Thanks to all who contributed to the brick-dust urine debate, including Jan
Barger who said this is important, and let's discuss it more.
Two replies that indicated personal observations in their own children and
not deemed to be serious:-
(1) at 4 and 5 days, milk came in late on Day 5
(2) at 3 - 4 months after baby had taken longest sleep of the day, 8 hours.
(3) I'll add to that, seen once in my eldest son at 7 months after nap (hot
weather).
Then four replies expressing concern:-
(1) good sign of concentrated urine, dehydration and/or inadequate intake,
should be seen by physician and have hydration and intake assessed
(2) crystals at 12 days in baby with undiagnosed heart problem
(3) common in first few days, beyond day 3 - 5 usually a sign of
dehydration, ensure baby is fed one way or another, once fluids
increase usually continue to see crystals for another 24 hours,
sign of kidney failure in adults
(4) sometimes seen as early as Day l. Recent case noted, seen in
2 diapers, disappeared as soon as milk came in on Day 4
Jan asks further questions - If cardinal sign dehydration wouldn't
this be mentioned somewhere? Is brick-dust a function of kidney
being unable to concentrate urine?
I'm wondering if we can work out some kind of protocol for this. For example
if brickdust urine is seen on Days 1, 2, 3, but if baby appears well
hydrated, not too jaundiced, is bright, active, and alert when awake, and
waking to feed every 2 - 3 hours, and swallowing is observed for several
minutes during breastfeeding, and if his weight loss does not exceed 7% then
we're on track, right?
If, on the other hand we note few wet, dark urine diapers (I'll never get
used to this word - nappies!) and then brick-dust from Day 3, 4, 5, 6, a
weight loss of 10% or more, little swallowing during breastfeeding, or not
breastfeeding at all for whatever reason, baby becoming lethargic, jaundice
down to palms and soles, sunken fontanelle, slow pinch-test on abdomen, then
- what??? I've seen various combinations of these red flags, and often the
paediatrician is simply not available.
Here's how I manage this, would like to run it past you, for comments or
better ways of doing it:-
(1) baby to see doctor/paed urgently, the same day if at all possible
(2) meanwhile, (or if doc/paed unavailable) obtain EBM if possible,
and feed to baby by easiest method, at the rate of 100ml/kg (Day 3),
120ml/kg (Day 4), 150ml/kg (Day 5), 180ml/kg (Day 6)
(3) if insufficient EBM available, top up with ABM to make up
the above amounts (with *great* reluctance, thinking
allergies vs dehydration!)
Question: if baby is already dehydrated, should some other
liquid be fed first (glucose water, plain boiled water?),
if so how much, for how long?
(4) close follow-up until age-appropriate urine/stool output achieved
and baby has regained weight-loss to above discharge weight
(say 7%)
(5) continue expressing/pumping breasts until baby breastfeeding well.
Let's keep it going, people - with 1100 opinions to choose from we can
surely come up with lots more!
Pamela, Zimbabwe
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