It’s 4am and a familiar voice sings through the phone. “Hi! I’m calling from the newborn nursery! I have a baby with a weight loss of 10%. Would you like us to start supplementing?”
For pediatric hospitalists who also cover well newborn units, the question of how much weight loss is concerning, when to supplement and with what is a constant predicament. The availability of the Newborn Weight Tool (NEWT) has provided a valuable evidence base for what we can expect with respect to weigh loss in neonates but questions remain. In this month’s issue of Hospital Pediatrics, Kair et al (10.1542/hpeds.2020-0037) used an established national network of well newborn units in the United States (US), the Better Outcomes through Research for Newborns (BORN) network to survey the BORN site representative for each institution and report on practices around supplementation. Interestingly, we don’t all agree on admission criteria to the well newborn unit with regards to birthweight and gestational age, for example.
The investigators highlight differences in practices around when to supplement (most commonly for weight loss >10%) and how to supplement (most use bottles). Most sites supplemented term infants with standard formula (63%) and donor breastmilk (28%). Authors note that the use of donor breastmilk in well newborn units in the US has increased. The American Academy of Pediatrics recommends the use of donor milk in late preterm infants when mother’s milk is not available but has not formally recommended donor milk for use in term infants. Participants’ perspectives on the perceived risks and benefits of donor milk in the qualitative portion of Kair et al’s study highlights the need for more research.
Although the study raises more questions than answers, knowing about the variation in approaches to supplementation amongst mostly academic affiliated well newborn units creates some transparency around practices but also helps identify opportunities for further research. For now, after reading this study, I will tell my morning caller that based on my recent reading, many clinicians in US well newborn nurseries will initiate supplementation with formula in a bottle for a weight loss of greater than 10% but I’ll be there in just a few hours and we can gather more information and discuss our options together with the family.