I was just reporting what I saw in a mid eastern USA city.  But it became so 
customary that it was always there in the back of my mind.  This was 20 
years ago or so and deliveries weren't as medically managed, not tons of 
IVs, few epidurals etc.  But from my more recent experience as a PNP I still 
found, not at birthweight by 2 weeks was too far out.    I saw babies 20 
years ago at 48-72 hours, ditto for present day.  Weight at 48-72 on 
consistent scales, consistent clothes, done by me.


----- Original Message ----- 
From: "heather" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, November 11, 2011 5:29 AM
Subject: Re: bowel movements


> >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
>
>             ***********************************************
>
> Archives: http://community.lsoft.com/archives/LACTNET.html
> To reach list owners: [log in to unmask]
> Mail all list management commands to: [log in to unmask]
> COMMANDS:
> 1. To temporarily stop your subscription write in the body of an email: 
> set lactnet nomail
> 2. To start it again: set lactnet mail
> 3. To unsubscribe: unsubscribe lactnet
> 4. To get a comprehensive list of rules and directions: get lactnet 
> welcome 

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome