One of the downsides of all the attention that dehydration is getting is
that instead of using common sense altogether too many pediatricians are
going hog wild with septic workups for fever.

Okay, if the baby is not dehydrated, why does he need extra water?
Well, maybe the baby is a little dry, but does he need a septic workup
and transfer to the NICU for that?  In the old days, which are beginning
to look very comforting, when a baby in this situation got a little
fever, the nurses gave the baby some water or sugar water by bottle, and
the fever disappeared within an hour or so.  Only if it didn't did the
physician get called.  I don't see why we couldn't still do the same,
except: We help the mother's latch and use compression to help the baby
get more breastmilk.  If that doesn't work, we give the baby some sugar
water with a lactation aid.  Only if the fever does not come down
quickly, then we call the physician.

Who says that mild temperature elevation is abnormal in this situation?
Maybe it is, maybe it isn't.  One of the watchwords of pediatrics is
"children are *not* small adults".  I am sure neonatologists would agree
that "newborns are *not* small children".  I am not saying we should
ignore this, but it might just be a normal reaction, just like the
sodium rising is a normal finding on the second or third day of life.
It may be some physiologic response which encourages the baby to drink
more.

Why not sugar water?  Many babies do not like plain water.  I prefer
expressed milk, by all means, but it may not be easy to get.  Why would
I be worried about rebound glucose after sugar water.  This not to be
expected in a normal healthy newborn.  IV boluses of glucose may cause
rebound hypoglycemia, particularly in a baby who is producing lots of
insulin (infant of diabetic mother), but oral glucose?

If we are serious in our thinking, how can we offer formula?  If we
really believe that early exposure to cow's milk protein increases the
risk of diabetes, why are we so casual about giving formula as a
supplement in the early days.  In theory, one drink of cow's milk
formula could set off the trigger which eventually leads to juvenile
diabetes.  If the baby is not genetically at risk, this may make no
difference, but if he is, his risk of developing diabetes just increased
by a factor of 4 to 10.

A few drinks of sugar water in the first few days is not going to cause
hyponatremia.  These babies already have "high" sodiums (or sodia).

Jack Newman, MD, FRCPC