Initial Weight Loss Among Breastfed Ugandan Neonates and Its Association with Subsequent Growth

Abstract

Abstract Objectives To describe initial newborn weight loss and its association with subsequent growth among at-risk newborn populations in Uganda. Methods We weighed 205 breastfeeding infants born at ≥2000 g in Kampala and Mukono, Uganda, to ± 5 g at <6 hours of age and at 1, 2, 3, 4, 5, 12 and 30 days of age. Data was collected on feeding and health outcomes. Percent weight change was defined as the difference between weight at <6 hours and subsequent weight, expressed as a proportion of birth weight. Fisher's exact and the Wilcoxon rank sum test were used for bivariate analysis of dichotomous and continuous variables, respectively, to account for outcome frequency. Results In this cohort, all infants were delivered vaginally and 99 (49%) were male (Table). Mean weight and length at birth were 3153 ± 415 g and 48.2 ± 2.0 cm, respectively; 9 (4%) infants were low birth weight (LBW). At 30 days of age, 199 (99.5%) of infants were still breastfeeding, 173 (85%) infants had received supplementary feeding during the first month, and 4 (2%) had received formula during the first month. Weight nadir occurred at 1.7 ± 1.3 days of age, when weight change was −5.6 ± 3.4% of birthweight. At 30 days of age, weight-for-age z-score (WAZ) ≤−2 occurred among 10 (5%) infants. Weight nadir was 9.3% ± 5.7% below birth weight for infants who eventually had 30-day WAZ ≤−2, compared to 5.4% ± 3.2% below birth weight for infants who eventually had 30-day WAZ >−2 (P = 0.005). In this cohort, 8 (90%) of LBW infants were born to primiparous mothers, compared to 59 (30%) non-LBW infants (P = 0.002). Infants of primiparous mothers were also more likely to have low WAZ at 30 days of age (70% vs. 31%; P = 0.02). Conclusions In this cohort of breastfed infants from Kampala and Mukono, Uganda, breastfeeding newborns lost about 6% of their birth weight at nadir, which occurred at an average of 1.7 days of age. Infants born to primiparous mothers appeared to be at greater risk of underweight at 30 days of age. Understanding the relationship between early weight loss and subsequent outcomes could inform the development of strategies to optimize growth. Funding Sources The Bill and Melinda Gates Foundation.