Neuraxial labor analgesia (NLA) has long been considered a risk factor for cesarean and vacuum delivery. We aim to investigate if, as suggested in the literature, these adverse outcomes are rather associated with a dystocic painful labor prompting an NLA request. This community-based cohort study was conducted from January 2010 to March 2023 in a Baby Friendly Hospital which supports physiological childbirth. Nulliparous women who received NLA (n = 1905) were divided into 2 groups according to whether they chose to request NLA a priori (before experiencing labor pain; AP group, n = 395) or in labor (after experiencing labor pain; IL group, n = 1510). A descriptive analysis of the sample was performed. The primary outcome was mode of delivery. A multinomial logistic regression model was used to assess in-labor request as a possible predictor of vacuum extraction and cesarean delivery, considering maternal age, height, and BMI as confounders. Groups differed in median maternal age (31 vs 30years AP vs IL, respectively P < 0.001) and neonatal weight (3195 vs 3270, P < 0.007). The risk of cesarean delivery was higher in the IL group (RRR 2.35; 95% CI 1.70 to 3.23; P < 0.001), while that of vacuum extraction was comparable between the two groups (RRR 0.81; 95% CI 0.53 to 1.21; P = 0.293). The higher incidence of cesarean delivery in the IL group compared to the AP group suggests that many women asking for NLA in labor have underlying risk factors for cesarean delivery: the relationship between NLA and cesarean delivery might not be causal. The association with vacuum remains less clear.

Pregnancy after bariatric surgery: persistent obesity and longer time to conception influences peripartum outcomes more than the type of operation.

Vancomycin-induced nephrotoxicity is associated with an increased risk of neonatal mortality and prolonged neonatal intensive care unit (NICU) stay. This retrospective cohort study aimed to assess the incidence of vancomycin-associated nephrotoxicity and its risk factors in neonates. The study included neonates admitted to the NICU of the Maternity and Children Hospital (Makkah, Saudi Arabia) from January 2018 to December 2020 who received intravenous vancomycin for more than 48h. The primary outcome was the incidence of newly developed acute kidney injury (AKI) after the initiation of vancomycin therapy, defined according to the neonatal modified Kidney Disease: Improving Global Outcomes criteria. Analyses included AKI incidence, comparison of clinical parameters between neonates with and without AKI, and multivariable logistic regression to identify predictors of AKI and mortality. Among 362 neonates treated with vancomycin, 11.3% developed AKI. Neonates with AKI had a lower postmenstrual age (31.3 vs. 34.1weeks, p = 0.01) and higher rates of extreme prematurity (31.7% vs. 14.3%, p = 0.02) and extremely low birth weight (43.9% vs. 18.7%, p = 0.00). Vancomycin trough levels > 15mg/L were more frequent in the AKI group (26.8%, 11/41) than in others (11.8%, 35/321) (p = 0.00). Only one-third of vancomycin trough measurements were obtained according to guideline-recommended timing. In multivariable analysis, each additional week of postmenstrual age was independently associated with a 10% reduction in the odds of AKI (OR 0.90; p = 0.00). Higher weight was associated with lower mortality (OR = 0.26; p < 0.001), while AKI incidence was associated with increased mortality (OR = 5.88; p < 0.001). Caffeine citrate use was associated with lower odds of mortality, but was not associated with AKI (OR = 0.21; p < 0.001). Lower postmenstrual age independently predicted vancomycin-associated AKI. Lower neonatal weight and AKI were associated with increased mortality, reinforcing the importance of individualized monitoring during vancomycin therapy.

Introduction: Postpartum urinary retention (PUR) is the inability to void voluntarily after delivery, with overt PUR defined as no spontaneous voiding within six hours post-vaginal delivery or requiring re-catheterization post-cesarean. In rural Nepal, PUR risks bladder overdistension, detrusor failure, and renal complications due to limited monitoring. This study assessed the prevalence of overt PUR and risk factors, including primigravida status, gestational age, neonatal birth weight, delivery mode, perineal tears, episiotomy, vulvar edema, and prepartum catheterization. Methods: This was a Prospective cross-sectional study conducted at Karnali Academy of Health Sciences, Jumla, from November 2022 to July 2023 among postpartum females. Data were collected using a pre-formatted pro forma after obtaining informed consent. Sampling was conducted using a convenience sampling technique, with a sample size of 78 (expected prevalence: 5.37%; 95% CI; 5% margin of error). Analysis was done in Microsoft Excel and SPSS v16.0. Chi-square, Fisher’s exact, and Mann-Whitney U tests were applied based on the data distribution. Results: Overt PUR prevalence was 3 (3.8%). Primigravida was significantly associated (p=0.027). No significant associations were observed with age (median 24 years), gestational age (91% at term, p=0.750), neonatal weight (median 3000 grams, p=0.471), delivery mode (67% vaginal, p=0.547), perineal tears (first degree, p=0.99, second degree, p=0.280), episiotomy (p=0.216), vulvar edema (p=0.99), or catheterization (p=0.547). Conclusion: Primigravida elevates overt PUR risk in rural settings; recommend targeted postpartum screening for primipara to prevent complications.

Neonatal hypernatremic dehydration (NHD) is a dangerous disease that can lead to hospitalization of the infant, serious complications, and death. Despite the significant advantages of breast milk for both the mother and the baby, some neonates who are exclusively breastfed experience malnutrition in the first few days. This study aims to evaluate the clinical presentations, maternal and neonatal risk factors, and preventive strategies for hypernatremic dehydration in term and late-preterm infants who were exclusively breastfed. In this study, neonates who were hospitalised with the diagnosis of hypernatremic dehydration in the Neonatal Intensive Care Unit of Mardin Training and Research Hospital between 2019 and 2023, who were exclusively breastfed after birth, whose gestational age was 35 weeks and above, and whose serum sodium concentration was measured ≥150 mEq/L were retrospectively evaluated. Statistical analyses were performed using SPSS 25.0 software. A total of 141 newborns diagnosed with hypernatremic dehydration were included in the study. The mean age at presentation was 4 (1-20) days, and 53% of the patients were male. The mean birth weight was 3248.16±491.05 g, while the mean admission weight was 2885.67±477.61 g, indicating a significant weight loss of 11.33±7.46%. The mean maternal age was 28.95±6.22 years, and 41% of deliveries were by caesarean section. Transcranial ultrasonography was normal in 97.2% of the patients, while 2.8% had signs of haemorrhage or oedema. The most common presenting complaint was malnutrition (46.8%), followed by jaundice (41.1%). Awareness of NHD among both mothers and healthcare personnel is the most important factor. Calling babies for early postnatal check-ups, close monitoring of neonatal weight loss, and encouraging successful breastfeeding techniques may reduce hospitalization rates.

Gestational weight gain (GWG) and birth weight (BW) have a multifactorial etiology, which makes identifying the most influential determinants difficult. The association between variants of the FTO and LEPR genes has been explored as contributing factors to obesity in various age groups; however, their role in GWG and BW in adolescent mothers and their offspring is uncertain. To determine whether the presence of polymorphisms rs9939609 (FTO) and rs1137101 (LEPR) is associated with gestational weight gain and newborn weight in a cohort of adolescent mothers. Methods: A prospective cohort study of 305 mother-child dyads was conducted between 2020 and 2024. Genotyping of the single nucleotide variants (SNVs) rs9939609 of the FTO gene and rs1137101 of the LEPR gene was performed using real-time PCR and high-resolution melting analysis (qPCR-HRM), using maternal peripheral blood and umbilical cord blood samples. GWG, BW, energy intake, and other perinatal data were recorded and classified. Genetic data from 305 mother-offspring dyads were analyzed. The median maternal age was 16 years, and 71.4% had a normal pre-pregnancy body mass index (BMI). The most frequent genotypes were TT for FTO rs9939609 and AG for LEPR rs1137101. In both groups, the genotypic distribution significantly deviated from Hardy-Weinberg equilibrium (p < 0.0001). The AA genotype of FTO was associated with a higher probability of excessive gestational weight gain (GWG) after adjustment for pre-pregnancy BMI and dietary and sociodemographic factors. High protein and lipid intake increased the risk of excessive GWG, whereas adequate intake of carbohydrates and legumes showed a protective effect. An initial significant association was identified between the LEPR rs1137101 variant (AA allele) and low birth weight (LBW); however, this association was lost after adjustment for confounding factors. The FTO rs9939609 variant was significantly associated with GWG. On the other hand, the LEPR rs1137101 variant in the offspring showed an association with BW categorized by percentiles (in crude analysis), while the FTO variant showed no relationship with birth weight.

