Excessive Weight Loss in Breastfed Infants During the Postpartum Hospitalization

doi:10.1111/j.1552-6909.2009.01085.x

Journal of Obstetric, Gynecologic & Neonatal Nursing

Volume 39, Issue 1, January–February 2010, Pages 15-26

https://doi.org/10.1111/j.1552-6909.2009.01085.x Get rights and content

ABSTRACT

Objective

To examine differences in breastfeeding frequency, voids, and stools in infants with weight losses < or ≥7% during the postpartum hospitalization.

Design

Secondary analysis of data from a primary psychometric study examining the Mother Infant Breastfeeding Progress Tool (MIBPT).

Setting

A midwestern community hospital in a multicultural racially diverse community.

Participants

Convenience sample of 53 breastfeeding women and infants hospitalized after birth.

Methods

Data were collected during a chart review; infants were divided into < or ≥7% weight loss groups at 2 days postpartum, and breastfeeding frequency, voiding, and stooling were examined between groups and used to predict a ≥7% weight loss at 2 days postpartum.

Results

Of the 53 infants, 20.8% lost ≥7% of their birth weight. Infants who lost ≥7% of their birth weight had significantly more total voids and a higher breastfeeding frequency on the day of birth than infants who lost <7% of their birth weight. A logistic regression analysis resulted in total voids being the only significant predictor of a ≥7% weight loss, with an odds ratio of 1.74 (95% CI=1.09, 2.75, p <; .05).

Conclusion

In the absence of other indicators of ineffective breastfeeding, breastfeeding infants who lose ≥7% of their birth weight during the first 2 days postpartum might be experiencing a physiologic diuresis after birth, unrelated to their breastfeeding behaviors. More research is necessary to determine the cause of a ≥7% weight loss in newborns during the first 48 hours after birth.

Section snippets

Weight Loss in the Breastfed Infant

The expected weight loss in the breastfed infant has been revised over the last several decades. Original estimations suggested that breastfed infants would lose up to 10% of their birth weight in the first 5 days of life, returning to birth weight by 14 days of age (Neifert 1999, Odent 1990, Salariya and Robertson 1993). Some clinicians still use a 10% weight loss threshold to determine if additional assessment or follow-up care for the breastfeeding newborn is warranted (Dewey,

Breastfeeding Frequency

Researchers have supported demand feeding for breastfeeding infants since the early 1980s, citing more frequent breastfeeding, increased passage of meconium, higher breast milk production, and higher weight gains at 2 weeks postpartum in breastfed infants who feed on demand (De Carvalho, et al., 1982, Yamauchi and Yamanouchi 1990, Yamauchi and Yamanouchi 1990). The benefits of demand breastfeeding and of breastfeeding at least 8 times in 24 hours have resulted in breastfeeding guidelines

Voiding and Stooling

Professional organization guidelines for voiding and stooling frequencies primarily focus on minimum frequencies indicative of effective breastfeeding after the 3rd to 5th day postpartum, concurrent with the occurrence of lactogenesis II, which is the dramatic increase in breast milk volume in breastfeeding mothers (American Academy of Pediatrics 2005, International Lactation Consultant Association 2005, Smith and Tully 2001). After lactogenesis stage II occurs, a breastfed infant's number of

Procedure

Data for this pilot study were obtained through a secondary analysis of the data acquired for a previous study investigating the reliability of the Mother Infant Breastfeeding Progress Tool (MIBPT) (Johnson et al., 2007). Potential participants for the original study were identified by the primary investigator after admission to the postpartum unit based on the study selection criteria. The primary investigator or a research assistant then provided eligible mothers with information about the

Results

Fifty-three of the 62 mothers and infants in the original study had a length of stay of greater than 2 days and a weight recorded for postpartum day 2. The demographic statistics for the sample of mothers and infants are presented in Table 2. Infant characteristics for all infants and infant characteristics divided by normal weight loss and excessive weight loss groups are presented in Table 3.

