Prevention of hypernatraemic dehydration in breastfed newborn infants by daily weighing

  • Gabriel Konetzny
  • Hans Ulrich Bucher
  • Romaine Arlettaz
Original Paper


Hypernatraemic dehydration, which predominantly appears in breastfed neonates, can cause serious complications, such as convulsions, permanent brain damage and death, if recognised late. Weight loss ≥10% of birth weight could be an early indicator for this condition. In this prospective cohort study from October 2003 to June 2005 in the postnatal ward of the University Hospital Zurich, Switzerland, all term newborns with birth weight ≥2,500 g were weighed daily until discharge. When the weight loss was ≥10% of birth weight, serum sodium was measured from a heel prick. Infants with moderate hypernatraemia (serum sodium = 146–149 mmol/l) were fed supplementary formula milk or maltodextrose 10%. Infants with severe hypernatraemia (serum sodium ≥150 mmol/l) were admitted to the neonatal unit and treated in the same way, with or without intravenous fluids, depending on the severity of the clinical signs of dehydration. A total of 2,788 breastfed healthy term newborns were enrolled. Sixty-seven (2.4%) newborns had a weight loss ≥10% of birth weight; 24 (36%) of these had moderate and 18 (27%) severe hypernatraemia. Infants born by caesarean section had a 3.4 times higher risk for hypernatraemia than those born vaginally. All newborns regained weight 24 h after additional fluids. Conclusion: In our study, one out of 66 healthy exclusively breastfed term neonates developed hypernatraemic dehydration. Daily weight monitoring and supplemental fluids in the presence of weight loss ≥10% of birth weight allows early detection and intervention, thereby preventing the severe sequellae of hypernatraemic dehydration.


Newborns Breastfeeding Dehydration Hypernatraemia 


  1. 1.
    American Academy of Pediatrics Policy Statement (2005) Breastfeeding and the use of human milk. Pediatrics 115:496–506. doi:10.1542/peds.2004-2491 CrossRefGoogle Scholar
  2. 2.
    Cohn A (2005) A simple method for assessing if weight loss is greater or less than 10%. Arch Dis Child 90:88. doi:10.1136/adc.2004.061507 PubMedCrossRefGoogle Scholar
  3. 3.
    Cooper WO, Atherton HD, Kahana M, Kotagal UR (1995) Increased incidence of severe breastfeeding malnutrition and hypernatremia in a metropolitan area. Pediatrics 96:957–960PubMedGoogle Scholar
  4. 4.
    Dewey KG, Nommsen-Rivers LA, Heinig MJ, Cohen RJ (2003) Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics 112:607–619. doi:10.1542/peds.112.3.607 PubMedCrossRefGoogle Scholar
  5. 5.
    Edmonson MB, Stoddard JJ, Owens LM (1997) Hospital readmission with feeding-related problems after early postpartum discharge of normal newborns. JAMA 278:299–303. doi:10.1001/jama.278.4.299 PubMedCrossRefGoogle Scholar
  6. 6.
    Escobar GJ, Gonzales VM, Armstrong MA, Folck BF, Xiong B, Newman TB (2002) Rehospitalization for neonatal dehydration: a nested case–control study. Arch Pediatr Adolesc Med 156:155–161PubMedGoogle Scholar
  7. 7.
    Harding D, Cairns P, Gupta S, Cowan F (2001) Hypernatraemia: why bother weighing breast fed babies? Arch Dis Child Fetal Neonatal Ed 85:F145. doi:10.1136/fn.85.2.F145a PubMedCrossRefGoogle Scholar
  8. 8.
    Harding D, Moxham J, Cairns P (2003) Weighing alone will not prevent hypernatraemic dehydration. Arch Dis Child Fetal Neonatal Ed 88:F349. doi:10.1136/fn.88.4.F349 PubMedCrossRefGoogle Scholar
  9. 9.
    Iyer NP, Srinivasan R, Evans K, Ward L, Cheung WY, Matthes JWA (2008) Impact of an early weighing policy on neonatal hypernatraemic dehydration and breast feeding. Arch Dis Child 93:297–299. doi:10.1136/adc.2006.108415 PubMedCrossRefGoogle Scholar
  10. 10.
    Laing IA, Wong CM (2002) Hypernatraemia in the first few days: is the incidence rising? Arch Dis Child Fetal Neonatal Ed 87:F158–F162. doi:10.1136/fn.87.3.F158 PubMedCrossRefGoogle Scholar
  11. 11.
    Livingstone VH, Willis CE, Abdel-Wareth LO, Thiessen P, Lockitch G (2000) Neonatal hypernatremic dehydration associated with breast-feeding malnutrition: a retrospective survey. CMAJ 162:647–652PubMedGoogle Scholar
  12. 12.
    Macdonald PD (2007) Postnatal weight monitoring should be routine. Arch Dis Child 92:374–375PubMedGoogle Scholar
  13. 13.
    Macdonald PD, Grant L, Ross SR (2003) Hypernatraemia in the first few days: a tragic case. Arch Dis Child Fetal Neonatal Ed 88:F350. doi:10.1136/fn.88.4.F350 PubMedCrossRefGoogle Scholar
  14. 14.
    Macdonald PD, Ross SR, Grant L, Young D (2003) Neonatal weight loss in breast and formula fed infants. Arch Dis Child Fetal Neonatal Ed 88:F472–F476. doi:10.1136/fn.88.6.F472 PubMedCrossRefGoogle Scholar
  15. 15.
    Maisels MJ, Gifford K (1983) Breast-feeding, weight loss, and jaundice. J Pediatr 102:117–118. doi:10.1016/S0022-3476(83)80305-9 PubMedCrossRefGoogle Scholar
  16. 16.
    Manganaro R, Mamì C, Marrone T, Marseglia L, Gemelli M (2001) Incidence of dehydration and hypernatremia in exclusively breast-fed infants. J Pediatr 139:673–675. doi:10.1067/mpd.2001.118880 PubMedCrossRefGoogle Scholar
  17. 17.
    McKie A, Young D, Macdonald PD (2006) Does monitoring newborn weight discourage breast feeding? Arch Dis Child 91:44–46. doi:10.1136/adc.2005.074484 PubMedCrossRefGoogle Scholar
  18. 18.
    Moritz ML, Manole MD, Bogen DL, Ayus JC (2005) Breastfeeding-associated hypernatremia: are we missing the diagnosis? Pediatrics 116:e343–e347. doi:10.1542/peds.2004-2647 PubMedCrossRefGoogle Scholar
  19. 19.
    Neifert MR (2001) Prevention of breastfeeding tragedies. Pediatr Clin North Am 48:273–297PubMedCrossRefGoogle Scholar
  20. 20.
    Oddie S, Richmond S, Coulthard M (2001) Hypernatraemic dehydration and breast feeding: a population study. Arch Dis Child 85:318–320. doi:10.1136/adc.85.4.318 PubMedCrossRefGoogle Scholar
  21. 21.
    Odeka EB (2003) Weighing of breast fed babies is important. Arch Dis Child Fetal Neonatal Ed 87:F158–F162, e-letter in response to LaingGoogle Scholar
  22. 22.
    Paul IM, Phillips TA, Widome MD, Hollenbeak CS (2004) Cost-effectiveness of postnatal home nursing visits for prevention of hospital care for jaundice and dehydration. Pediatrics 114:1015–1022. doi:10.1542/peds.2003-0766-L PubMedCrossRefGoogle Scholar
  23. 23.
    Rosenbloom AL (2004) Permanent brain damage from hypernatremic dehydration in breastfed infants: patient reports. Clin Pediatr (Phila) 43:855–857. doi:10.1177/000992280404300911 CrossRefGoogle Scholar
  24. 24.
    Savenije OEM, Brand PLP (2006) Accuracy and precision of test weighing to assess milk intake in newborn infants. Arch Dis Child Fetal Neonatal Ed 91:F330–F332. doi:10.1136/adc.2005.091876 PubMedCrossRefGoogle Scholar
  25. 25.
    Shroff R, Hignett R, Pierce C, Marks S, van’t Hoff W (2006) Life-threatening hypernatraemic dehydration in breastfed babies. Arch Dis Child 91:1025–1026. doi:10.1136/adc.2006.095497 PubMedCrossRefGoogle Scholar
  26. 26.
    UNICEF (1991) The Baby-Friendly Hospital Initiative. Ten steps to successful breastfeeding. Available online at:
  27. 27.
    van Dommelen P, van Wouwe JP, Breuning-Boers JM, van Buuren S, Verkerk PH (2007) Reference chart for relative weight change to detect hypernatraemic dehydration. Arch Dis Child 92:490–494. doi:10.1136/adc.2006.104331 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Gabriel Konetzny
    • 1
  • Hans Ulrich Bucher
    • 1
  • Romaine Arlettaz
    • 1
  1. 1.Clinic of NeonatologyUniversity Hospital ZurichZurichSwitzerland

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