This study aims to examine the correlation between neonatal reactions and umbilical artery half peak systolic velocity deceleration time (UA HPSVDT). For the research, participants were selected among 24-40 weeks pregnant women. While the study group consisted of those with fetal growth restriction (FGR), the control group included the rest. To determine UA HPSVDT and certain Doppler parameters, Doppler ultrasonography was used and within a week before delivery, the middle cerebral artery (MCA Doppler was obtained). Likewise, a peri-operatively taken blood sample made it possible to determine Cord blood pH. Apgar scores of neonates were assessed within the 1-5th minutes. In terms of fetal weight, cord blood pH, 1st and 5th minute Apgar scores and UA HPSVDT (for all parameters p < 0.01), a significant statistical difference was found between FGR and control groups. On the other hand, a significant correlation among neonatal weight, cord blood pH, 1-5th minute Apgar scores and UA HPSVDT were observed. It was clear that in the FGR group (for all parameters p < 0.01), the Apgar scores, cord blood pH, and neonatal weight decreased as the UA HPSVDT decreased. However, between UA HPSVDT and other variables, no remarkable statistical significance was determined. The research makes it clear that the UA HPSVDT time is related to umbilical artery of blood pH levels and post-natal Apgar scores; therefore, it can be useful for efforts to minimize the rate of mortality and morbidity in perinatal practices.

Objective: To investigate the relationship between the number of previous implantation failures (IFs) and embryo ploidy status, as well as subsequent clinical outcomes, in women with recurrent implantation failure (RIF) undergoing preimplantation genetic testing for aneuploidy (PGT-A). Methods: This retrospective cohort study included 422 women with RIF who underwent their first PGT-A cycle between 2017 and 2022. Participants were stratified by maternal age (<38 years, n = 292; ≥38 years, n = 130) and by the number of previous IFs, categorized as 3, 4, or ≥5. The primary outcomes were embryo ploidy rates (euploidy, aneuploidy, and mosaicism). Secondary outcomes included reproductive outcomes after single euploid blastocyst transfer (biochemical pregnancy, clinical pregnancy, ongoing pregnancy, live birth, and pregnancy loss) and neonatal birth weight. Results: Women aged ≥38 years had a significantly lower euploidy rate than those <38 years (24.8% vs. 47.3%, p < 0.001). Ploidy distribution did not differ significantly across IF categories. Among women aged <38 years with ≥5 IFs, a greater number of previous embryo transfer attempts was independently associated with higher odds of live birth after euploid embryo transfer (adjusted OR = 1.258, 95% CI: 1.051-1.505; p = 0.012). Neonatal weight did not differ significantly across IF categories. Conclusions: The number of previous IFs was not independently associated with embryo ploidy or clinical outcomes after euploid transfer, whereas advanced maternal age was strongly associated with a lower likelihood of obtaining euploid embryos. In younger women with ≥5 IFs, a greater number of previous embryo transfer attempts was associated with live birth after euploid transfer; however, this exploratory subgroup finding should be interpreted cautiously and requires prospective validation. Because this study did not directly evaluate therapeutic strategies, any potential role for individualized endometrial evaluation or optimization should be considered as hypothesis-generating rather than supported by the present data.

