Ann Perry asks how a two day old baby could become hypernatremic, since the fluid reserves they are born with should cover them through the first couple of days on colostrum. I don't know any of the details on the baby Ann refers to, so my post is about a hypothetical baby based on lots that I have seen in my career. Some babies are born juicier than others. Some babies show signs of dehydration almost from birth - low skin turgor on the first day of life. These are often dysmature babies who really need a continuous supply of colostrum if they are to establish a normal fluid balance. Lots of times they will be able to manage because they have access to the breast without limits or hindrances and are able to communicate what they need, but if the mother doesn't know how important it is to let the baby just stay at the breast, or if the mother is unable to get baby well latched or to express and feed colostrum, these babies go downhill fast. Think of a scenario with a vacuum extraction or forceps for the 'fetal distress' that is not uncommonly seen in cases of placental insufficiency, a 6 pound (approx 2700 g), 21 inch (52 cm), term baby with a bruised head, no energy or fluid stores to draw on, and a mother whose large fleshy primiparous nipples are made even less protractile by the fact that she was given several liters of IV fluid during labor including some containing pitocin and who can't sit comfortably because of the generous episiotomy she had with the VE. They are at the precipice from the beginning and it takes almost nothing to push them over the edge. Sending babies home without either ascertaining that they are feeding well at the breast or having close, competent follow-up in place for the first few days after going home, is tantamount to child neglect, IMO. Babies have to be sent home in an approved car seat in many places, and sometimes they are kept in hospital if they can't maintain oxygen saturation for 20 minutes in that car seat, but what is done to make sure they can take in nourishment? (Rhetorical question, I know the answer, groan groan.) It is so damaging for the mother's confidence in her ability to feed, for the baby to be readmitted with a serious problem 'from breastfeeding' - not to mention how damaging it is for her confidence in herself as mother. And we haven't even mentioned how dangerous it can be for the baby. Just for the record, of course I don't think we should start measuring serum electrolytes routinely before discharge. We should redouble our efforts to ensure that mothers and babies are getting it together before they are cast out into the great unknown, because in virtually all cases the mother has what the baby needs and wants, and this problem is avoidable. I will also disclose that in my hospital, many of the house pediatricians (!!!) are quick to order FORMULA for these babies during the first 48 hours of life 'until the mother has milk', as they do not seem to know that formula actually subjects the baby to an obligate fluid loss, thus further endangering them and prolonging the problem. We're working toward applying for certification as Baby-Friendly so I expect this to change and I will be happier when it does. Rachel Myr Kristiansand, Norway *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html