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Reference chart for relative weight change to detect hypernatraemic dehydration


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: 1544 healthy, exclusively breast-fed infants with 3075 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 using 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 produce 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.

  • PPV, positive predictive value
  • RWC, relative weight change
  • SDS, standard deviation score
  • breast feeding
  • weight loss
  • growth monitoring
  • infancy
  • hypernatraemic dehydration

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