OR = 2.68, 95% CI 1.13–6.33), and formula/mixed feeding (OR = 1.74, 95% CI 1.13–2.66).Conclusion Excessive NWL was positively associated with maternal age and education, cesarean delivery, and phototherapy-treated jaundice. Insufficient NWL reflected child's feeding. As breastfed newborns did not lose weight excessively, but newborns with formula/mixed feeding had insufficient NWL, our study supports that breastfeeding provides excellent nutrition during this period.
To determine the effect of conservative versus usual intrapartum intravenous (IV) fluid management for low-risk women receiving epidural analgesia on weight loss in breastfed newborns. A randomized controlled trial. A tertiary perinatal center in a large urban setting. Women experiencing uncomplicated pregnancies who planned to have epidural analgesia and to breastfeed. Healthy pregnant women were randomized to receive an IV epidural preload volume of <500 mLs continuing at an hourly rate of 75-100 mL/h (conservative care) or an epidural preload volume of ≥500 mLs and an hourly rate >125 mL/h (usual care). The primary study outcome was breastfed newborn weight loss >7% prior to hospital discharge. Secondary study outcomes included breastfeeding exclusivity, referral to outpatient breastfeeding clinic support, and delayed discharge. Other outcomes were admission to the neonatal intensive care unit and cord blood pH <7.25. Two hundred women participated (100 in the conservative care and 100 in the usual care groups). Forty-eight of 100 infants in the usual care group and 44 of the 100 infants in the conservative care group lost >7% of their birth weight prior to discharge, p < 0.52 RR 0.92 [0.68-1.24]. A policy of restricted IV fluids did not affect newborn weight loss. Women and their care providers should be reassured that the volumes of IV fluid <2500 mLs are unlikely to have a clinically meaningful effect on breastfed newborn weight loss >7%. Exploratory analyses suggest that breastfed newborn weight loss increases when intrapartum volumes infused are >2500 mLs. Care providers are encouraged to consider volumes of IV fluid infused intrapartum as a factor that may have contributed to early newborn weight loss in the first 48 h of life.
Few if any studies have examined weight loss among term newborns by weighing infants daily for the first week of life. Perhaps because so few data exist, there is no standard in the United States for normal newborn weight loss. Our objective was to investigate normal newborn weight loss among infants born in a US Baby-Friendly hospital, by weighing infants daily for the first week of life. Using a prospective cohort design, infants born at an urban Boston, MA, hospital were enrolled within 72 hours of delivery and weighed daily for the first week of life. In hospital, infant weight was obtained from the medical record; post discharge, a research assistant visited the home daily and weighed the baby. All feeds in week 1 of life were recorded. Birth-related factors potentially affecting weight loss were abstracted from the medical record. Complete data were collected on 121 infants. Mean weight loss was 4.9% (range=0.0% to 9.9%); 19.8% (24 of 121) of infants lost >7% of their birth weight; no infant lost >10%. Maximum percent weight loss was significantly associated with feeding type: exclusively and mainly breastfed infants lost 5.5%, mainly formula-fed infants lost 2.7% and exclusively formula-fed infants lost 1.2% (P<0.001). Type of delivery and fluids received during labor were not associated with weight loss. Clinical practices at a Baby-Friendly hospital, which support and optimize breastfeeding, appear to be associated with only moderate weight loss in exclusively and mainly breastfed infants.