Breast-feeding-associated hypernatremia: Retrospective analysis of 169 term newborns

Background: The aim of the present paper was to define the incidence, complications, morbidity and mortality of hypernatremic dehydration due to inadequate breast‐feeding in a neonatal intensive care unit. Methods: A retrospective study was carried out between 2002 and 2005, to identify the term breast‐fed neonates with serum sodium level ≥150 mEq/L at the Ministry of Health Ankara Diskapi Children’s and Research Hospital. Results: The incidence of hypernatremic dehydration secondary to inadequate breast‐feeding was 4.1%, occurring in 169 term infants among 4136 hospitalized term neonates with the following characteristics: mean gestational age, 39.1 weeks (37–42 weeks); birthweight, 3352 g (2200–4500 g); mother’s age, 26.1 years (17–38 years); weight loss, 15.9% (5.4–32.7%); proportion of spontaneous vaginal deliveries, 75.7%; and proportion of first‐time mothers, 74.6%. Major presenting symptoms were neonatal jaundice (47.3%) and poor infant suck (29.6%). The median sodium; blood urea nitrogen (BUN); and creatinine levels on admission were 155 mmol/L (150–194 mmol/L), 35 mg/dL (7–253 mg/dL), and 0.9 mg/dL (0.2–10 mg/dL), respectively. Major complications were as follows: acute renal failure, 82.8%; elevated liver enzymes, 20.7%; disseminated intravascular coagulation, 6.5%; brain edema, 5.2%; intracranial hemorrhage, 3.6%; cavernous sinus thrombosis, 1.2%; and bilateral iliac artery thrombosis, 0.6%. Ten patients (5.9%) developed seizure within the first 24 h of rehydration therapy with a mean sodium decrease of 11.9 mmol/L per day (4–19 mmol/L per day). Two patients (1.2%) died. There were positive correlation between weight loss and serum sodium, BUN, bilirubin levels (P 0.05). Conclusions: Hypernatremic dehydration in neonates due to inadequate breast‐feeding is a serious, potentially devastating and life‐threatening disorder, and can damage the central nervous system. Follow up of infants for adequate breast‐feeding is important. Pediatricians must maintain a high level of suspicion, especially in cases of pathologic infant weight loss after delivery.