Article Text

  1. S MeloGomes1,
  2. C AlmeidaFernandes2,
  3. H Ramos3,
  4. E Fernandes4,
  5. M Santos4,
  6. C Neves4,
  7. O Nascimento4,
  8. A MarquesValido4
  1. 1Pediatrics Department, Centro Hospitalar Das Caldas Da Rainha, Caldas Da Rainha, Portugal
  2. 2Pediatrics Department, Centro Hospitalar de Setubal, EPE, Setubal, Portugal
  3. 3Pediatrics Department, Espírito Santo Hospital, Evora, Portugal
  4. 4Pediatrics Department, Dr Alfredo Da Costa Maternity, Lisbon, Portugal


Background In the last few years there has been an increase in case reports of hypernatremic dehydration in breast-fed newborns. Insufficient intake has an important role in the pathophysiology of this condition.

The aim of this study was to evaluate breast-fed neonates admitted for hypernatremic dehydration.

Methods Retrospective study conducted by clinical chart review of breast-fed neonates with hypernatremic dehydration, between March 2002–March 2008.

Results 19 cases were identified (0.44% of neonatal intermediate care hospitalizations): 47% female and 53% male. Annual distribution revealed a higher number of cases in 2008: 26.3% in only 3 months. BW ranged from 2370 g to 4145 g (median 3000 g), and gestational age from 35 w to 40 w (mean- 38 w). Vaginal delivery was the most frequent. Maternal age ranged from 16 to 38 years old (mean 29 y), the majority of mothers being primiparous (79%). Admissions were made through the emergency department in 68.4% of cases. Main reasons for seeking medical attention: poor oral intake (32%), weight loss (26%) and jaundice (26%). Age at admission ranged from 2 to 21 days (median-4 days). Percentage of weight loss: 6.7%–40%, median 11%. Dehydration signs were absent in 42%. Na+ values:146–196 mEq/L, median 152 mEq/L. Co-morbidities were found in 74% of patients, jaundice being the most frequent (100%). Intravenous fluids were administered in 89%. Acute neurological complications were found in 21%. There were no deaths.

Discussion Breast-feeding associated hypernatremic dehydration seems to be a consequence of breast-feeding difficulties in inexperienced mothers. This strengthens the need for better support from health care professionals in education and follow-up monitoring of breast-feeding techniques.

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