Neonatal hypernatremic dehydration associated with breast-feeding malnutrition: a retrospective survey

Background: Hypernatremic dehydration in neonates is a potentially devastat ing condition. Recent reports have identified breast-feeding malnutrition a s a key factor in its pathophysiology. Methods: Using a theoretical framework for breast-feeding kinetics, a retro spective chart review of all neonates less than 28 days of age who were see n at either British Columbia's Children's Hospital or the Vancouver Breastf eeding Centre between 1991-1994 was conducted to identify and classify poss ible causes of breast-feeding malnutrition among neonates who developed hyp ernatremic dehydration. Results: Twenty-one cases hypernatremic dehydration were identified. Infant weight loss ranged from 8% to 30% of birth weight, and serum sodium levers ranged from 146 mmol/L to 207 mmol/L. In each case, maternal or infant fac tors (e.g., poor breast-feeding technique, lactation failure following post partum hemorrhage and infant suckling disorders associated with cleft palat e or ankyloglossia) that could interfere with either lactation or breast-fe eding dynamics and account for insufficient breast milk intake were identif ied. Interpretation: 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 pre vention of neonatal hypernatremic dehydration.