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 *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome