Impact of an early weighing policy on neonatal hypernatremic dehydration and breast feeding

Narayan P Iyer ^1*, Ramesh Srinivasan ¹, Karen Evans ², Louise Ward ², Wai-Yee Cheung ³ and Jean Matthes ¹

¹ Singleton Hospital, Swansea, United Kingdom
² Swansea NHS Trust, Swansea, United Kingdom
³ University of Wales, Swansea, United Kingdom

^* To whom correspondence should be addressed. E-mail: iyerprabhu{at}yahoo.co.in.

Accepted 4 April 2007

Abstract

Aims: To ascertain the impact of a policy of early weighing on the detection and severity of Neonatal Hypernatraemic Dehydration (NHD) and its effect on breast feeding rates in the short and medium term.

Methods: A policy of weighing infants at 72-96 hours was introduced from 1st July 2004. Two time periods were studied: pre policy and post policy (18 months each). Babies <28 days of age referred to hospital from the community who upon investigation had plasma sodium levels of > 145 mmol /L were identified. Age, plasma sodium level, percentage body weight loss at presentation, breast feeding rates at discharge, at 8 weeks and complications due to hypernatremia or its management were compared between the two groups.

Results: A total of 60 cases of NHD were identified; 23 pre policy and 37 post policy. Post policy, there was earlier recognition of NHD ( median 3 v/s 6 days post delivery), lower percentage weight loss (11 v/s 15 %), less sodium elevation (147 v/s 150 mmol/L), higher breast feeding rate at discharge (73 v/s 22%) and at 8 weeks (57 v/s 22%). All the differences were statistically significant with p< 0.01. There was 1 death in the pre policy group while there was no mortality in the post policy group.

Conclusions: Weighing babies early coupled with appropriate lactation support resulted in the early recognition of NHD, with less dehydration, less severe hypernatremia and higher breast feeding rates in the short and medium term.

Keywords: breast-feeding, dehydration, hypernatremia, neonate, weight

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