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ORIGINAL ARTICLE
Year : 2017  |  Volume : 6  |  Issue : 2  |  Page : 85-89

Pattern of weight loss in breastfed neonates in initial 72 h of life


Department of Pediatrics, Command Hospital Air Force, Bengaluru, Karnataka, India

Date of Web Publication13-Apr-2017

Correspondence Address:
Biju M John
Department of Pediatrics, Command Hospital Air Force, Bengaluru - 560 007, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcn.JCN_68_16

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  Abstract 

Background: Neonates are expected to have weight loss in the first few days of life. Many factors are considered to affect newborn weight loss such as breastfeeding adequacy, maternal parity, intravenous fluids administered during labor, and environmental factors. Most of the studies have yielded variable results. The primary objective of this study was to assess the pattern of newborn weight loss in initial 72 h after birth and the factors affecting it. The secondary objective was to assess the impact of initial weight loss on neonatal jaundice beyond 72 h and regaining birth weight at the 10th day of life. Materials and Methods: A study was carried out on 250 term exclusively breastfed newborn babies. Neonates were weighed initially at birth and then regularly at 12 hourly intervals for 72 h. Data pertaining to various maternal factors affecting neonatal weight loss, birth weight of newborns, and adequacy of breastfeeding were recorded. The weight of the neonates on the 10th day was also recorded. Results: About 79.2% of babies lost 5%–10% of birth weight and 12.8% of babies lost more than 10%. The maximum weight loss occurred between 60 and 72 h of life. The mean (standard deviation [SD]) percentage of weight loss in babies with inadequate breastfeeding was 9.01 (2.58) compared to 7.31 (1.82) in the adequately breastfed babies (P < 0.001). The mean (SD) percentage of weight loss in babies born to primipara was 8.31 (1.77) and in multipara it was 7.51 (2.43) (P = 0.005). Neonates who developed significant jaundice had a mean (SD) percentage weight loss of 9.87 (3.40) compared to the rest in whom it was 7.59 (1.92) (P < 0.001). In the subgroup of babies who lost >10% of birth weight at 72 h, 88.2% did not regain birth weight on day 10 of life as compared to 55% of babies in the subgroup with weight loss <10% (P < 0.003). Conclusion: Regular monitoring of weight in exclusively breastfed babies is potentially useful. Particular attention may need to be given to primipara mothers and babies who lose more than 10% weight by 72 h.

Keywords: Exclusively breastfed, newborn, weight loss


How to cite this article:
Joshi R, John BM, Negi V. Pattern of weight loss in breastfed neonates in initial 72 h of life. J Clin Neonatol 2017;6:85-9

How to cite this URL:
Joshi R, John BM, Negi V. Pattern of weight loss in breastfed neonates in initial 72 h of life. J Clin Neonatol [serial online] 2017 [cited 2019 Jul 21];6:85-9. Available from: http://www.jcnonweb.com/text.asp?2017/6/2/85/204517


  Introduction Top


Newborns are expected to have weight loss in the first few days of life, and there are various putative mechanisms proposed for the same. They have an expanded extracellular compartment (ECF) compartment at birth due to various maternal, fetal, and placental factors. The weight loss is primarily due to the contraction of this expanded ECF compartment.[1] In the immediate postnatal period, changes such as oxygenation increase in capillary membrane integrity leads to movement of fluid from interstitial space into the vessels. This aids in maintaining intravascular volume during the first 24–48 h when oral fluid intake may be limited. Many factors may affect newborn weight loss such as parity of the mother, intravenous (IV) fluids administered during labor, and breastfeeding adequacy. The extent of this weight loss and the factors associated with it has been a subject of study for many years. The current clinical practice guidelines vary, with some recommending interventions, including extra assessments or supplementation with formula, when total weight loss exceeds 7% and others identify a loss of ≥10% as a sign of breastfeeding inadequacy.[2]

In one landmark study done by MacDonald et al.,[3] where they followed infants for 14 days, the infants were weighed daily while in hospital but intermittently after discharge. Based on the results of this study, it appeared that weight loss of up to 12% of birth weight is experienced by about 95% of neonates, and on an average, newborns started gaining weight by day 4 and regained their birth weight by day 9. In various studies including a systematic review done by Noel-Weiss et al.,[4] it was found that median percentage of weight loss ranged from 3.2 to 8.3, with the majority of reported medians around 6%. Studies have also been done to look for any factor which might affect weight loss in neonates apart from breastfeeding, with differing results. These include factors such as parity, mode of delivery, IV fluids administered during cesarean section, maternal illnesses, perinatal complications, and environmental factors.[5]

