Differentiating Normal New-born Weight Loss from Breastfeeding Failure
As a Lactation consultant in a tertiary hospital, I’m always keen to update my knowledge with current research evidence. No doubt, ALCI’s annual conference is the best chance for that. As usual, this year’s conference was also packed with, lots of valuable information along with inspiring stories and case studies. It was exciting to hear from national and international speakers with a wealth of knowledge and experience. Here, I would like to review a lecture given by Catherine Watson Genna on “Differentiating Normal Newborn Weight Loss from Breastfeeding Failure”. I enjoyed this informative lecture and gained lots of evidence-based knowledge to apply into my clinical practice.
Catherine is an inspiring IBCLC, currently working in private practice in New York City. She is the author of many breastfeeding books. She was the Associate Editor for the United States, Journal of Clinical Lactation. Catherine discussed recent data on normal weight changes in exclusively breastfed infants and those at risk for hypernatremic dehydration to help health professionals to determine when infants require further supplementation.
Normal weight loss
Catherine started her lecture by giving a short description of normal weight loss. Newborns are expected to lose weight in the first few days after birth as a part of healthy adaptation to extra uterine life and promptly begin gaining as milk production increases (Mulder & Gardner, 2015). Breastfeeding difficulties and also perinatal practices can exaggerate normal weight loss (Mulder, Johnson, & Baker, 2010). Giudicelli, M et al (2021) revealed that excessive intravenous fluids during labor and delivery may lead to increased weight loss in the first 24 hours of life. It is valuable information that newborn care practices like separation from parents, cold stress, restrictive feeding routines, delayed initiation/ mismanagement of breastfeeding also reduce weight gain. She discussed ABM Clinical Protocol #3 (2017) and explained medical indications for supplementation which has given insight into the careful regulation of breast milk substitutes.
Hyponatremic Dehydration (HND)
I was curious to hear a precise explanation of hyponatremic dehydration. Sodium (Na+) >145-150 mEq/L can lead to renal injury, intravascular coagulation, cerebrovascular events, and Cerebral edema (if rapid refeeding). Therefore symptoms of dehydration or low breast milk intake should not be disregarded at any age. Signs of dehydration may be subtle in HND as fluid is shifted to the extracellular compartment by osmotic pressure from the elevated sodium. Signs and symptoms such as dry mucous membranes, lethargy, Irritability, inconsolable crying with constant ineffective feeding attempts should be investigated.
Evidence based practice
Furthermore, the lecturer illustrated a few recent pieces of research on infant weight loss. She explained the importance of routine use of “24-hour weight” as the reference for newborn weight loss calculation. Deng & McLaren (2018) demonstrated that their overall supplementation rate decreased from 43.6% pre- to 27.4% post-intervention. Research done by DiTomasso, D., & Paiva, A. L. (2018) found that Weight loss > 7% may be a normal phenomenon among breastfeeding newborns. Use of formula significantly increased at 7% weight loss. Thus I learned that it’s vital to rethink weight loss expectations before supplementation. Frequent or daily weighing in the first 5 to 7 days has been also proposed to reduce the risk of HND (Bucher, & Arlettaz, 2009). According to Zia, M et al (2021) intervention is initiated when there is >=5% weight loss in any 24 hours. Lactation consultation, 2 hourly breast feedings, skin-to-skin contact, hand expression of colostrum, and reweighing in 12 hours are recommended and they found fewer nursery admissions for HND after intervention which is a very interesting and informative study.
Identifying infants at risk
It was my new knowledge about nomogram charts. These charts help to capture the time dimension and individual variations to identify babies at risk. Several groups have produced nomograms that clinicians can use to help screen newborns. As per studies, mild hypernatremia may be normal and HND can occur regardless of weight loss. Von Dommelen’s nomogram captures infants at high risk for HND and treated it along with the continuation of breastfeeding. From her lecture, I learned that an infant who is remaining below 10% below birth weight after 1 week is at high risk than who is 10% below birth weight at 2 days old.
To conclude, I gained a wealth of knowledge from Catherine’s lecture. Research on infant weight changes highlighted the impact and importance of perinatal practices and postpartum breastfeeding management. Understanding the data we have about weight loss, and carefully assessing the breastfeeding dyad, can help prevent hypernatremic dehydration and conversely, unnecessary formula supplementation. I take this opportunity to thank ALCI for organizing such a knowledgeable international guest lecturer and also a huge thank you to Catherine Watson for generously sharing her expertise.
Iby Chacko October 2021.
Iby received a bursary of €100 from ALCI to attend the 2021 ALCI Conference.