Dear Gonneke

You might want to check out this paper by Crossland et al. [Crossland, D.
S., Richmond, S., Hudson, M., Smith, K., Abu-Harb, M. (2008). Weight change
in the term baby in the first 2 weeks of life. Acta Pædiatrica 97, 425–429.]

Crossland found that 54% of the breastfed babes and 39% of the formula fed
babes had not regained their birth weight by 8 days of age.

I recently did a systematic review to determine physiological (normal)
weight loss in breastfed neonates.  The four clinical practice guidelines I
looked at favoured 7% as a threshold, and I pulled all of their references
along with my search of electronic databases.  

I found 6.5 or thereabouts was an average/mean loss - this would mean that
50% of the babies lose more.  How can 7% be used as a threshold when it is a
mean loss?

In the research I am doing right now, I have come to realize that we use
birth weight as a baseline and that might be a problem straight off - should
the weight measured within minutes of birth be the baseline or should
babies' fluids settle before the baseline weight is measured?

So I see two issues - 1) what is acceptable loss, and 2) how do we determine
how much a baby has lost?

I appreciate the importance of weight as an assessment tool, and I agree
that we should monitor closely.  It is best to catch problems early.  Our
comfort with measurements can lead to clinical decisions based the number
and not the whole picture.

Joy

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