ZFHX3, a multifunctional transcription factor, plays pivotal roles in a variety of physiological and pathological processes, including neuronal differentiation, development, atrial fibrillation, and cancer. Notably, homozygous deletion of Zfhx3 is embryonic lethal, whereas its hemizygous deletion results in reduced neonatal body weight and increased preweaning mortality in mice. Also, a deletion mutation in Zfhx3 is significantly associated with reduced litter size, a key reproduction-related trait in goats, suggesting that ZFHX3 is involved in reproductive development. However, its specific function in female reproduction remains unclear. Given that oocyte meiosis is a fundamental process in female reproduction, we investigated the role of Zfhx3 in this process. We performed siRNA microinjection, immunofluorescence staining, chromosome spreading, Western blotting and other experiments to investigate the function of Zfhx3 in mouse oocyte meiosis. We found that Zfhx3 was present in both the nucleus and cytoplasm in GV oocytes and became predominantly localized to the cytoplasm after germinal vesicle breakdown. Knockdown of Zfhx3 caused failure of first polar body extrusion due to sustained activation of the spindle assembly checkpoint (SAC). Zfhx3-deficient oocytes were defective in spindle assembly, microtubule-kinetochore attachment, and chromosome segregation during meiosis I, resulting in aneuploidy in MII oocytes. These defects could be ameliorated by ectopic expression of Zfhx3 mRNA. Our findings provide evidence for an essential role of Zfhx3 in spindle assembly and chromosome segregation during mouse oocyte meiosis I, and provide a mechanistic basis for its mutations in female reproductive disorders.

The emergence of bipedal locomotion during human evolution has considerably reshaped the hominin pelvis, which also impacted the pelvic floor musculature. Among early hominins, australopithecines have an anteroposteriorly narrow, transversely wide bony pelvis. This study investigates whether this particular shape of the birth canal weakens the pelvic floor during childbirth in these hominins and if the pelvic floor contributes to rotational birth. As such, we explored the stress values at the pelvic floor that occur during the descent of the fetal head, using 3D models of extant humans based on the reconstruction of pelvic-fetal dyads from hospital records with known birth outcomes. We then compared this to 3D models based on pelvic reconstructions of A.L. 288-1 (Australopithecus afarensis), Sts 14 (A. africanus), and MH2 (A. sediba) using a 110 g neonatal brain weight. The early hominin pelvic floor was reconstructed by warping the pelvis and pelvic floor extracted from an MRI of a modern adult woman to the australopithecine pelvic morphology. Our results suggest that the range of stress values on the pelvic floor is comparable between humans (5.3-10.5 MPa) and australopithecines (4.9-10.7 MPa), suggesting that their females may have been exposed to a similarly high risk of perineal laceration during vaginal delivery as modern humans. None of the four australopithecine simulations, and only one out of two modern human simulations, showed an internal rotation of the fetal head into an occiput anterior orientation, suggesting this movement is particularly complex and involves influences beyond just the levator ani musculature.

