Risk factors for excess weight loss and hypernatremia in exclusively breast-fed infants

Abstract

Data were prospectively obtained from exclusively breast-fed healthy term neonates at birth and from healthy mothers with no obstetric complication to determine risk factors for excess weight loss and hypernatremia in exclusively breast-fed infants. Thirty-four neonates with a weight loss ≥10% were diagnosed between April 2001 and January 2005. Six of 18 infants who were eligible for the study had hypernatremia. Breast conditions associated with breast-feeding difficulties (P < 0.05), primiparity (P < 0.005), less than four stools (P < 0.001), pink diaper (P < 0.001), delay at initiation of first breast giving (P < 0.01), birth by cesarean section (P < 0.05), extra heater usage (P < 0.005), extra heater usage among mothers who had appropriate conditions associated with breast-feeding (P < 0.001), mean weight loss in neonates with pink diaper (P < 0.05), mean uric acid concentration in neonates with pink diaper (P < 0.0001), fever in hypernatremic neonates (P < 0.02), and the correlation of weight loss with both serum sodium and uric acid concentrations (P < 0.02) were determined. Excessive weight loss occurs in exclusively breast-fed infants and can be complicated by hypernatremia and other morbidities. Prompt initiation of breast-feeding after delivery and prompt intervention if problems occur with breast-feeding, in particular poor breast attachment, breast engorgement, delayed breast milk "coming in", and nipple problems will help promote successful breast-feeding. Careful follow-up of breast-feeding dyads after discharge from hospital, especially regarding infant weight, is important to help detect inadequate breast-feeding. Environmental factors such as heaters may exacerbate infant dehydration.

Excessive weight loss in exclusively breastfed full-term newborns in a Baby-Friendly Hospital

“…Thus, the evaluation of other variables associated with weight loss and breastfeeding difficulties13 , 20 was not performed, which can be seen as a study limitation. Also, the longer duration of hospital length of stay after a cesarean delivery when compared to vaginal delivery would predispose to the observation of weight loss nadir in this first group 21.…”

“…, 12 In these studies, the factors associated with weight loss are multiple and among them is the cesarean delivery. On the other hand, there have been few studies in newborns that are exclusively breastfed3 , 13 and in Baby-Friendly Hospitals 1415 The aim of this study was to determine the risk factors for weight loss greater than 8% in full-term newborns that are exclusively breastfed in a Baby-Friendly Hospital.…”

Associated Factors with Neonatal Weight Loss After Birth

“…Despite the proven benefits of breastfeeding, dehydration and poor weight gain after birth are common among infants, who are breastfed. These conditions are often preventable and if diagnosed early, they will not have long-term effects on infants (14,22,23).…”

“…Weight loss rate among infants with hypernatremia has been reported from 8% to 30% (12). Hypernatremic dehydration is a potentially destructive condition, which occurs in infants, who lose weight excessively (13,14) and can cause serious medical complications and even death. Thus, identification of factors associated with EWL could be helpful in the prevention and treatment of complications (15).…”

“…Thus, identification of factors associated with EWL could be helpful in the prevention and treatment of complications (15). These factors, include increased length of hospital stay, female gender, high or low birth weight, the use of epidural analgesia (2), jaundice (16), providing no training to mothers in hospitals, pathological congestion of the breast, increased interval between childbirth and the first breastfeeding, and the use of an additional heater (14).…”