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Neonatal weight loss in breast and formula-fed infants

Macdonald, P.D. and Ross, S.R.M. and Grant, L. and Young, D. (2003) Neonatal weight loss in breast and formula-fed infants. Archives of Disease in Childhood, 88 (6). pp. 472-476. ISSN 0003-9888

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We have observed an increase in the number of breast fed babies presenting with dehydration and/or failure to thrive because of lactation failure and non-recognition of feeding problems. Recent reports1,2 support this experience and recommend monitoring of the weight of infants through the neonatal period. However, these reports acknowledge uncertainty as to what actually constitutes normal neonatal weight loss. Maisels and colleagues published two studies which have been quoted as giving guidance on normal loss. Both studies were designed primarily to study factors that influence breast milk jaundice. The first3 reported a mean weight loss of about 6% in 100 unselected well babies during the first 3 days. The subsequent study4 reported a mean weight loss of 6.86% in 186 infants. The timescale over which babies were weighed was not clearly indicated, although it may have only been 2-3 days. The sample was neither population based nor randomly selected, being largely preselected because of the presence of more pronounced jaundice. The distribution of data points for early neonatal weight loss are likely to be skewed, yet both studies reported the results as mean (SD). Owing to the design and method of data presentation, these studies cannot reliably inform the debate as to what constitutes the norm. Marchini and colleagues published reports also designed primarily to study other issues. One5 indicated a mean early weight loss of 5.7%. Measurements were recorded over a three day period, and no indication is given of the skewness of the data. Another study6 reported a median weight loss of about 6% recorded over a four day period. At least one baby lost > 15% of his/her birth weight during this time, but there is no clear information as to the frequency with which more extreme degrees of weight loss are observed.