Dear Folks:
    Pediatrics 1995 Nov;96(5 Pt 1):957-60


Increased incidence of severe breastfeeding malnutrition and hypernatremia in
a metropolitan area.

Cooper WO, Atherton HD, Kahana M, Kotagal UR.

Department of Pediatrics, University of Cincinnati College of Medicine, USA.

OBJECTIVE: To identify common characteristics among infants with
breastfeeding malnutrition in a region with an increasing incidence of
breastfeeding malnutrition. DESIGN. Retrospective case series. SETTING. A
361-bed regional tertiary care children's hospital in a 1.7 million
population metropolitan area. PATIENTS. Case series: five infants with severe
breastfeeding malnutrition and hypernatremia admitted to a tertiary care
children's hospital over a 5-month period. Retrospective case review: 166
infants admitted between 1990 and 1994 with the diagnosis of dehydration,
hypernatremia, or malnutrition. MAIN OUTCOME MEASURES. Maternal
characteristics, age at presentation, percent loss from birth weight, serum
sodium, average age at birth hospital discharge, neurologic, or
cardiovascular complications. RESULTS. Five infants were admitted to a
children's hospital over a 5-month period with severe breastfeeding
malnutrition and hypernatremia. The average weight loss at time of
readmission was 23% (+/- 8%) from birth weight. The average presenting sodium
was 186 +/- 19 mmol/L. Three suffered significant complications. From 1990
through 1994, there was a statistically significant (P < .05) annual increase
in the number of infants admitted with breastfeeding malnutrition and
hypernatremia. CONCLUSIONS. While breastfeeding malnutrition and
hypernatremia is not a new problem, this cluster of infants represents an
increase in frequency and severity of the problem and could be a consequence
of several factors, including inadequate parent education about breastfeeding
problems and inadequate strategies for infant follow-up.

The babies in this study had normal  urine specific gravities. Some of the
implications for breastfeeding support were that the mothers were feeding at
4-6 hour intervals, babies slept a lot,  babies were nursing 10 minutes and
then sleeping at breast, and breastfeeding classes were inadequate in that
they did not teach women about feeding cues and normal infant behavior.
    Warmly,
Nikki Lee RN, MSN, Mother of 2, IBCLC, CIMI
craniosacral therapy practitioner; childbirth educator
Elkins Park (a suburb of Philadelphia, Pennsylvania; northeastern USA)
supporting the WHO Code and the Mother Friendly Childbirth Initiative

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