title: Early weight loss nomograms for exclusively breastfed newborns.
abstract: BACKGROUND
  The majority of newborns are exclusively breastfed during the birth hospitalization, and weight loss is nearly universal for these neonates. The amount of weight lost varies substantially among newborns with higher amounts of weight loss increasing risk for morbidity. No hour-by-hour newborn weight loss nomogram exists to assist in early identification of those on a trajectory for adverse outcomes.
  
  
  METHODS
  For 161 471 term, singleton neonates born at ≥36 weeks' gestation at Northern California Kaiser Permanente hospitals in 2009-2013, data were extracted from the birth hospitalization regarding delivery mode, race/ethnicity, feeding type, and weights from electronic records. Quantile regression was used to create nomograms stratified by delivery mode that estimated percentiles of weight loss as a function of time among exclusively breastfed neonates. Weights measured subsequent to any nonbreastmilk feeding were excluded.
  
  
  RESULTS
  Among this sample, 108 907 newborns had weights recorded while exclusively breastfeeding with 83 433 delivered vaginally and 25 474 delivered by cesarean. Differential weight loss by delivery mode was evident 6 hours after delivery and persisted over time. Almost 5% of vaginally delivered newborns and >10% of those delivered by cesarean had lost ≥10% of their birth weight 48 hours after delivery. By 72 hours, >25% of newborns delivered by cesarean had lost ≥10% of their birth weight.
  
  
  CONCLUSIONS
  These newborn weight loss nomograms demonstrate percentiles for weight loss by delivery mode for those who are exclusively breastfed. The nomograms can be used for early identification of neonates on a trajectory for greater weight loss and related morbidities.
authors.affiliation: Departments of Pediatrics, and Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California; flahermanv@peds.ucsf.edu.
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: Flaherman
authors.affiliation: Departments of Public Health Sciences, and.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Schaefer
authors.affiliation: Departments of Pediatrics, and Division of Research, Kaiser Permanente, Oakland, California.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kuzniewicz
authors.affiliation: Division of Research, Kaiser Permanente, Oakland, California.
authors.forename: Sherian X
authors.initials: SX
authors.lastname: Li
authors.affiliation: Division of Research, Kaiser Permanente, Oakland, California.
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Walsh
authors.affiliation: Departments of Public Health Sciences, and Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania; and.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Paul
mesh_terms: D000367:Age Factors; D001724:Birth Weight; D001942:Breast Feeding; D006801:Humans; D007231:Infant, Newborn; D049451:Nomograms; D015431:Weight Loss
keywords: breastfeeding; infant; lactation; newborn; weight loss