Theresa, and everyone,
When I converted all the weights to metric, the weight loss seems to be just
over 13%.
(birthweight 3665 g, discharge weight 3465 g, weight at 6 days 3180)
3665 - 3180 = 485
485/3665 = .132 or 13.2%

Not trivial but not life-threatening either.  At 6 days post partum I would
be very concerned about turning the weight around as soon as possible.
Unless baby is having yellow, loose, curdy stools at least once a day, I
agree that one pre- and post-feed weighing could be informative - maybe he
is just 'pretending to breastfeed' as Dr.Jack says - and expression should
be started if baby is not transferring at least a couple of ounces per feed.
I'd recommend finger feeding for getting the expressed milk into him.  If
there is no expressed milk to be had from his mother and he continues to
lose weight, I'd be looking for food elsewhere, either donor milk or 'the
fourth best choice' of formula.

Parents should be trying to see to it that baby feeds 8 or more times in 24
hours, as you indicate you are encouraging them to do.  They should have the
opportunity for daily contact with a person who can weigh the baby and make
other assessments of adequacy of intake and of the baby's general health.

At our unit we follow babies of this age with up to 15% weight loss from
birth weight without supplementing, but we are following them very closely.
Sometimes they are 3 weeks old before they are 'weaned' from follow-up but
usually it goes faster than that.  The mothers generally need lots of
encouragement that this is just a slow starter (assuming that's all it is -
we do check for other problems but usually they are perfectly healthy babies
who just haven't 'gotten it' and given this baby's start, he would be a
prime candidate.

Since there is no good evidence for maternal IV fluids making babies
waterlogged, I think we have to assume that the birth weight is the correct
starting point.  You don't mention how long they were in hospital so we
don't know how fast the initial loss occurred.  What it looks like is that
the baby hasn't stopped losing weight, and that should be stopped before it
gets any worse.

An aside: all the electronic scales I have ever seen have a toggle switch
just below the display, for going between metric and pounds.  If you just
switch the toggle, you get the metric weight automatically.  If you do that
every time you weigh the baby, you don't need to use a chart to find out
whether baby has lost more than 10%, because the arithmetic is very simple
in metric.  This baby could lose 366 grams before passing the 10% line.
That can easily be converted to ounces by dividing by 28, or very roughly,
by 30.  About 12 oz.  That would mean that when baby dipped below 7 lb 5 oz,
you should be concerned.  Laurie writes that 7% weight loss is of concern
where she works.  I'm pleased we have a more relaxed approach.  Also, we
check the weight on the third day of life to assess adequacy of intake.
Recently more mothers have been going home earlier, and it seems babies
weigh less on the second day of life than on the third.  Fortunately we do
not base decisions to supplement on a weight at this time.  We weigh them
mainly so that when they return for the PKU test, we can tell whether they
are going up or down.

Sorry this got so long.  Theresa's nephew is probably all sorted out by now!
Rachel Myr
Kristiansand, Norway

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