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First-day weight loss predicts eventual weight nadir for breastfeeding newborns
  1. Valerie J Flaherman1,
  2. Michael W Kuzniewicz2,
  3. Sherian Li2,
  4. Eileen Walsh2,
  5. Charles E McCulloch3,
  6. Thomas B Newman1,3
  1. 1Department of Pediatrics, School of Medicine, University of California, San Francisco, California, USA
  2. 2Division of Research, Northern California Kaiser Permanente, Oakland, California, USA
  3. 3Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California, USA
  1. Correspondence to Dr Valerie Flaherman, Department of Pediatrics, University of California, San Francisco, 3333 California St., Box 0503, San Francisco, CA 94143-0503, USA; FlahermanV{at}


Objective To examine the relationship between high (≥5%) weight loss during the first 24 h after birth and eventual excess weight loss (EWL) of ≥10% of birth weight.

Design Retrospective cohort study.

Setting Kaiser Permanente Northern California hospitals.

Patients 63 096 infants born at ≥36 weeks in 2009–2010, of whom 59 761 (94.5%) had a weight subsequent to birth weight measured at <24 h.

Main predictor measure Per cent of birth weight lost by 24 h of age.

Main outcome measure Weight nadir, defined as the lowest recorded inpatient or outpatient weight in the first 30 days after birth, expressed as a percentage of birth weight.

Results Among infants who breastfed at least once, mean (±SD) weight nadir was 6.3±3.5% below birth weight, and 9.6% of the newborns lost ≥10% of birth weight. Among 2670 infants who lost ≥5% of their birth weight in the first 24 h, 782 (29%) eventually developed EWL, compared with 4840 (8%) of 57 109 infants who lost <5% (p<0.0005). In multivariate analysis, ≥5% first-day weight loss predicted eventual EWL (≥10%) with an OR of 4.06 (95% CI 3.69 to 4.46) after adjusting for gestational age, method of delivery, maternal race/ethnicity and hospital of birth.

Conclusions High first-day weight loss predicts eventual weight nadir and can be used to identify infants who might benefit from targeted interventions to support breastfeeding and prevent EWL.

  • General Paediatrics
  • Growth
  • Health services research
  • Nutrition

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