Studies from Indian subcontinent on the subject are few. In one such study done by Bhat et al.[6] on exclusively breastfed, term, healthy babies, the weight loss was significant in 6.8% of babies (>10%), 24.7% of babies lost >5%, and in the remaining weight loss was not significant (<5%).

In view of the variability of findings in the different studies and a paucity of data from Indian subcontinent on the subject, the present study was undertaken to explore the pattern of weight loss and the factors responsible for the same in the neonate in initial 72 h of life.


  Materials and Methods Top


A prospective observational study was conducted in a tertiary care hospital in South India from December 2013 to March 2015 to ascertain the neonatal weight loss in initial 72 h of life and the various factors affecting it and its effect on neonatal jaundice and weight change on the 10th day of life. Two hundred and fifty term, healthy exclusively breastfed newborn babies were enrolled in the study. Babies who required resuscitation, received IV fluids or top feeds or phototherapy in the first 72 h, or were unwell due to any reason were excluded from the study. Data pertaining to various maternal factors such as parity, mode of delivery, fluids received by mothers 2 h before delivery, and adequacy of breastfeeds as ascertained by asking mothers regarding (i) number of times the baby was fed (minimum eight times), (ii) feeling of emptying of breasts after feeding, (iii) whether baby slept well after feeds, and (iv) passed adequate urine were recorded in a predesigned pro forma. Neonates were weighed initially at birth by a digital weighing machine (Goldtech Digital Weighing Scale, Precision Electronic Instruments Company, New Delhi, India) and then regularly at 12 hourly intervals for 72 h along with measurement of urine and stool output. The weight on the 10th day was recorded on the same scale by recalling them to hospital. This weighing scale was used throughout the study. The pattern of weight loss and the association of various factors with newborn weight loss were studied.

Descriptive and inferential statistical analysis was carried out in the present study. Results on continuous measurements were calculated as mean ± standard deviation (SD) and results on categorical measurements as number (%). Significance was assessed at 5% level of significance. Analysis of variance was used to find the significance of study parameters between three or more groups of patients, and Student's t-test (two-tailed, independent) was used to find the significance of study parameters on continuous scale between two groups (intergroup analysis) on metric parameters.


  Results Top


The profile of study population is depicted in [Table 1].
Table 1: Demographic profile of study population

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Neonates were weighed regularly at 12 hourly intervals for 72 h along with measurement of urine and stool output. In our study, 8% of babies lost <5% of their birth weight, majority of babies (79.2%) lost 5%–10%, and 12.8% of babies lost more than 10% of weight at 72 h compared to birth weight. The pattern of weight loss across 72 h is shown in [Figure 1]. There was a uniform loss of weight over 72 h. The highest weight loss was around 60–72 h of life.
Figure 1: Pattern of weight lossto

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The association of various factors such as parity, mode of delivery, IV fluids administered to mother 2 h before delivery, initial birth weight, and breastfeeding adequacy was studied and is shown in [Table 2].
Table 2: Factors affecting newborn weight loss

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The mean (SD) percentage of weight loss in babies born to primi and who were not adequately breastfed was statistically more significant than their respective counterparts. Percentage of weight loss was more in babies born by lower segment cesarean section (LSCS) and where mothers received more than 1000 ml of fluids 2 h before delivery but statistically it was not significant. The weight loss was more in babies <2500 g; however, this too was statistically not significant.