IntroductionLactation is the final pathway for the maternal metabolism to influence the neonate. Studies in women and animals have shown maternal body condition affecting milk composition and/or offspring growth and adiposity. The effect of the body condition of the dam on neonatal puppy growth rate has never been examined, despite a growing population of overweight breeding dogs. This study aimed to compare the milk macronutrient composition and puppy growth rate during the neonatal period between overweight and lean bitches.MethodsA total of 16 litters from 15 medium- to large-breed client-owned dogs were enrolled after whelping. Dams were classified into lean (LE, body condition score [BCS]: 4–5/9, n = 8) and overweight (OW, BCS: 6–7/9, n = 8) groups. Milk was collected from bitches at 5 timepoints (0.5, 1, 2, 3, and 4 weeks of lactation). Growth curves of a total of 106 puppies born alive to LE (n = 58) and OW (n = 48) mothers and exclusively nursing on the dam were analyzed until 21 days of age. Birth weight, daily body weights, average daily weight gain (ADGg), average daily percent gain (ADG%), average daily percent gain from birth (ADGB%), and total percent gain from birth (TGB%), as well as milk dry matter, crude protein, sugar, fat, ash, and calculated gross energy, were analyzed using a mixed-model analysis of variance (ANOVA); the significance level was set at a p-value of <0.05.ResultsPuppy birth weights were unaffected by litter size and the dam BCS. Puppy growth curves and TGB% were significantly different between the two maternal groups. ADGg, ADG%, and ADGB% were significantly higher in OW dam puppies on day 2 and day 4 after birth. Puppies born heavier remained heavier, while ADG% and ADGB% were inversely related to birth weight. Litter size had no effect on these growth parameters. Swimmer puppy syndrome was observed in eight puppies from three OW dam litters. Dam BCS had no significant effect on milk macronutrients in the first 4 weeks of lactation.DiscussionIn conclusion, despite the similar day-to-day neonatal body weights between the maternal groups, puppies from OW dams grew differently, gaining more weight in the first week of life. Factors other than milk macronutrient composition are likely responsible for these differences.

Low birth weight in neonates born to mothers with hypertensive disorders of pregnancy: A retrospective observational study

Background:Postpartum hemorrhage (PPH) is a global health concern and remains the leading cause of maternal death worldwide. Studies assessing the prevalence of PPH and related maternal risk factors in the United Arab Emirates are scarce.Objectives:This study aims to evaluate the prevalence of PPH and associated maternal risk factors in women in the Emirate of Abu Dhabi.Design:Prospective mother and child cohort study.Methods:This analysis was based on data from the Mutaba’ah Study. The sample composed of 2937 women who underwent normal vaginal delivery (2017–2023). Descriptive analysis was performed to compare the characteristics between patients with PPH and those without PPH. Logistic regression analysis was performed to identify maternal characteristics associated with PPH.Results:Overall prevalence of PPH was 4.3% (n = 125, 95% CI: 3.6%–5.1%). The median total blood loss among women with PPH was 700 mL (interquartile range (IQR): 600–1000), and 20% of affected women required blood transfusion. No observed significant difference between those with and without PPH regarding maternal education, body mass index, and comorbidities (p > 0.05). Women with PPH were younger at pregnancy (median (IQR): 28.4 (23.8, 34.3) versus 29.8 (25.4, 34.6), p = 0.022), and had higher proportions of assisted vaginal delivery (13% versus 3.7%, p < 0.001) compared to those without PPH. Women with PPH had significantly greater neonate weight compared to women without PPH (median (IQR): 3210 (2975, 3490) versus 3140 (2865, 3430), p = 0.029). In the adjusted analysis, women who underwent assisted vaginal delivery (adjusted odds ratio, aOR (95% CI): 2.82 (1.60, 4.97)), and those with increased neonate weight (aOR per 100 g: 1.06 (1.01, 1.10)) remained significantly associated with developing PPH.Conclusion:Findings of this study underscore the importance of early identification of women at increased risk of PPH to provide tailored obstetric care. Improved management protocols and increased awareness among healthcare providers are essential to mitigate the risk of PPH and ultimately enhance maternal outcomes.

