Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research

(SDAS) Early Weight Loss Nomograms For Exclusively Breastfed Newborns

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Project Number: R40MC26811
Grantee: Pennsylvania State University
Department/Center: Pediatrics College of Medicine
Project Date: 04/01/2014

Final Report


Principal Investigator

Ian Paul M, MD
500 University Drive PO Box 850, MC HS83
Hershey, PA  17033
Phone: (717) 531 8006


  • Perinatal/Infancy (0-12 months)


For most newborns, and particularly for those that are exclusively breastfed, the two most common acute medical issues during the birth hospitalization are newborn weight loss and the development of jaundice. While widely used nomograms have been developed for neonatal jaundice to demonstrate normal and abnormal bilirubin trajectories during the immediate postnatal period, nothing similar has been developed to demonstrate typical patterns of newborn weight loss in the first days after birth. As a result, when confronted with newborn weight loss, clinicians and mothers make non- evidence-based decisions regarding formula supplementation founded on clinical and personal judgment that varies from clinician to clinician and from mother to mother. Using a well-defined data set from Northern California Kaiser Permanente, we therefore propose to develop the first hourly nomograms for weight loss among exclusively breastfed newborns during the birth hospitalization with distinct plots based on delivery mode (vaginal and Cesarean). The Kaiser data set includes records from over 63,000 birth hospitalizations from 2009-2010 with recorded daily newborn weights. For neonates not yet exposed to nutrition other than breast milk, the proposed research will establish hour-by-hour trajectories for newborn weight loss that will be constructed with curves representing the 50th, 75th, 90th, and 95th percentile for weight loss. Quantile regression methods will be used to develop these curves. Logistic regression will then be used to model neonatal readmission and treatment of jaundice by weight loss quantile zones, and Kaplan-Meier curves will also be plotted to display the estimated probability of breastfeeding discontinuation over time by weight loss quantile zone. The results of this study will enable clinicians to share precise data with mothers on whether a newborn is "getting enough" nutrition compared with a large sample of healthy, exclusively breastfed newborns as well as the risks associated with their current trajectory. The nomograms for newborn weight loss will have a tremendous impact on the care of well newborns, while also addressing Maternal and Child Health Bureau (MCHB) Strategic Research Issue #3 (Services and systems to assure quality of care for MCH populations), MCHB Strategic Research Issue #4 (Promoting the healthy development of MCH populations), Healthy People 2020 Objective MICH-21 (Increase the proportion of infants who are breastfed), and Healthy People 2020 Objective MICH- 23 (Reduce the proportion of breastfed newborns who receive formula supplementation within the first 2 days of life).


Listed is descending order by year published.

Flaherman VJ, Schaefer EW, Kuzniewicz MW, Li SX, et al. Early weight loss nomograms for exclusively breastfed newborns. Pediatrics. 2015;135(1):e16-23. Epub 2014 Dec 1. PMID: 25554815

Miller JR, Flaherman VJ, Schaefer EW, Kuzniewicz MW, et al. Early weight loss nomograms for formula fed newborns. Hospital Pediatrics 2015; 5:263-8.

Schaefer EW, Flaherman VJ, Kuzniewicz MW, Li SX, et al. External validation of early weight loss nomograms for exclusively breastfed newborns. Breastfeed Med. 2015 Dec;10:458-63.


Breastfeeding, Cesarean, Clinical Practice, Nutrition & Diet, Physical Growth, Postpartum, Health Care Quality

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