title: Newborn wet and soiled diaper counts and timing of onset of lactation as indicators of breastfeeding inadequacy.
abstract: Using data from 242 exclusively breastfeeding mother-infant pairs, newborn elimination patterns were analyzed. Sensitivity (Se) and Specificity (Sp) of day 4 (72-96 hours) wet and soiled output, in addition to the timing of onset of lactation, in identifying cases of breastfeeding inadequacy (defined as neonatal weight loss >or= 10% of birth weight) were examined. The usefulness of 2 measures in parallel was also explored. Median number of diapers (wet, soiled) on days 1, 4, and 7, respectively, was 2, 3; 5, 4; and 7, 6. The most efficient day 4 predictor of breastfeeding inadequacy was soiled diaper output <or= 3 (Se = .75, Sp = .66). Sensitivity improved when used in parallel with delayed onset of lactation (>or= 72 hours); Se = .86 (95% confidence interval, .73-.99) and Sp = .59 (.55-.63). Fewer than 4 soiled diapers on day 4 when used in conjunction with delayed onset of lactation may be indicative of breastfeeding inadequacy, but low specificity will result in many false positives.
authors.affiliation: Department of Nutrition, University of California at Davis, Davis, CA 95616, USA. lanommsen@ucdavis.edu
authors.forename: Laurie A
authors.initials: LA
authors.lastname: Nommsen-Rivers
authors.forename: M Jane
authors.initials: MJ
authors.lastname: Heinig
authors.forename: Roberta J
authors.initials: RJ
authors.lastname: Cohen
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Dewey
mesh_terms: D001942:Breast Feeding; D003672:Defecation / Q000502:physiology; D041381:Diapers, Infant / Q000706:statistics & numerical data*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D018730:Infant Behavior; D007231:Infant, Newborn / Q000378:metabolism* / Q000652:urine; D007774:Lactation / Q000502:physiology*; D007775:Lactation Disorders / Q000175:diagnosis*; D008297:Male; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014554:Urination / Q000502:physiology