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Newborn Wet and Soiled Diaper Counts and Timing of Onset of Lactation as Indicators of Breastfeeding Inadequacy

Department of Nutrition at the University of California at Davis, lanommsen{at}ucdavis.edu

M. Jane Heinig, PhD

Department of Nutrition at the University of California at Davis

Roberta J. Cohen, PhD

Department of Nutrition at the University of California at Davis

Kathryn G. Dewey, PhD

Department of Nutrition at the University of California at Davis

Using data from 242 exclusively breastfeeding mother-infant pairs, newborn elimination patterns were analyzed. Sensitivity (Se) and Specificity (Sp) of day 4 (72-96 hours) wet and soiled output, in addition to the timing of onset of lactation, in identifying cases of breastfeeding inadequacy (defined as neonatal weight loss 10% of birth weight) were examined. The usefulness of 2 measures in parallel was also explored. Median number of diapers (wet, soiled) on days 1, 4, and 7, respectively, was 2, 3; 5, 4; and 7, 6. The most efficient day 4 predictor of breastfeeding inadequacy was soiled diaper output 3 (Se = .75, Sp = .66). Sensitivity improved when used in parallel with delayed onset of lactation ( 72 hours); Se = .86 (95% confidence interval, .73-.99) and Sp = .59 (.55-.63). Fewer than 4 soiled diapers on day 4 when used in conjunction with delayed onset of lactation may be indicative of breastfeeding inadequacy, but low specificity will result in many false positives. J Hum Lact. 24(1):27-33.

Key Words: assessment • breastfeeding • milk intake • predictor • weight

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