Elizabeth,
You shared with us an article by Marten and Romphf.  "Factors Associated
With Newborn In-Hospital Weight Loss: Comparisons by Feeding Method,
Demographics, and Birthing Procedures." It said that << the heaviest infants
show the greatest weight loss>>
This makes sense because we usually look at percent weight loss, and my
understanding is that about 5-6% is usual and not problematic. For a 3500
gram infant, that would be around 193 g and for a 4500 gram infant that
would be around 248 g, but percentage-wise, it's still 5.5%.

 You also said that <<and their own research showed "an approximate 1%
greater weight loss for every 1000-g increase in birth weight" as well as an
increase in weight loss of babies born to mothers who had epidurals that
"may be attributable to intravenous fluid overload ...>>
Now here is something different. If this were true, then the 4500 gram baby
might lose 6-7% which I would not consider problematic either. I think it
stands to reason a 10 ml serving of colostrum, for example, would provide
more nutrition proportionately for the 3500 gram infant than the 4500 gram
infant. Supply and demand are in place, though, and wouldn't the 4500 gram
infant demand more, and therefore consume more, and mother make more, or
maybe it takes a couple days to drive up production. So I can understand and
believe this 1% greater for each 1000 grams.

Now for the epidurals....*Anecdotally* I do not see weight loss associated
with epidurals or long IV therapy for the mother. Virtually all of the
mothers I've worked with over the last 7 yrs have epidurals. And they get
them fairly early like 4-5 cms. What I see are sleepy babies and temporarily
physically disabled mothers and mother/baby separation and all these things
are likely ASSOCIATED with epidurals, and that's why we see the
correlation.  I am very good at predicting which babies will come for
followup with a larger weight loss and jaundice, based on gestational age,
baby behavior in hospital (sleepiness), effectiveness of latch, and those
types of things. Te epidural is a factor in that it damps down the alertness
and capability of the mother and baby, but does not inflate the baby's
weight, in my opinion. I may be proven wrong, however, and I'll accept that.
Laurie Wheeler, RN, MN, IBCLC
Mississippi USA

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