Early weight loss nomograms for exclusively breastfed newborns

Valerie J. Flaherman, Eric W. Schaefer, Michael W. Kuzniewicz, Sherian X. Li, Eileen M. Walsh, Ian M. Paul

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

Original languageEnglish (US)
Pages (from-to)e16-e23
JournalPediatrics
Volume135
Issue number1
DOIs
StatePublished - Jan 1 2015

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Nomograms
Weight Loss
Newborn Infant
Birth Weight
Weights and Measures
Hospitalization
Morbidity
Breast Feeding
Parturition

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Cite this

Flaherman, V. J., Schaefer, E. W., Kuzniewicz, M. W., Li, S. X., Walsh, E. M., & Paul, I. M. (2015). Early weight loss nomograms for exclusively breastfed newborns. Pediatrics, 135(1), e16-e23. https://doi.org/10.1542/peds.2014-1532
Flaherman, Valerie J. ; Schaefer, Eric W. ; Kuzniewicz, Michael W. ; Li, Sherian X. ; Walsh, Eileen M. ; Paul, Ian M. / Early weight loss nomograms for exclusively breastfed newborns. In: Pediatrics. 2015 ; Vol. 135, No. 1. pp. e16-e23.
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Flaherman, VJ, Schaefer, EW, Kuzniewicz, MW, Li, SX, Walsh, EM & Paul, IM 2015, 'Early weight loss nomograms for exclusively breastfed newborns', Pediatrics, vol. 135, no. 1, pp. e16-e23. https://doi.org/10.1542/peds.2014-1532

Early weight loss nomograms for exclusively breastfed newborns. / Flaherman, Valerie J.; Schaefer, Eric W.; Kuzniewicz, Michael W.; Li, Sherian X.; Walsh, Eileen M.; Paul, Ian M.

In: Pediatrics, Vol. 135, No. 1, 01.01.2015, p. e16-e23.

Research output: Contribution to journalArticle

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N2 - BACKGROUND: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.

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Flaherman VJ, Schaefer EW, Kuzniewicz MW, Li SX, Walsh EM, Paul IM. Early weight loss nomograms for exclusively breastfed newborns. Pediatrics. 2015 Jan 1;135(1):e16-e23. https://doi.org/10.1542/peds.2014-1532