Iatrogenic newborn weight loss: knowledge translation using a study protocol for your maternity setting

We recommend a prospective observational study with data collected about maternal fluids, neonatal output, and newborn weight measurements. The methods we suggest include specifics about recruitment, data collection, and data analysis.Quality assurance and research ethics considerations are described. We also share practical information that we learned from our original study. Ultimately, to encourage knowledge translation and research uptake, we provide a protocol and sound advice to do a research study in your maternity setting.It is expected that breastfed newborns will lose weight following birth [1-4]. Clinicians (e.g., dieticians, lactation consultants, nurses, and physicians) who work with breastfeeding women hold a number of assumptions about newborn weight change including: (a) weight measured within minutes of birth is an accurate baseline for calculating weight loss; (b) weight loss from baseline is due to insufficient intake (a lack of milk supply or transfer); and (c) weight loss past a certain threshold requires intervention which is often formula supplements [1-5]. Contrary to these assumptions, the newborn's weight loss may not be due to a lack of intake, but may be the result of increased neonatal output [6-9].There is research literature to support the proposition that some neonates are born with a fluid overload and that the resulting diuresis (i.e., correction of fluids) contributes to their weight loss [6-9]. The purpose of this paper is to provide a protocol for clinicians to collect and analyze data from their own maternity sites to determine whether newborns experience iatrogenic weight loss. This protocol is based on a research study that concluded that birth weight should not be baseline; rather a weight measured at 24 hours post birth should be baseline for assessing newborn weight change [9].This protocol can be used to test three hypotheses: during the first 24-72 hours postpartum there are positive associations among (a) maternal fluids