Evaluation of Test Weighing for Identifying Excessive Weight Loss in Exclusively Breastfed Term Neonates: A Single-Center Observational Study

Objective: To evaluate the diagnostic performance of single-feed test weighing on postnatal days 2 and 3 in identifying excessive weight loss among exclusively breastfed term neonates and to examine its potential clinical utility in early breastfeeding assessment. Methods: This prospective, single-center observational study included 102 exclusively breastfed term neonates recruited at a tertiary care teaching hospital between January and March 2020. Breast milk transfer was estimated by measuring the difference between infant weights recorded immediately before and after breastfeeding. Serial neonatal weight measurements were obtained to assess postnatal weight changes. Receiver operating characteristic (ROC) curve analysis evaluated the discriminatory performance of test weighing at weight-loss thresholds of 7% and 10% of birth weight. Results: Among 102 neonates, 28 (27.45%) experienced weight loss exceeding 10% of birth weight, with a maximum documented loss of 18%. Mean estimated milk transfer increased from 11.70±10.68 mL on day 2 to 13.28±7.80 mL on day 3. The area under the ROC curve ranged from 0.460 to 0.544, indicating poor discriminatory performance, with no statistically significant results. Although exploratory milk-transfer cut-offs of 9.5 mL and 10.5 mL were identified for days 2 and 3, respectively, inconsistencies in the reported diagnostic estimates precluded reliable clinical interpretation. Conclusion: Single-feed test weighing demonstrated limited accuracy in identifying neonates experiencing excessive weight loss. Serial weight monitoring, clinical assessment, and structured breastfeeding evaluation remain essential. Larger prospective studies employing precision weighing and validated diagnostic thresholds are warranted.