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OBJECTIVE: Clinicians expect newborns to surpass birth weight by age 10 to 14 days, yet few abstract
studies have examined the natural history of weight change in the weeks after birth. We
sought to determine the distribution of weight loss and subsequent regain during the first
month, the proportion not surpassing birth weight by 14 and 21 days, and whether findings
differed by delivery mode.
METHODS: For 161 471 singleton neonates delivered at ≥36 weeks’ gestation at Kaiser
Permanente Northern California Medical Centers between 2009 and 2013 and weighing
2000 to 5000 g at birth, we extracted daily weights from inpatient electronic records and
weights from outpatient visits in the first month. Quantile regression appropriate for
repeated measures was used to estimate percentiles of weight change as a function of time
after birth, stratified by delivery mode.
RESULTS: After exclusions, weight data were analyzed from 143 889 newborns (76% born
vaginally). Based on percentile estimates, 50% of newborns were at or above birth weight
at 9 and 10 days after vaginal and cesarean delivery, respectively. Among those delivered
vaginally, 14% and 5% were not back to birth weight by 14 and 21 days, respectively. For
those delivered by cesarean, 24% and 8% were not back to birth weight by 14 and 21 days,
respectively.
CONCLUSIONS: It is not uncommon for newborns to be below birth weight 10 to 14 days after
delivery. A larger percentage of newborns delivered by cesarean had yet to regain birth
weight at every time point through 1 month.
and the percentile method were used Hispanic. Exclusive breastfeeding Percentile curves of weight change
to obtain confidence intervals for each during the maternity stay occurred after birth are shown in Fig 3
percentile curve.16 We also examined in 63% of newborns, with only 4% separately for vaginal and cesarean
whether percentile estimates differed exclusively feeding formula. The deliveries. Differences in percentile
by gestational age (36–38, 39–40, median newborn lengths of stay were estimates between vaginal and
and 41–43 weeks) and birth weight 1.5 and 2.6 days after vaginal and cesarean deliveries occurred early and
(2000–2999, 3000–3999, and 4000– cesarean delivery, respectively. persisted through 30 days. The nadir
5000 g) groups. The same model as for the 50th percentiles was −5.9%
above was fit separately for each During the first month after birth, (61 hours) and −7.1% (68 hours)
gestational age and birth weight group infants delivered vaginally had after vaginal and cesarean delivery,
for each delivery mode. 480 491 weights subsequent to birth respectively; subsequent increases
weight recorded, with a median of weight gain for the 50th percentile
(interquartile range) of 5 (4–6) occurred at a rate of ~1.17 and ~1.11
RESULTS weights recorded across all settings percentage points per day through the
Among the cohort of 143 889 who (birth hospital, outpatient visit, end of the first month, respectively.
met all inclusion criteria and were inpatient visit). Infants delivered Averaging differences between
included in this analysis, 108 745 by cesarean had 188 170 weights cesarean and vaginal curves across all
(75.6%) were delivered vaginally subsequent to birth weight recorded, integer time points separately for each
and 35 144 (24.4%) were delivered with a median of 6 (5–7) weights percentile, cesarean curves were a
by cesarean (Table 1). Mean (SD) recorded through age 30 days. After mean 1.2 percentage points lower (5th
birth weight was 3435 g (458 g) the birth weight measurement, percentile) to 2.1 percentage points
for these neonates delivered at a weights were most commonly lower (50th and 75th percentiles).
median gestational age of 39 weeks. obtained during the newborn hospital After vaginal delivery, ∼50% of
Approximately 40% of mothers were stay, with additional clustering during newborns surpassed birth weight by
self-described as white, non-Hispanic, the first days after discharge and at age 9 days, although 14% and 5% had
with ~25% being each Asian and ~14 days of age (Fig 2). not achieved this milestone by ages
DISCUSSION
These analyses represent the most
detailed assessment of weight change
among well newborns in the first
month after birth to date and provide
data for several aspects of newborn
anticipatory guidance that previously
lacked sufficient evidence. Whereas
AAP-published texts suggest that FIGURE 3
newborns should surpass birth Estimated percentile curves of percentage weight change by time after birth. A, Vaginal delivery. B,
weight by age 7 days and that failure Cesarean delivery.
