Neonatal hypernatremic dehydration associated with breast-feeding malnutrition: a retrospective survey.
BACKGROUND
Hypernatremic dehydration in neonates is a potentially devastating condition. Recent reports have identified breast-feeding malnutrition as a key factor in its pathophysiology.


METHODS
Using a theoretical framework for breast-feeding kinetics, a retrospective chart review of all neonates less than 28 days of age who were seen at either British Columbia's Children's Hospital or the Vancouver Breastfeeding Centre between 1991-1994 was conducted to identify and classify possible causes of breast-feeding malnutrition among neonates who developed hypernatremic dehydration.


RESULTS
Twenty-one cases hypernatremic dehydration were identified. Infant weight loss ranged from 8% to 30% of birth weight, and serum sodium levels ranged from 146 mmol/L to 207 mmol/L. In each case, maternal or infant factors (e.g., poor breast-feeding technique, lactation failure following postpartum hemorrhage and infant suckling disorders associated with cleft palate or ankyloglossia) that could interfere with either lactation or breast-feeding dynamics and account for insufficient breast milk intake were identified.


CONCLUSIONS
Prenatal and in-hospital screening for maternal and infant risk factors for breast-feeding malnutrition combined with early postpartum follow-up to detect excessive infant weight loss are important for the prevention of neonatal hypernatremic dehydration.
Livingstone
V H
VH
Department of Family Practice, University of British Columbia, Vancouver. vlivings@direct.ca
Willis
C E
CE
Abdel-Wareth
L O
LO
Thiessen
P
P
Lockitch
G
G
D001942:Breast Feeding / Q000009:adverse effects*; D001955:British Columbia / Q000453:epidemiology; D003681:Dehydration / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D006955:Hypernatremia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D007231:Infant, Newborn; D009748:Nutrition Disorders / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D018743:Perinatal Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors