Reference chart for relative weight change to detect hypernatraemic dehydration

Paula van Dommelen ^1*, Jacobus P van Wouwe ¹, Jacqueline M Breuning-Boers ¹, Stef van Buuren ¹ and Paul H Verkerk ¹

¹ TNO Quality of Life, Netherlands

^* To whom correspondence should be addressed. E-mail: p.vandommelen{at}pg.tno.nl.

Accepted 7 July 2006

Abstract

Objective: The validity of the rule of thumb that infants may have a weight loss of 10% in the first days after birth is unknown. We assessed the validity of this and other rules to detect breast-fed infants with hypernatraemic dehydration.

Design: A reference chart for relative weight change was constructed by the LMS method. The reference group was obtained by a retrospective cohort study.

Participants: 1,544 healthy, exclusively breast- fed infants with 3,075 weight measurements born in the Netherlands and 83 cases of breast-fed infants with hypernatraemic dehydration obtained from literature.

Results: The rule of thumb had a sensitivity of 90.4%, a specificity of 98.3%, and a positive predictive value of 3.7%. Referring infants if their weight change is below -2.5 SDS (0.6th centile) in the reference chart in the first week of life and the rule of thumb in the second week had a sensitivity of 85.5%, a specificity of 99.4% and a positive predictive value of 9.2%.

Conclusions: The rule of thumb is likely to have too many false positive results, assuming that for screening purposes the specificity needs to be high. A chart for relative weight change can be helpful to detect infants with hypernatraemic dehydration.

Keywords: breastfeeding, growth monitoring, hypernatraemic dehydration, infancy, weight loss

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