Weight loss in exclusively breastfed infants differs by delivery type

1. Among a large, racially diverse cohort of newborns, almost 5% of those delivered vaginally had experienced >10% birth-weight loss at 48 hours post-delivery.

2. Newborns delivered by cesearean section had greater weight loss than those delivered vaginally. More than 10% of these newborns experienced ≥10% weight loss at 48 hours post-delivery, while more than 25% experienced ≥10% weight loss at 72 hours.

Evidence Rating Level: 2 (Good) 

Study Rundown: Postnatal weight loss is common among exclusively breastfed infants and is tolerated well by most. However, newborns with excessive postnatal weight loss may have increased morbidity due to complications, such as dehydration and hyperbilirubinemia. This study sought to create an hour-by-hour newborn weight loss nomogram for early identification of newborns at increased risk for morbidity. Approximately 5% of vaginally-delivered newborns were found to have lost ≥10% of their birth weight at 48 hours post-delivery. For cesarean-delivered newborns, >10% at 48 hours and >25% at 72 hours post-delivery had lost ≥10% of their birth weight. This study is limited by retrospective chart review of electronic medical records to determine mode of feeding and by variation between institutions in calibration and measurement of weights. However, these findings allow for a graphical depiction of hour-by-hour weight loss of exclusively breastfed newborns that physicians may utilize to better identify infants at risk for excessive loss.

Click to read the study, published today in Pediatrics

Relevant Reading: First-day weight loss predicts eventual weight nadir for breastfeeding newborns.

In-Depth [retrospective cohort study]: A total of 108 907 neonates born at ≥36 weeks gestation at Kaiser Permanente Northern California hospital sites were included in this study. Among these newborns, 42.8% were white, 24.5% were Hispanic, and 23.7% were Asian. A majority (76.6%) were delivered vaginally, with a mean gestational age of 39.2 weeks. Among vaginally-delivered infants, the median weight loss at 24, 48, and 72 hours post-delivery was 4.2%, 7.1%, and 6.4%, respectively. At 48 hours post-delivery, almost 5% of these newborns had lost ≥10% of their birth weight. Among cesarean-delivered infants, the median weight loss at 24, 48, 72, and 96 hours was 4.9%, 8.0%, 8.6%, and 5.8%, respectively. Of the cesarean delivered newborns, >10% of infants had lost ≥10% of their birth weight at 48 hours and >25% of infants had lost ≥10% of their birth weight at 72 hours.

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Image: PD 

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