title: Evidence Based Weighing Policy during the First Week to Prevent Neonatal Hypernatremic Dehydration while Breastfeeding.
abstract: BACKGROUND
  Neonatal hypernatremic dehydration is prevented by daily neonatal weight monitoring. We aim to provide evidence-based support of this universally promoted weighing policy and to establish the most crucial days of weighing.
  
  
  METHODS
  Weight measurements of 2,359 healthy newborns and of 271 newborns with clinical hypernatremic dehydration were used within the first seven days of life to simulate various weighting policies to prevent hypernatremic dehydration; its sensitivity, specificity and positive predictive value (PPV) of these policies were calculated. Various referral criteria were also evaluated.
  
  
  RESULTS
  A policy of daily weighing with a cut-off value of -2.5 Standard Deviation Score (SDS) on the growth chart for weight loss, had a 97.6% sensitivity, 97.6% specificity and a PPV of 2.80%. Weighing at birth and only at days two, four and seven with the same -2.5 SDS cut-off, resulted in 97.3% sensitivity, 98.5% specificity and a PPV of 4.43%.
  
  
  CONCLUSIONS
  A weighing policy with measurements restricted to birth and day two, four and seven applying the -2.5 SDS cut-off seems an optimal policy to detect hypernatremic dehydration. Therefore we recommend to preferably weigh newborns at least on day two (i.e. ~48h), four and seven, and refer them to clinical pediatric care if their weight loss increases below -2.5 SDS. We also suggest lactation support for the mother, full clinical assessment of the infant and weighing again the following day in all newborns reaching a weight loss below -2.0 SDS.
authors.affiliation: Department of Life Style, Netherlands Organization of Applied Scientific Research TNO, Leiden, the Netherlands.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Boer
authors.affiliation: Neonatal Intensive Care Unit, Ankara Children's Hematology and Oncology Research Hospital, Ankara, Turkey.
authors.forename: Sevim
authors.initials: S
authors.lastname: Unal
authors.affiliation: Department of Child Health, Netherlands Organization of Applied Scientific Research TNO, Leiden, the Netherlands.
authors.forename: Jacobus P
authors.identifier: http://orcid.org/0000-0001-9273-6258
authors.initials: JP
authors.lastname: van Wouwe
authors.affiliation: Department of Life Style, Netherlands Organization of Applied Scientific Research TNO, Leiden, the Netherlands.
authors.forename: Paula
authors.initials: P
authors.lastname: van Dommelen
mesh_terms: D001835:Body Weight; D001942:Breast Feeding; D003681:Dehydration / Q000503:physiopathology / Q000517:prevention & control; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D006955:Hypernatremia / Q000503:physiopathology / Q000517:prevention & control; D007223:Infant; D007231:Infant, Newborn; D008297:Male