Out of 250 babies, 26 (10.4%) had significant jaundice with mean (SD) percentage of weight loss of 9.87 (3.40) and of the remaining 224 babies who did not have significant jaundice, the mean (SD) percentage of weight loss was 7.59 (1.92) and this was statistically significant (P < 0.001) (95% confidence interval [CI]: 8.49–11.25 and 7.34–7.84, respectively). Jaundice beyond 72 h was taken as significant if it required intervention like phototherapy based on the standard nomogram.[1]

In the study group, 216 babies had <10% of weight loss and 34 babies had >10% of weight loss. Out of 216 babies who had lost <10% of birth weight, 98 (45%) regained birth weight by day 10. And of the remaining 34 babies who had lost >10% of birth weight, only four babies (11.8%) regained birth weight by day 10. Thus, majority of babies who had lost >10% of birth weight did not regain birth weight by day 10, which was statistically significant with P = 0.0003 [Table 3].
Table 3: Weight on day 10 of life

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  Discussion Top


In this present study, 8%, 79.2%, and 12.8% of babies lost up to 5%, 5%–10%, and more than 10% of birth weight, respectively, and the mean (SD) percentage of weight loss was 7.83 (2.22). The weight loss and its pattern in our study are similar to what has been described earlier. However, in our study, 12.8% of babies lost more than 10% of their weight. This may have been because our hospital is a certified baby-friendly hospital which insists on exclusive breastfeeding of all neonates.

In various studies including a systematic review done by Noel-Weiss et al.[4] which included 11 studies, in which definitions, types of measurements, and reporting styles varied among studies, daily weights were not measured, and measurements did not continue for 2 weeks. Mean weight loss ranged from 5.7% to 6.6%, with SDs around 2%. Median percentage of weight loss ranged from 3.2 to 8.3, with the majority around 6%. The majority of infants in these 11 studies regained their birth weight within the first 2 weeks of life. The 2nd and 3rd days following birth appeared to be the days of maximum weight loss. In an Indian study done by Bhat et al.[6] on exclusively breastfed, term, healthy babies, the weight loss was significant in 6.8% of babies (>10%), 24.7% of babies lost >5%, and in the remaining weight loss was not significant (<5%).

In our study, the mean (SD) percentage of weight loss in babies born to primipara was 8.31 (1.77), which was statistically more significant than in multipara in which it was 7.51 (2.43) with P = 0.005. In many other studies too done to ascertain factors affecting neonatal weight loss, it was found that babies born to primipara lose more weight compared to babies born to multigravida.[4],[7],[8],[9]

The effect of mode of delivery and IV fluids administered to mother during delivery on neonatal weight loss has been studied by many authors. Two studies in the literature done by Lamp and Macke [10] and Watson et al.[11] showed that there is no positive correlation between fluids administered to mother and neonatal weight loss. In another two studies done by Chantry et al. and Mulder et al., it was found that increased intrapartum IV fluids impacted neonatal weight loss in the first few day of life.[12],[13] In our study, mean (SD) percentage of weight loss in babies, where mother received IV fluids ≤500 ml, 500–1000 ml, and >1000 ml 2 h before delivery, was 7.85 (2.44), 7.52 (1.87), and 8.18 (2.00), respectively. Although percentage of weight loss was more in babies where mother received more than 1000 ml of fluids, statistically it was not significant with P = 0.278. Thus, we did not find any positive correlation between IV fluids administered during labor and neonatal weight loss. With respect to the mode of delivery, weight loss was more in babies born by LSCS but statistically it was not significant, with P = 0.917.

The effect of inadequate breastfeeding on neonatal weight loss has been studied by many authors. In one such study, it was found that inadequate feeding will lead to excessive weight loss, later to complications such as fever, hypernatremia, and jaundice.[14] In our study, breastfeeding was found to be inadequate in 30.4% of babies, and the mean (SD) percentage of weight loss in these babies was 9.01 (2.58). In 69.6% of babies, breastfeeding was adequate and mean (SD) percentage of weight loss in these babies was 7.31 (1.82) and this was significantly different (P < 0.001). Out of 250 babies, 26 (10.4%) had significant jaundice with mean (SD) percentage of weight loss of 9.87 (3.40) and of the remaining 224 babies who did not have significant jaundice, the mean (SD) percentage of weight loss was 7.59 (1.92), which was statistically significant (P < 0.001).

In a systematic review done by Noel-Weiss et al.,[2] the majority of infants regained their birth weight within the first 2 weeks of life. In our study group, 216 babies had <10% of weight loss and 34 babies had >10% of weight loss. Out of 216 babies who had lost <10% of birth weight, 98 (45%) regained birth weight by day 10. Moreover, the remaining 34 babies who had lost >10% of birth weight, only four babies (11.8%) regained birth weight by day 10. Thus, majority of babies who had lost >10% of birth weight did not regain birth weight by day 10, which was statistically significant with P = 0.0003.

