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.
When you visit the Site, we automatically collect certain information about your device, including information about your web browser, IP address, time zone, and some of the cookies that are installed on your device. Additionally, as you browse the Site, we collect information about the individual web pages or products that you view, what websites or search terms referred you to the Site, and information about how you interact with the Site. We refer to this automatically-collected information as Device Information."
We collect Device Information using the following technologies:
Additionally when you make a purchase or attempt to make a purchase through the Site, we collect certain information from you, including your name, billing address, shipping address, payment information (including credit card numbers), email address, and phone number. We refer to this information as "Order Information."
We use the Order Information that we collect generally to fulfill any orders placed through the Site (including processing your payment information, arranging for shipping, and providing you with invoices and/or order confirmations). Additionally, we use this Order Information to:
We use Student Access Information to provide accurate tracking to Users and Clients on completion and use of the courses, as well as for analysis on how to improve our services.
We use the Device Information that we collect to help us screen for potential risk and fraud (in particular, your IP address), and more generally to improve and optimize our Site (for example, by generating analytics about how our customers browse and interact with the Site, and to assess the success of our marketing and advertising campaigns).
We share your Personal Information with third parties to help us use your Personal Information, as described above. For example, with your employer who needs to verify your completion or progress of your studies. We also use Google Analytics to help us understand how our customers use the Site--you can read more about how Google uses your Personal Information here: https://www.google.com/intl/en/policies/privacy/. You can also opt-out of Google Analytics here: https://tools.google.com/dlpage/gaoptout.
Finally, we may also share your Personal Information to comply with applicable laws and regulations, to respond to a subpoena, search warrant or other lawful request for information we receive, or to otherwise protect our rights.
As described above, we use your Personal Information to provide you with targeted advertisements or marketing communications we believe may be of interest to you. For more information about how targeted advertising works, you can visit the Network Advertising Initiative's ("NAI") educational page at https://www.networkadvertising.org/understanding-online-advertising/how-does-it-work.
You can opt out of targeted advertising by:
Additionally, you can opt out of some of these services by visiting the Digital Advertising Alliance's opt-out portal at: http://optout.aboutads.info.
Please note that we do not alter our Site's data collection and use practices when we see a Do Not Track signal from your browser.
If you are a European resident, you have the right to access personal information we hold about you and to ask that your personal information be corrected, updated, or deleted. If you would like to exercise this right, please contact us through the contact information below.
Additionally, if you are a European resident we note that we are processing your information in order to fulfill contracts we might have with you (for example if you make an order through the Site), or otherwise to pursue our legitimate business interests listed above. Additionally, please note that your information will be transferred outside of Europe, including to Canada and the United States.
When you place an order through the Site, we will maintain your Order Information and Student Access Information for our records unless and until you ask us to delete this information. We are required to keep course completion records for at least 5 years in order to comply with certain accreditation requirements.
For more information about our privacy practices, if you have questions, or if you would like to make a complaint, please contact us by e-mail at firstname.lastname@example.org or by mail using the details provided below:
5890 Monkland Avenue, #16, Montreal, QC, H4A 1G2, Canada
Last Updated: September 2018