Published online August 31, 2005
PEDIATRICS Vol. 116 No. 3 September 2005, pp. e343-e347 (doi:10.1542/10.1542/peds.2004-2647)
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ELECTRONIC ARTICLE

Breastfeeding-Associated Hypernatremia: Are We Missing the Diagnosis?

Michael L. Moritz, MD*, Mioara D. Manole, MD{ddagger}, Debra L. Bogen, MD§ and J. Carlos Ayus, MD||

* Division of Nephrology
{ddagger} Emergency Medicine
§ General Academic Pediatrics, Department of Pediatrics, Children's Hospital Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
|| Division of Nephrology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas

Objectives. To assess the incidence and complications of breastfeeding-associated hypernatremic dehydration among hospitalized neonates.

Study Design. A retrospective study was conducted at Children's Hospital of Pittsburgh over a 5-year period, to identify otherwise healthy term and near-term (≥35 weeks of gestation) breastfed neonates (<29 days of age) who were admitted with serum sodium concentrations of ≥150 mEq/L and no explanation for hypernatremia other than inadequate milk intake.

Results. The incidence of breastfeeding-associated hypernatremic dehydration among 3718 consecutive term and near-term hospitalized neonates was 1.9%, occurring for 70 infants. These infants were born primarily to primiparous women (87%) who were discharged within 48 hours after birth (90%). The most common presenting symptom was jaundice (81%). Sixty-three percent of infants underwent sepsis evaluations with lumbar puncture. No infants had bacteremia or meningitis. Infants had hypernatremia of moderate severity (median: 153 mEq/L; range: 150–177 mEq/L), with a mean weight loss of 13.7%. Nonmetabolic complications occurred for 17% of infants, with the most common being apnea and/or bradycardia. There were no deaths.

Conclusion. Hypernatremic dehydration requiring hospitalization is common among breastfed neonates. Increased efforts are required to establish successful breastfeeding.

Key Words: breastfeeding • hypernatremia • dehydration • jaundice • neonate

Abbreviations: ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification • MWH, Magee-Womens Hospital

Accepted Apr 13, 2005.


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