Thus, in our study, major risk factors for excessive weight loss were primiparity and inadequate breastfeeding. We did not find any statistically significant association between mode of delivery and fluids administered to mother during labor on neonatal weight loss. Almost 12.8% of babies lost more than 10% of their weight which was higher than in earlier studies. Neonates who developed significant jaundice beyond 72 h had more weight loss than the rest. We found a positive association between excessive weight loss (>10%) in initial 72 h and failure to regain birth weight by day 10.


  Conclusion Top


Routine weighing of exclusively breastfed babies may be very useful to monitor breastfeeding adequacy and to avoid untoward effects of excessive weight loss. This is especially important for primi mothers who may initially face problems in feeding. Follow-up is also important in babies who lose >10% weight in initial 72 h. Our study interpretation may be limited by the sample size, and hence, similar studies using a larger cohort of babies in a given geographical area may be conducted to validate the same.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Gleason C, Devaskar S, Avery M. Avery's Diseases of the Newborn. 9th ed. Philadelphia, PA: Elsevier, Saunders; 2012.  Back to cited text no. 1
    
2.
Noel-Weiss J, Woodend AK, Peterson WE, Gibb W, Groll DL. An observational study of associations among maternal fluids during parturition, neonatal output, and breastfed newborn weight loss. Int Breastfeed J 2011;6:9.  Back to cited text no. 2
    
3.
Macdonald PD, Ross SR, Grant L, Young D. Neonatal weight loss in breast and formula fed infants. Arch Dis Child Fetal Neonatal Ed 2003;88:F472-6.  Back to cited text no. 3
    
4.
Noel-Weiss J, Courant G, Woodend AK. Physiological weight loss in the breastfed neonate: A systematic review. Open Med 2008;2:e99-110.  Back to cited text no. 4
    
5.
Marchini G, Stock S. Thirst and vasopressin secretion counteract dehydration in newborn infants. J Pediatr 1997;130:736-9.  Back to cited text no. 5
    
6.
Bhat SR, Lewis P, David A, Liza SM. Dehydration and hypernatremia in breast-fed term healthy neonates. Indian J Pediatr 2006;73:39-41.  Back to cited text no. 6
    
7.
Kools EJ, Thijs C, Kester AD, de Vries H. The motivational determinants of breast-feeding: Predictors for the continuation of breast-feeding. Prev Med 2006;43:394-401.  Back to cited text no. 7
    
8.
Hill PD. The enigma of insufficient milk supply. MCN Am J Matern Child Nurs 1991;16:312-6.  Back to cited text no. 8
    
9.
Dewey KG, Nommsen-Rivers LA, Heinig MJ, Cohen RJ. Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics 2003;112(3 Pt 1):607-19.  Back to cited text no. 9
    
10.
Lamp JM, Macke JK. Relationships among intrapartum maternal fluid intake, birth type, neonatal output, and neonatal weight loss during the first 48 hours after birth. J Obstet Gynecol Neonatal Nurs 2010;39:169-77.  Back to cited text no. 10
    
11.
Watson J, Hodnett E, Armson BA, Davies B, Watt-Watson J. A randomized controlled trial of the effect of intrapartum intravenous fluid management on breastfed newborn weight loss. J Obstet Gynecol Neonatal Nurs 2012;41:24-32.  Back to cited text no. 11
    
12.
Chantry CJ, Nommsen-Rivers LA, Peerson JM, Cohen RJ, Dewey KG. Excess weight loss in first-born breastfed newborns relates to maternal intrapartum fluid balance. Pediatrics 2011;127:e171-9.  Back to cited text no. 12
    
13.
Mulder PJ, Johnson TS, Baker LC. Excessive weight loss in breastfed infants during the postpartum hospitalization. J Obstet Gynecol Neonatal Nurs 2010;39:15-26.  Back to cited text no. 13
    
14.
Caglar MK, Ozer I, Altugan FS. Risk factors for excess weight loss and hypernatremia in exclusively breast-fed infants. Braz J Med Biol Res 2006;39:539-44.  Back to cited text no. 14
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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