The majority (79.2%) of infants had a normal weight loss of less than 7% of their birth weight. Eleven

Discussion

Most breastfeeding newborns in this pilot study lost less than 7% of their birth weight, with the mean weight loss of 5.69% falling within previously reported mean weight losses for breastfed infants in industrialized countries (see Table 1). In a similar study examining in-hospital weight loss of newborns in Canada, Martens and Romphf (2007) reported that exclusively breastfeeding newborns had an average weight loss of 5.49% during their postpartum stay. However, Martens and Romphf's study

Limitations

As this pilot study used data from a previous study and used a small sample of infants, the type of information available was limited and the conclusions drawn from this study are preliminary and need to be replicated with larger samples. Data collection was primarily through chart review, using measurements undertaken in clinical practice. Therefore, there was no control over the age of infants when they were weighed, as they were all weighed at the same time according to hospital policy. The

Conclusion

Effective breastfeeding requires that the transfer of breast milk meets the infant's nutritional needs (Mulder, 2006). During the first 1 to 3 days postpartum, breastfeeding on demand provides a small, but physiologically adequate amount of fluid and calories (Marchini, Persson et al., 1998). Although weight loss after birth is expected, the controversy continues to exist over where to draw the line between a normal, physiologic weight loss and a pathological weight loss associated with a

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By 2 days after birth, mean weight loss among neonates was 6% to 7% of birth weight, and by Day 3, mean weight loss was usually 7% to 8%. The nadir of lost birth weight occurred on Days 2, 3, or 4 after birth. At times, breastfed newborns lost 10% or more of their birth weight. By 10 to 14 days, most newborns regained their birth weight. Rates of exclusive breastfeeding decreased when newborns lost greater amounts of weight. Compared with past studies, more sample groups in this review included exclusively breastfed newborns and weight assessments beyond birth hospitalization.
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Newborn Nursery Care
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RESEARCHExcessive Weight Loss in Breastfed Infants During the Postpartum Hospitalization

ABSTRACT

Objective

Design

Setting

Participants

Methods

Results

Conclusion

Section snippets

Weight Loss in the Breastfed Infant

Breastfeeding Frequency

Voiding and Stooling

Procedure

Results

Discussion

Limitations

Conclusion

Newborn and Infant Nursing Reviews

Journal of Obstetric, Gynecologic, & Neonatal Nursing

American Journal of Obstetrics and Gynecology

Journal of Pediatrics

Journal of Pediatrics

Journal of Obstetric, Gynecological, & Neonatal Nursing

Clinics in Perinatology

Pediatric Clinics of North America

Journal of Obstetric, Gynecological, & Neonatal Nursing

Midwifery

Journal of Midwifery and Women's Health

Journal of Obstetric, Gynecologic, & Neonatal Nursing

Reversible renal medullary hyperechogenicity in neonatal hypernatremic dehydration

Pediatric Nephrology

Breastfeeding and the use of human milk

Pediatrics

Breastfeeding support: Prenatal care through the first year

Red flags and risk factors for breastfeeding

Clinical Issues in Lactation

Maternal, fetal, and neonatal physiology. A clinical perspective

The relation between cord serum sodium levels in newborn infants and maternal intravenous therapy during labor

British Journal of Obstetrics and Gynaecology

Impact of postpartum hospital-stay legislation on newborn length of stay, readmission, and mortality in California

Pediatrics

Frequency of breast-feeding and serum bilirubin concentration

American Journal of Diseases in Children

Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss

Pediatrics

A comparison of intakes of breast-fed and bottle-fed infants during the first two days of life

Journal of the American College of Nutrition

Rehospitalization for neonatal dehydration

Archives of Pediatrics and Adolescent Medicine

Rehospitalization after birth hospitalization

Archives of Disease in Childhood

In-hospital formula supplementation of healthy breastfeeding newborns

Journal of Human Lactation

Breastfeeding and jaundice

Journal of Perinatology: Official Journal of the California Perinatal Association

Supplementation of breastfeeding infants and weight loss in hospital

Journal of Human Lactation

Readmission of breastfed infants in the first 2 weeks of life

Journal of Perinatology: Official Journal of the California Perinatal Association

Serum bilirubin levels at 72 hours by selected characteristics in breastfed and formula-fed term infants delivered by cesarean section

Acta Paediatrica

Clinical guidelines for the establishment of exclusive breastfeeding

RESEARCH
Excessive Weight Loss in Breastfed Infants During the Postpartum Hospitalization