>For starters: 1. I'm of the opinion that 10 days or 2 weeks is too 
>long for a baby to regain to birth weight.  I wasn't in a position 
>to study this when I got my MSN in 1994, but while working on my MSN 
>I did home vss for a hospital that did 24 hour discharges with a 
>home vss on day 2 and 4. Invariably I saw babies who were nursing OK 
>on day 2 to be back to birth weight by day 4.  If they weren't back 
>to birth weight by day 4, I considered baby at risk and could get 
>another vss.  If they weren't back to birth weight by day 4, it was 
>usually a problem in baby or mom.
>2. A baby at 10 days, below birth weight, not having adequate stool, 
>would have all my red flags waving.  Something is wrong with 
>production (mom) or transfer (baby).  Pat in SNJ


Pat - the overwhelming evidence is that return to birthweight is not 
fixed in stone at an early stage. The  WHO weight and growth charts 
(from data taken from excl breastfed babies)start do not start until 
2 weeks for that reason.

I think the evidence is pretty clear: the key to assessing how well a 
baby is doing vis a vis his weight gain is *trajectory*, not a date 
by which the baby achieves birthweight....birthweight can be i) badly 
recorded ii) artificially inflated - see the recent paper on maternal 
intra-partum fluids .

A newborn should be *gaining* weight, for sure, after about day 4-5 - 
there are a number of  studies that confirm this -  but I don't know 
of any studies (and I have done a fairly recent trawl of the 
literature on this for a piece of work I did for my organisation) 
that indicate failure to reach birthweight by day 4 to be a sign of 
being 'at risk'. If there has been more recent work done on this, I'd 
be interested.

All mothers and babies should be supported and their feeding 
effectiveness assessed throughout the newborn period, as part of 
normal postnatal care. So stooling is *one* part of the picture. A 
baby 'close to birthweight' at day 10, whose  feeding is going well, 
whose weight is going upwards,  who is being seen by someone capable 
of assessing this (as opposed to listening on the phone to the 
mother's report, which may not be accurate)....that baby may also 
stooling 'inadequately' but be ok. The stooling or lack of it is a 
red flag to check all that other stuff out.

To check for  'achieves birthweight by day 4' is  to set a very high 
bar indeed,  IMO, and risks worrying mothers and HCPs unnecessarily. 
Far more helpful at that stage is to ascertain that feeding is going 
well (or on its way to going well - we can 'allow' some learning time 
for both mother and baby if everything else is ok :) )

Happy to hear other comments about this from others!

Heather Welford Neil
NCT bfc, tutor, UK
-- 
http://www.heatherwelford.co.uk

http://heatherwelford.posterous.com

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