Susan
I just wanted to mention that seeing such a high weight loss amount somewhat
frequently makes me wonder if these babies had *true* birthweights. By that I
mean was the birth weight artificially inflated. Did the mother have lots of
IV fluids in labor, was she diabetic, did she have edema? All of those
factors can cause inflated birthweights.
A baby with 20% weight loss would be lethargic, have very few, if any stools,
and generally look unwell.
If these babies look OK and are still having lots of stools then I would
suspect inflation or errors in the initial birthweights. We found that
excessive maternal IV fluids and general edema in labor would make the babies
weigh more at birth. Then baby would pee it all off and some would drop 10%
or more. But they always looked great.
Whenever we had a run of babies with high initial weight loss or weights that
are all over the place we would try to track down the source, looking for
commonalties. We had a problem with the nurses converting grams to pounds and
ounces for a while. Then there was a delivery room scale that was off. We
also had a particular nurse who didn't weigh the babies correctly she wasn't
balancing out the scale. We also had a problem in the peds clinic. Babies
were being weighed with the clothing on. In addition, one kind of scale that
used a car seat like set up was notorious for being off. Babies would loose
or gain a half pound or more going directly from the peds office to ours.
In cases where the baby looks well, is having good stools and is nursing
well, we would just weigh the baby every day or every other day to make sure
the baby was gaining weight.
We had an additional problem in the babies who have large initial losses--the
ped often doesn't count weight gain from the lowest weight but from the birth
weight. We were getting moms panicked because their babies weren't at
birthweight at 2 weeks of age. We had to present at peds committee to clarify
the definition of weight gain. Another local IBCLC tells me she has the same
problem with the NICU nurses.
FWIW
Marie Davis, RN, IBCLC

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