to do so by 14 days suggests feeding
cessation,19–21 it is possible that use and newborns who were weighed
difficulties, our data suggest that the
of these new nomograms may even only within the first week may
majority of newborns take more than
reduce the risk of breastfeeding have substantially influenced our
a week to achieve this milestone,
cessation by reassuring mothers estimated curves. We examined
sometimes weeks longer. Those
about normal newborn weight these scenarios by fitting separate
delivered by cesarean on average take
trends. Similarly, some office visits models after randomly selecting only
longer to regain their birth weight
and medical evaluations may be 1 weight for each newborn in the
than those delivered vaginally. After
avoided. data set, and after using matching
they reach their weight nadir, weekly
The data presented here are similar to impute data for newborns with
weight gain on average exceeds the 4
to those described previously with last recorded weight at ≤7 days.
to 7 ounces cited by AAP texts, with
smaller samples. For example, Estimates were in accordance
on average a 35 to 40 g daily gain that
Crossland et al6 studied 111 with the final models (not shown),
varies slightly by birth weight and
exclusively breastfed women and indicating that our final estimates
delivery mode.
found that ∼50% and 25% were were robust to these potential issues.
Each of these new findings has below birth weight at 8 and 12 days, As opposed to our nomograms
important implications for newborn respectively. Macdonald et al5 constructed for the birth
care, particularly among those who similarly reported a median time hospitalization,1,2 the differences
are breastfeeding. Mothers with to surpass birth weight among in percentage weight change as a
newborns still below birth weight 395 breastfeeding newborns of 8.3 function of birth weight may limit
10 to 14 days after delivery may feel days, although ∼5% took ≥19 days. broad application of a single weight
anxious about their milk supply as a Times were shorter for formula-fed change nomogram to the outpatient
result of providers holding them to a newborns in that study. In addition setting. Stated most simply, because
non–evidence-based norm.12,17 to the small sample sizes, these 2 actual daily weight gain is similar
Using these new nomograms to studies and others are limited by irrespective of birth weight, those
understand normal newborn weight describing the experience at a single with lower birth weights have faster
trends may reduce the need for center with research designs that percentage weight gain, whereas
clinicians to recommend formula involved frequent weights and contact larger newborns gain a smaller
supplementation for breastfed with study or clinical personnel that percentage per day. These larger
newborns who have not regained differ from real-world practice. These newborns therefore on average
their birth weight by 10 to 14 days previous studies also failed to stratify take longer to get back to birth
after birth. Our new nomograms may by delivery mode, which we have weight than those with lower birth
also provide reassurance to parents shown to be an important factor for weights.
of infants who are still below birth weight change during the first days
weight at 10 to 14 days after birth. and weeks after birth. Our study has additional limitations.
Because newborn weight can affect As opposed to our previous
maternal milk supply concern,12,18 a We were concerned that newborns publications describing the birth
common contributor to breastfeeding with a large number of weights hospitalization,1,2 we did not have
precise data on infant feeding In summary, these data remains an important part of well
mode in the outpatient setting. demonstrate that it is not newborn care, advice based on
Therefore, data on weight change uncommon for newborns to be anecdote can now be replaced with
through age 1 month does not below birth weight 10 to 14 days hard data.
account for infant feeding mode. after delivery regardless of delivery
Furthermore, weights obtained for mode. This is especially true for
this study were obtained as part of those delivered by cesarean, who ABBREVIATION
routine clinical care, and calibration lose more weight on average in the
AAP: American Academy of
of these scales is subject to individual first few days. Although ensuring
Pediatrics
institutional guidelines. adequate feeding and weight gain
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Subspecialty Collections This article, along with others on similar topics, appears in
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Fetus/Newborn Infant
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Nutrition
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Breastfeeding
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