Weight evolution after outpatient breastfeeding support in clinically stable newborns with ≥7% early weight loss: a retrospective descriptive cohort study

Abstract

Background : Weight loss during the first week of life is common in newborns, particularly among exclusively breastfed infants. Some institutional protocols use weight-loss thresholds of 7%–10% to trigger intensified evaluation or hospitalization, although thresholds and management approaches vary across settings. Structured breastfeeding support and close follow-up may allow selected clinically stable newborns to be managed as outpatients.

Methods: A single-center retrospective descriptive cohort study without a comparison group was conducted at a quaternary-level referral hospital in Bogotá, Colombia, in 2022. Eligible newborns were those delivered at the institution and documented to have ≥7% weight loss from birth weight at the first outpatient check-up. The primary outcome was weight stabilization or gain at the second check-up, defined as weight equal to or greater than that recorded at the first outpatient visit. Proportions and 95% confidence intervals (CIs) were calculated for the main outcomes. A weight loss of ≥10% by itself was not an indication for admission; hospitalization was determined by clinical warning signs .  

Results:  A total of 381 newborns were included; 51.2% were female, 55.9% were firstborn, 54.9% were delivered by cesarean section, and 92.4% were exclusively breastfed. At the first outpatient check-up, 57.7% had weight loss of 7% to <10%, while 42.3% had weight loss ≥10%. Weight stabilization or gain was observed in 332 newborns (87.1%; 95% CI, 83.4%–90.1%), including 84.4% of those with weight loss ≥10%. Within the analytic cohort, five newborns (1.3%; 95% CI, 0.6%–3.0%) required hospitalization at or after the second outpatient assessment. The median interval between visits was 4 days (IQR, 3–5).

Conclusions: In this selected cohort of clinically stable newborns with ≥7% early weight loss, outpatient breastfeeding support was associated with weight stabilization or gain in most cases. Further prospective comparative studies with predefined safety outcomes are needed.