Breastfeeding-Associated Hypernatremia: Are We Missing the Diagnosis?

Moritz, Michael L.; Manole, Mioara D.; Bogen, Debra L.; Ayus, Juan Carlos

doi:10.1542/peds.2004-2647

Cited by 110 publications

(95 citation statements)

References 43 publications

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“…However, it is difficult to make comparisons due to differences in the organisation of medical care (such as the time of discharge, organisation of out-patient follow-up) in the individual countries, differences in the populations studied and varying study inclusion criteria. We did not find a correlation between the serum sodium level and the degree of weight loss, as described in the literature [18]. This may possibly be explained by the low number of dehydrated newborn infants.…”

Section: Discussioncontrasting

confidence: 61%

“…For those with severe hypertonic dehydration defined as sodium values ≥150 mmol/l, the incidence was 0.6%. In the literature, the incidence for hypertonic dehydration varies widely [9,16,18]. However, it is difficult to make comparisons due to differences in the organisation of medical care (such as the time of discharge, organisation of out-patient follow-up) in the individual countries, differences in the populations studied and varying study inclusion criteria.…”

Section: Discussionmentioning

confidence: 99%

“…Dehydration is usually defined as a weight loss of more than 10% of the birth weight [2,10,16]. The data currently available are very variable with respect to the incidence reported [3,8,10,15,16,18,20]. The studies cannot be compared with one another due to large differences in study designs and the populations examined, and due to the differing practices of various countries concerning medical care of the newborn.…”

Section: Introductionmentioning

confidence: 99%

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Prevention of hypernatraemic dehydration in breastfed newborn infants by daily weighing

2008

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Hypernatraemic dehydration, which predominantly appears in breastfed neonates, can cause serious complications, such as convulsions, permanent brain damage and death, if recognised late. Weight loss ≥10% of birth weight could be an early indicator for this condition. In this prospective cohort study from October 2003 to June 2005 in the postnatal ward of the University Hospital Zurich, Switzerland, all term newborns with birth weight ≥2,500 g were weighed daily until discharge. When the weight loss was ≥10% of birth weight, serum sodium was measured from a heel prick. Infants with moderate hypernatraemia (serum sodium=146-149 mmol/l) were fed supplementary formula milk or maltodextrose 10%. Infants with severe hypernatraemia (serum sodium ≥150 mmol/l) were admitted to the neonatal unit and treated in the same way, with or without intravenous fluids, depending on the severity of the clinical signs of dehydration. A total of 2,788 breastfed healthy term newborns were enrolled. Sixty-seven (2.4%) newborns had a weight loss ≥10% of birth weight; 24 (36%) of these had moderate and 18 (27%) severe hypernatraemia. Infants born by caesarean section had a 3.4 times higher risk for hypernatraemia than those born vaginally. All newborns regained weight 24 h after additional fluids. Conclusion: In our study, one out of 66 healthy exclusively breastfed term neonates developed hypernatraemic dehydration. Daily weight monitoring and supplemental fluids in the presence of weight loss ≥10% of birth weight allows early detection and intervention, thereby preventing the severe sequellae of hypernatraemic dehydration.

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Section: Discussioncontrasting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevention of hypernatraemic dehydration in breastfed newborn infants by daily weighing

2008

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“…However, severe life threating hypernatremic dehydration is usually reported anecdotally in case studies (7,8), often with fatal outcome (9, 10). Hypernatremic dehydration in exclusively breastfed infants usually occurs between the first and the third week of life, and can be difficult to recognize clinically (11). Most infants are reported to present with jaundice or are lethargic, septic and irritable.…”

Section: Discussionmentioning

confidence: 99%

Severe hypernatremic dehydration in a breastfed infant

2016

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Objective -To report a rare case of hypernatremic dehydration in an exclusively breastfed infant. Case report -We present a term newborn, 14-day-old boy, exclusively breastfed, who was lethargic and severely dehydrated upon admission (35% birth weight loss). The newborn was found to have severe hypernatremic dehydration (Na + 197 mmol/l), acute renal insufficiency (Creatinine 273 µmol/l) and metabolic acidosis. Also, the blood culture result was positive. Intravenous rehydration and antibiotic therapy were started. After 22 days of hospitalization, the infant was discharged home in a good general condition. Now the child is 13 months old, he is healthy and no neurologic sequelae are noticed. Conclusion -Hypernatremic dehydration in newborns is a rare complication, which is dangerous, but also preventable. Prevention consists in educating mothers about successful breastfeeding techniques, and also early newborn reassessment after discharge from the hospital is mandatory.

