hypernatremia and breastfeeding

[selvanr4]

My cousin's granddaughter has been diagnosed to have hypernatremia on 21 st postnatal day. The mother's breastmilk sodium is 45 .If the mother wants to breastfeed the baby how to go about after sodium becomes normal? Till what level we ask the mother not to breastfeed and supplement with formula? If the mother doesn't have mastitis what is the reason for high sodium in the milk?
thanks
selvan.r

[Stefan Johansson]

how is the weight of the infant?

Have never heard about a fully breastfed infant getting hypernatremic from breast milk only. But seen many infants with hypertonic dehydration. Due to nonestabl breastfeeding and lactation

[selvanr4]

baby has lost 1 kg weight. Now has regained around 500 gms
with iv fluids. Icterus has come down with phototherapy and fluids. Mother has been advised not to use breast milk. One case report i have seen in indian pediatrics on breastfed baby getting hypernatremia. I would like to whether stopping the milk is evidence or practice based?


----------------------------
Selvan.R
Erode, India

[JACK]

Relevant here:

Moritz ML, Manole MD, Bogen DL, Ayus JC. Breastfeeding-associated
hypernatremia: are we missing the diagnosis? Pediatrics. 2005 Sep;116(3):e343-7.
LINK TO DOWNLOAD (http://pediatrics.aappublications.org/cgi/reprint/116/3/e343)

Laing IA, Wong CM. Hypernatraemia in the first few days: is the incidence
rising? Arch Dis Child Fetal Neonatal Ed. 2002 Nov;87(3):F158-62. PubMed PMID:
12390982; PubMed Central PMCID: PMC1721477
LINK TO DOWNLOAD (http://fn.bmjjournals.com/content/87/3/F158.full.pdf+html)

Konetzny G, Bucher HU, Arlettaz R. Prevention of hypernatraemic dehydration in
breastfed newborn infants by daily weighing. Eur J Pediatr. 2009
Jul;168(7):815-8. Epub 2008 Sep 26. PubMed PMID: 18818944.
LINK -ABSTRACT (http://www.springerlink.com/content/h5376k1h32200793/)

Ozdogan T, Iscan M, Ellikcioglu C, Yildiz E. Hypernatraemic dehydration in
breast-fed neonates. Arch Dis Child. 2006 Dec;91(12):1041. PubMed PMID: 17119086;
PubMed Central PMCID: PMC2082999
LINK TO DOWNLOAD (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2082999/pdf/1041.pdf)

Caglar MK, Ozer I, Altugan FS. Life threatening hypernatraemic dehydration in
breast fed babies. Arch Dis Child. 2006 Oct;91(10):874. PubMed PMID: 16990364;
PubMed Central PMCID: PMC2066031.
LINK TO DOWNLOAD (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2082999/pdf/1041.pdf)

van Dommelen P, van Wouwe JP, Breuning-Boers JM, van Buuren S, Verkerk PH.
Reference chart for relative weight change to detect hypernatraemic dehydration.
Arch Dis Child. 2007 Jun;92(6):490-4. Epub 2006 Jul 31. PubMed PMID: 16880225;
PubMed Central PMCID: PMC2066175.
LINK TO DOWNLOAD (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2066175/pdf/490.pdf)

[selvanr4]

Thanks for the inputs. Baby took nearly 5 days to settle down. Mother didnt have confidence in her ability to feed. We counselled her by being with us for a day. Now she is feeding and the baby is gaining weight. She is asking me when she can join her husband in USA!
dr.r.selvan