Dear Folks:
  I must respectfully disagree with Dr. Jack when he says:
"I wish to reiterate that the idea of going by percent weight loss is not a
good idea. I think it will lead to bad practice, including interventions
when they are not necessary and reassurance when it is not warranted.

Watch the baby breastfeed! If the baby is breastfeeding well and getting
milk (open-pause-close type of sucking) the weight will come up even if the
baby has lost 15%. And if the baby spends his time nibbling and not
drinking, he will continue losing, even if the weight is down 3%."
   Kay Hoover has published a letter in the most recent JHL recommending that
the baby's electrolytes need to  be checked if baby has lost 15% or more  of
weight. While observing the breastfeeding relationship is, as Dr. Jack says,
of utmost importance, the first rule is to feed the baby.
   I have known of a newborn with sunken fontanelles,no stooling the previous
two days, who hadn't lost as much as 15%, although it was over 10% of birth
weight; this baby acted fine.  The baby was admitted for dehydration; the
hospital encouraged the mother to stay and continue nursing.  In this case,
her milk volume increase was delayed.
    The margin of safety in newborns is small and when one talks about things
like seizures from electrolyte imbalance, in that particular case, I would
want intense medical supervision as well as breastfeeding support.
  In the Cooper study, looking at babies admitted for dehydration and FTT
which led to serious medical problems, the babies had lost as much as 23% of
birthweight.
  In a case where more than 10% of weight had been lost in the first week
after birth, I would be so careful and want to know if the weight loss had
bottomed out or was going on farther. This gets into a scary area for me. How
does everyone else feel? Warmly, Nikki Lee