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“…[1][2][3][4][5][6][7] Recent reports suggest incidence is increasing.1 Early detection of NHD is not always easy because of variable clinical presentation. 2,6 It has been reported that environmental factors causing increased imperceptible losses, 3 early postpartum discharge and inadequate feeding are recognized as most important causes of NHD.…”

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confidence: 99%

Hypernatremic dehydration in term and near-term neonates

Jain

Basu

2010

Indian J Pediatr

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Sir,Neonatal Hypernatremic dehydration, NHD in apparently healthy breastfed neonates by day 3-13 is well described in literature. [1][2][3][4][5][6][7] Recent reports suggest incidence is increasing.1 Early detection of NHD is not always easy because of variable clinical presentation. 2,6 It has been reported that environmental factors causing increased imperceptible losses, 3 early postpartum discharge and inadequate feeding are recognized as most important causes of NHD. 4 We present a series of 30 cases of apparently healthy neonates, >34wk of gastation age and or 1.8 Kg of birthweight, discharged by day 2 in case of vaginal delivery and by day 4 to 5 in cesarean section. Thus presented over a period of one year with features quite similar to that of sepsis but on investigations finally diagnosed and managed as hypernatremic dehydration without sepsis. They were considered to have NHD only if weight loss was >10% of the birth weight and or >5% in 24 hours and serum sodium concentration was >149 meq/l at presentation. Babies who were sick looking, had respiratory distress, shock, received special medical treatment or had major congenital malformations were not included. Sepsis was ruled out in all the babies with laboratory investigations.Out of all, 24 babies were born to primigravida mother and cesarean section rate was 60%. Mean day of presentation was 5.30 ± 2.33 and mean birth weight of these babies was 2.63 ± 0.398 Kg, mean weight loss was 15.74±5.072% and serum sodium values of 153.50 ± 9.78 meq/l. Presenting clinical features were; fever and poor feeding in 24 cases, decreased urine output in 22, lethargy in 19, constipation and icterus in 7 cases and seizures in 1. 62% mothers complained of inadequate lactation due to nipple anomalies or perception of not enough milk.Primiparous mothers presented late (p=0.011) with more weight loss (p=0.026) and hypernatremia (p=0.005). 2-tailed significance of weight loss with serum sodium (p=0.000), blood urea (p=0.03) and serum creatinine (0.036) was obtained. There was significant correlation between day of presentation and weight loss (p=0.034). The same variables were compared between babies born via vaginal delivery and cesarean section. There was no significant difference in two groups other than hypernatremia, which was more in babies born to cesarean section mothers (p=0.061).Summer months were taken as April-Sep and winter months as Oct-Dec. 83.5% cases were reported in summer months. Clinical symptoms were same in both summers and winters with significantly more (p=0.051) weight loss in summer months. Management was done by slow rehydration with 5% dextrose in N/2 saline. Breastfeeding was promoted and continued during fluid correction.Early weighing coupled with appropriate lactation support and taking care of insensible losses in summers might result in early detection of cases of NHD.5 Breast examination during antenatal period and more counseling to first time and cesarean section mothers might decrease the incidence of NHD.

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Breastfeeding-Associated Hypernatremia: Are We Missing the Diagnosis?

Cited by 110 publications

References 43 publications

Prevention of hypernatraemic dehydration in breastfed newborn infants by daily weighing

Prevention of hypernatraemic dehydration in breastfed newborn infants by daily weighing

Severe hypernatremic dehydration in a breastfed infant

Hypernatremic dehydration in term and near-term neonates

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