Hypernatraemic dehydration in Jamaican breastfed neonates: a 12-year review in a baby-friendly hospital

Abstract

A 12-year retrospective review of neonates admitted with hypernatraemic dehydration to the neonatal unit of the University Hospital of the West Indies was conducted between 1 January 1990 and 31 December 2001. Twenty-four infants fulfilled the criteria for hypernatraemic dehydration. Nineteen (79%) women were either nulliparous or primiparous with a mean (SD) age of 26.9 (4.4) yrs. Modal length of hospital stay for mothers was 24 hrs. Twenty (83.3%) infants were exclusively breastfed. Mean (SD) age at presentation was 7.4 (3.8) days. Mean (SD) percentage weight loss between birth and presentation was 18.9% (6.3). Mean (SD) serum sodium at presentation was 164.8 (13.9) mmol/L. Babies visited at home by nurses had a lower mean serum sodium, were less dehydrated and were significantly less acidiotic. Their mean (SD) length of hospital stay was also significantly less [4.2 (1.4) days] than those who were not visited [7.9 (3.8) days] (p < 0.05). Complications occurred in 19 (79%) of infants and included renal failure (19, 79%), seizures (3, 13%) and intraventricular haemorrhage (1, 4%), and one died (4%). Hypernatraemic dehydration is an uncommon complication of failure to establish breastfeeding but is associated with severe morbidity and mortality. Education programmes are needed to increase awareness amongst health-care workers and mothers in order to prevent the problem.

Hypernatraemia in the breastfed infant

“…Is it a new phenomenon or has it been overlooked? 16 Trotman et al's paper 17 and other studies from the UK 4 and Canada 3 suggest that the condition is becoming more prevalent, possibly as recognition of the value of breastfeeding spreads. Failure of lactation probably always existed but, in societies where formula-feeding became the norm, it was common.…”

“…Trotman et al 17 show that Jamaican infants who were weighed, or just visited, at home within 3-5 days of birth drew attention to their condition through huge weight loss or their distressing appearance earlier than infants referred by their families. Can we successfully keep watch for significant breastfeeding failure without threatening mothers' confidence in their ability to feed their infants successfully?…”

“…exclusive) breastfeeding for the infants in their study. 17 Nevertheless, their range of 0-14 months suggests significant numbers of their subjects either failed to establish, or did not try to establish, effective lactation.…”

“…How do we recognise infants at risk of breastfeeding hypernatraemia without daily weighing, test-feeding, prolonged hospital stay and other past interferences with the mother-newborn dyad? Trotman et al 17 and others 3,4 highlight 'at-risk' mothers as primiparous, young and unsupported with short hospital stays and little contact with health personnel. There is little to distinguish at-risk infants although they may be small, sleepy and undemanding.…”

Content Validation of Nursing Diagnosis of Deficient Fluid Volume [Dehydration] in the Context of Neonatological Nursing

“…A study by Erdemir et al (2014) presents clinical characteristics accompanying hypernatraemic dehydration in newborns including: fever, hepatitis, weak suction, and restlessness. Similarly, Trotman et al (2004) and Uras et al (2007) report fever, weak suction, irritability, lethargy, sleepiness, hepatitis, vomiting, and low urine output. The characteristic of decreased urine output achieved a weighted score of 0.91 in our study.…”