BACKGROUNDUtero-placental insufficiency seen in perinatal asphyxia may adversely affect left ventricular (LV) geometry.AIMTo document the LV mass values in perinatal asphyxia and to elicit associated factors.METHODSThis was a cross-sectional study conducted in a tertiary health facility among newborns with perinatal asphyxia. Echocardiography was used to compare the LV mass of 84 new-borns with perinatal asphyxia with the LV mass of 48 new-borns without perinatal asphyxia matched for age. The data was analysed using SPSS version 25 (IBM, United States).RESULTSThe mean LV mass (7.9 ± 2.3 g) of perinatal asphyxia is lower than control (10.1 ± 0.7 g) P = 0.001. New-borns with severe perinatal asphyxia had the lowest mean LV mass (7.1 ± 1.5), while the moderate group had the highest (8.8 ± 2.5), with the Analysis of Variance (ANOVA) result of F = 1.26 and P = 0.289. The mean LV mass was highest on day 1 (8.1 ± 2.5) and slightly lower on days 2 and 3 (both 7.7 ± 1.9 and 7.7 ± 2.0, respectively). Though ANOVA result (F = 2.47, P = 0.7282) indicates no significant relationship between the age of the newborn and LV mass, a weak positive correlation was observed between LV mass and gestational age which is statistically significant (r = 0.269 P = 0.028). A moderate positive correlation between the LV mass and birth weight of newborn was observed. This is statistically significant (r = 0.610, P = 0.001). There was weak negative correlation (r = -0.10, P = 0.752), between LV mass and age of the newborn without perinatal asphyxia but a moderate positive correlation (r = 0.69, P = 0.015) was observed, between LV mass and weight in non-asphyxiated newborn.CONCLUSIONThis study showed that the LV mass in perinatal asphyxia was significantly lower than those without asphyxia. There was a direct correlation between LV mass and birth weight of neonates with perinatal asphyxia. Early detection of the cardiac disease, appropriate management and sustained reduction of birth asphyxia, and improved intra-partum quality of care are key.

Background & Objective: Physical, functional, and behavioral changes take place during adolescence. Pregnancy at adolescence can have a negative impact on the mother's and the fetus's health. The present study was conducted with aim to explore the maternal and fetal health outcome in adolescent pregnancies. Materials & Methods: This descriptive study was conducted on 100 adolescent pregnant who were admitted to Al-Elwiya Maternity Teaching hospital from 12 December 2024 to 1 March 2025. All the statistical procedures were tested at P ≤0.05. Results: In this study, 70% of participants were within age group (16-20) years. (67%) are related to their husbands. Most mothers experienced multiple pregnancies. The rates of abortion were notable. Regarding antenatal complications, anemia, hypertension, antepartum hemorrhage and stress incontinence were the significant complications that warrant attention. Moreover, 63% of deliveries were normal reflecting a generally favorable outcome for maternal health and 71% of them had labor inductions. Notably, uterine prolapse emerged as a highly significant complication during postnatal. Concerning the neonate outcomes, 84% of mothers, their neonate weight was between (2500-4000 gr) and 85% had good apgar score between (7-10). The majority of neonate had no congenital anomalies. Conclusion: This study highlights significant complications such as anemia, hypertension, and stress incontinence during pregnancy, while normal deliveries reflect positively on maternal health. Additionally, many postnatal complications were reported, the prominence of uterine prolapse as a highly significant for urgent attention and intervention. Finally, neonatal weight outcomes are good. However, they did not occurrence of congenital anomalies.

Association between unexplained recurrent pregnancy loss history and adverse neonatal outcomes among infertile women undergoing ART.

Neonatal adiposity is predominantly influenced by maternal hyperglycemia than obesity: Evidence from India.

