Breastfeeding-associated hypernatremia: are we missing the diagnosis?
OBJECTIVE
To assess the incidence and complications of breastfeeding-associated hypernatremic dehydration among hospitalized neonates.


METHODS
A retrospective study was conducted at Children's Hospital of Pittsburgh over a 5-year period, to identify otherwise healthy term and near-term (> or =35 weeks of gestation) breastfed neonates (<29 days of age) who were admitted with serum sodium concentrations of > or =150 mEq/L and no explanation for hypernatremia other than inadequate milk intake.


RESULTS
The incidence of breastfeeding-associated hypernatremic dehydration among 3718 consecutive term and near-term hospitalized neonates was 1.9%, occurring for 70 infants. These infants were born primarily to primiparous women (87%) who were discharged within 48 hours after birth (90%). The most common presenting symptom was jaundice (81%). Sixty-three percent of infants underwent sepsis evaluations with lumbar puncture. No infants had bacteremia or meningitis. Infants had hypernatremia of moderate severity (median: 153 mEq/L; range: 150-177 mEq/L), with a mean weight loss of 13.7%. Nonmetabolic complications occurred for 17% of infants, with the most common being apnea and/or bradycardia. There were no deaths.


CONCLUSIONS
Hypernatremic dehydration requiring hospitalization is common among breastfed neonates. Increased efforts are required to establish successful breastfeeding.
Moritz
Michael L
ML
Division of Nephrology, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. michael.moritz@chp.edu
Manole
Mioara D
MD
Bogen
Debra L
DL
Ayus
J Carlos
JC
D001049:Apnea / Q000209:etiology; D001919:Bradycardia / Q000209:etiology; D001942:Breast Feeding / Q000009:adverse effects*; D003681:Dehydration / Q000209:etiology; D006801:Humans; D006955:Hypernatremia / Q000175:diagnosis / Q000209:etiology*; D007231:Infant, Newborn; D015431:Weight Loss