title: Breastfeeding-Associated Hypernatremia: A Systematic Review of the Literature.
abstract: There are increasing reports on hypernatremia, a potentially devastating condition, in exclusively breastfed newborn infants. Our purposes were to describe the clinical features of the condition and identify the risk factors for it. We performed a review of the existing literature in the National Library of Medicine database and in the search engine Google Scholar. A total of 115 reports were included in the final analysis. Breastfeeding-associated neonatal hypernatremia was recognized in infants who were ≤ 21 days of age and had ≥ 10% weight loss of birth weight. Cesarean delivery, primiparity, breast anomalies or breastfeeding problems, excessive prepregnancy maternal weight, delayed first breastfeeding, lack of previous breastfeeding experience, and low maternal education level were significantly associated with breastfeeding-associated hypernatremia. In addition to excessive weight loss (≥ 10%), the following clinical findings were observed: poor feeding, poor hydration state, jaundice, excessive body temperature, irritability or lethargy, decreased urine output, and epileptic seizures. In conclusion, the present survey of the literature identifies the following risk factors for breastfeeding-associated neonatal hypernatremia: cesarean delivery, primiparity, breastfeeding problems, excessive maternal body weight, delayed breastfeeding, lack of previous breastfeeding experience, and low maternal education level.
authors.affiliation: Pediatric Department of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland.
authors.forename: Camilla
authors.initials: C
authors.lastname: Lavagno
authors.affiliation: Pediatric Department of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland.
authors.forename: Pietro
authors.initials: P
authors.lastname: Camozzi
authors.affiliation: Pediatric Department of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland.
authors.forename: Samuele
authors.initials: S
authors.lastname: Renzi
authors.affiliation: Pediatric Department of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland University Children's Hospital Berne and University of Berne, Switzerland.
authors.forename: Sebastiano A G
authors.initials: SA
authors.lastname: Lava
authors.affiliation: Pediatric Department of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland University Children's Hospital Berne and University of Berne, Switzerland.
authors.forename: Giacomo D
authors.initials: GD
authors.lastname: Simonetti
authors.affiliation: Pediatric Department of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland mario.bianchetti@pediatrician.ch.
authors.forename: Mario G
authors.initials: MG
authors.lastname: Bianchetti
authors.affiliation: Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Pediatric Emergency Department, Milan, Italy.
authors.forename: Gregorio P
authors.initials: GP
authors.lastname: Milani
mesh_terms: D001942:Breast Feeding / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006955:Hypernatremia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D007231:Infant, Newborn; D012307:Risk Factors; D015431:Weight Loss
keywords: breastfeeding; dehydration; hypernatremia; newborn infant; review