What standards do you use at your facility to determine whether an infant's weight loss is within normal limits (WNL) or has exceeded those limits and is now considered excessive prior to discharge? Most facilities will use the standard 7% as WNL, with 10% as excessive. But where did those numbers originate?
In a published systematic review, Diane Thulier, PhD, RN, reports that there is little reliable evidence that supports those numbers as a standard. She was able to collect and study all research done since 2008, when Noel-Weiss et al. completed a systematic review on physiological weight loss in the breastfed neonate. From 2009 to 2015, nine studies were identified and reviewed by Thulier and her colleagues. The number of participants ranged from 53 to 108,907. The average weight loss ranged from 3.79% +/- 1.25% to 7.2 +/- 2.1%, and the time to return to birth weight (nadir) ranged from 38.7 hours +/- 18.5 hours to 43.72 hours +/1 11.6 hours.
The challenging aspect of all of these studies was the methodologic flaws found by Thulier, which included:
The review concluded with, "It is unfortunate that the current literature still does not provide enough evidence to accurately determine" the normal weight loss, when the greatest loss occurs, and time to nadir. "Clinicians require accurate data to make sound decisions...it is only when clinicians have this information that they can provide the best guidance and care to promote, protect, and support breastfeeding infants.
You might consider studying your current policy to determine on what research your current guidelines are based. Does it reflect the current literature? Does it need changing? It would be interesting to have an online discussion regarding these guidelines.
Kathy Parkes, MSN-Ed, BSPsy, RN, IBCLC, RLC, FILCA
Professional Development Educator, Step 2 Education International
Thulier, D. (2016). Weighing the facts: A systematic review of expected patterns of weight loss in full-term, breastfed infants. Journal of Human Lactation; 32(1):28.
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