Peripherally inserted central catheters (PICCs) have become universal in the care of neonatal patients. The use of an infant's length, weight, or post-menstrual age (PMA) may be an alternative method for measuring the depth of a PICC. The purpose of this study was to explore the relationships among neonatal length, weight, PMA, and PICC depth. Inpatient neonates admitted to a Nationwide Children's Hospital's Newborn Intensive Care Unit requiring placement of PICC were enrolled between January 2022 and April 2024. Standard PICC procedures were maintained. The research group corroborated appropriate PICC tip position of enrolled infants. Multivariable linear regression with robust standard errors was used to evaluate linear relationships between PICC insertion depth and current weight, current length, and PICC insertion site. Birth demographics of enrolled infants had gestational ages of 22 to 41weeks, weights of 450to 4160g, and lengths of 25.5 to 54.6 cm. Of the 182 infants enrolled, 72 underwent antecubital, 71 ankle, and 39 knee insertions. Three models were analyzed: current length, current weight, and PMA, demonstrating a significant association with PICC depth (P <.0001). Infant length proved to be the strongest predictor of PICC depth. This investigation provides an alternative method of measurement for estimating centimeter length of neonatal PICC depth. Further examination into the data by stratifying an infant's weight and length and/or gestational age may prove to be a more appropriate prediction model.

Abstract Background: The umbilical coiling index (UCI), defined as the ratio of vascular coils to cord length, has been proposed as an indicator of fetal well-being. Deviations from normal coiling—whether reduced (hypocoiling) or excessive (hypercoiling)—have been linked with unfavorable maternal and neonatal outcomes. However, its routine clinical use remains limited, particularly in low-resource environments. Objective: To evaluate the relationship between umbilical coiling patterns and perinatal outcomes in uncomplicated term singleton pregnancies. Methods: A cross-sectional observational study was carried out on women with term, cephalic, singleton gestations. The umbilical cord was examined immediately after delivery, and UCI was calculated based on length and number of vascular coils. Cases were grouped into hypocoiled, normocoiled, and hypercoiled categories according to percentile-based cutoffs. Maternal and fetal outcomes—including operative delivery, fetal distress, meconium-stained liquor, neonatal condition at birth, and need for NICU admission—were compared across groups. Associations with maternal comorbidities were also analyzed. Results: Cords with normal coiling formed the majority, while both under-and over-coiling patterns were associated with adverse pregnancy outcomes. Abnormal UCI correlated with higher rates of fetal compromise, low neonatal weight, increased NICU admissions, and growth restriction. Maternal complications, including hypertensive disorders and gestational diabetes, were also more frequent among abnormal coiling groups. Operative interventions, particularly cesarean deliveries, were more common in such cases. Conclusion: Umbilical coiling abnormalities serve as important predictors of perinatal risk. Incorporating UCI evaluation into obstetric assessment—postnatally and potentially during antenatal sonography—could enhance risk identification and support timely clinical decision-making, thereby improving maternal and neonatal outcomes.

Breast milk provides optimal nutrition for infants, with exclusive breastfeeding recommended for the first 6 months of life. Education during birth hospitalization is vital to promote exclusive breastfeeding. However, standardized references for neonatal weight loss rates based on data including national representative, multi-hospital, with different policies remain unavailable. Data of 4774 participants from 146 hospitals throughout Japan were obtained from the national growth survey. Among them, 3302 were eligible for the analysis. Daily exclusive breastfeeding rates and their associations with facility and individual characteristics during birth hospitalization were then analyzed. Additionally, weight loss percentile reference curves by delivery mode were established using the Lambda-Mu-Sigma method. The rate was 60.8% on day 0 and plateaued at approximately 25% on day 3. Being born in a facility with high exclusive breastfeeding rate (odds ratio [OR]: 333.3, 95% confidence interval [CI]: 15.2-7142, p < 0.0001), multiparity (OR: 1.9, 95% CI: 1.4-2.5, p < 0.0001), vaginal delivery (OR: 2.2, 95% CI: 1.6-3.1, p < 0.0001), and lower weight loss rate on day 3 (OR: 1.2, 95% CI: 1.1-1.2, p < 0.0001) were identified as independent factors, and facility-level differences accounted for 58.4% of the total variability for exclusive breastfeeding at discharge. Using the data from 831 neonates with exclusive breastfeeding at discharge, weight loss rate references were established. This study revealed Japan's nationwide daily exclusive breastfeeding rates during birth hospitalization and their significant influencing factors. The established references may be useful in promoting exclusive breastfeeding clinically.