Nikki Lee <[log in to unmask]> wrote:

> Dear Friends:
> 
> I found this commentary by Kumral et al. (*Acta Paediatr 91* 2002;
> 1268-1275) and feel it is interesting enough to use my 3rd post of the day.
> 
> "In summary, these results suggest that unwanted pregnancy, disordered
> parenting styles, and high sodium levels in breast milk are risk factors for
> unsuccessful lactogenesis."

I don't have access to this paper, but is it surprising that women with
unwanted pregnancies (I note they say "unwanted", not "unplanned") are
less likely to breastfeed?

On sodium, if breastfeeding is not establishing well, the milk measures
higher in sodium concentration, so the correlation is also entirely
unsurprising. As far as I can tell from the research, higher milk sodium
is simply a correlate with poor lactogenesis, not a "cause" as such -
hypernatremic dehydration isn't "due to" high milk sodium levels. The
sodium concentration of milk naturally drop as the transition to mature
milk occurs. Low milk volume = higher sodium concentration. 

Hypernatremic dehydration in young infants is typically caused by
inadequate fluid intake, not by excessive sodium intake. It's lack of
water, not "salt poisoning", except in rare cases of artificial feeding
gone horribly wrong. 

If clinicians are trying to undermine breastfeeding by saying that
hypernatremic dehydration  is tantamount to "breastmilk poisoning", this
dynamic would seem to be functioning in much the same way that
breastmilk is being blamed for neonatal jaundice when it's actually _not
enough breastmilk_ that's actually the problem. Another case of
sacrificing breastfeeding on the altar of ignorance.

This paper is worth reading:

"Hypernatraemia in the first few days: is the incidence rising?"
I A Laing, C M Wong
Archives of Disease in Childhood Fetal and Neonatal Edition 2002;87:F158
<http://fn.bmj.com/cgi/content/full/87/3/F158>

Excerpted (emphasis is mine):

" [...] Anand et al28 studied the breast milk of one mother whose breast
fed baby presented at 15 days of age with a serum sodium of 192 mmol/l.
On day 18 the mother's breast milk had a sodium content of 31 mmol/l,
and on day 23 the sodium concentration was 28 mmol/l. It is tempting to
conclude that the high sodium content of the milk was the cause of the
problem. ***Nevertheless the infant was feeding for only five minutes
every four hours, and had lost 36% of birth weight in 15 days. It seems
unlikely that such a limited intake of high sodium content milk was
sufficient to raise the child's plasma sodium concentration to such a
degree. It is more probable that poor suckling by the infant caused the
elevated milk sodium concentration***. 

Kini et al29 reported on three infants presenting with hypernatraemic
dehydration whose mothers had high breast milk sodium concentrations,
but again the volumes of breast milk consumed were very small. All three
children were discharged on proprietary milk, and the authors,
incorrectly in our view, attributed the infants' problems to the high
sodium content of the breast milk. In one of the two cases described by
Rowland et al,6 the breast milk sodium concentration was also high, but
again the infant showed considerable weight loss. While the infant was
being breast fed by a surrogate mother, the sodium concentration of the
breast milk of the biological mother declined dramatically as the volume
produced increased. Thullen7 also studied a mother whose breast milk
volume was exceedingly low with a sodium concentration of 74 mmol/l.
During her child's rehydration period, she used a breast milk pump to
establish good milk volumes, and the sodium concentration fell to normal
levels over two weeks.

***Today the evidence suggests that the most common cause of
hypernatraemic dehydration is low volume intake of breast milk***."

Lara Hopkins

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