Significant weight loss and hypernatremia in exclusively breast-fed neonates

Daniel Jayaraj, Poornima Kumar, Peter Prasanth Kumar Kommu, Lalitha Krishnan


Background: Weight loss in the early neonatal period is a problem that often goes unrecognized. Weight loss of upto 5-7% of birth weight is normal but losses more that 10% may result in increased morbidity, especially hypernatremia.

Methods: Prospective cohort study of 900, exclusive breastfed inborn babies, >34 weeks gestation and >1800g born in a tertiary care hospital in South India. Babies who were discharged before 96 hours of life, admitted to intensive care and received phototherapy for >24hrs were excluded. Maternal and neonatal variables were collected, and daily weight loss percent was calculated. Data was entered in EPI-INFO and analysed. Independent sample t test was used to compare the means of two independent normally distributed sample groups, ANOVA was used to compare means of more than 2 variables, linear logistic regression was used to find out the relationship between significant weight loss and hypernatremia

Results: The mean birth weight of the cohort was 2937±438.4 g and the gestational age was 38±5weeks. The mean maximum weight loss for the entire cohort was 178.71g (±82.08 g) and the mean percent weight loss was 6.12% (2.69). The mean weight nadir of the entire cohort was 2758.32±425.67g. Mean serum sodium levels for all babies who lost >10% of their birth weight was 145.95 (±2.34) mmol/L

Conclusions: Early neonatal weight loss is a universal phenomenon though often unrecognized. Babies losing more than 10% of birth weight are at risk of morbidities like hypernatremia.


Exclusively breast fed, Hypernatremia, Weight loss

Full Text:



Noel-Weiss J, Courant G, Woodend AK. Physiological weight loss in the breastfed neonate: a systematic review. Open Med. 2008;2(4):99-110.

Martens PJ, Romphf L. Factors Associated with newborn in-hospital weight loss: comparisons by feeding method, demographics, and birthing procedures. J Hum Lact. 2007;23(3):233-41.

Boskabadi H, Maamouri G, Ebrahimi M, Ghayour-Mobarhan M, Esmaeily H, Sahebkar A, et al. Neonatal hypernatremia and dehydration in infants receiving inadequate breastfeeding. Asia Pac J Clin Nutr. 2010;19(3):301-7.

Grossman X, Chaudhuri JH, Feldman-Winter L, Merewood A. Neonatal weight loss at a US baby-friendly hospital. J Acad Nutr Diet. 2012;112(3):410-3.

Academy of breastfeeding medicine protocol committee. ABM clinical protocol #3: hospital guidelines for the use of supplementary feedings in the healthy term breastfed neonate, revised 2009. Breastfeed Med Off J Acad Breastfeed Med. 2009;4(3):175-82.

Shroff RRH. Life-threatening hyponatraemic dehydration in breastfed babies. Arch Dis Child. 2007;91(12):1025-6.

Gourley GR. Breast-feeding, neonatal jaundice and kernicterus. Semin Neonatol SN. 2002;7(2):135-41.

Preer GL, Newby PK, Philipp BL. Weight loss in exclusively breastfed infants delivered by cesarean birth. J Hum Lact. 2012;28(2):153-8.

Livingstone VH, Willis CE, Abdel-Wareth LO, Thiessen P, Lockitch G. Neonatal hypernatremic dehydration associated with breast-feeding malnutrition: a retrospective survey. Can Med Assoc J. 2000;162(5):647-52.

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;92(6):490-4.

Macdonald PD, Ross SRM, Grant L, Young D. Neonatal weight loss in breast and formula fed infants. Arch Dis Child-Fetal Neonatal Ed. 2003;88(6):F472-6.

Caglar MK, Ozer I, Altugan FS. Risk factors for excess weight loss and hypernatremia in exclusively breast-fed infants. Braz J Med Biol Res Rev. 2006;39(4):539-44.

Fonseca MJ, Severo M, Barros H, Santos AC. Determinants of weight changes during the first 96 hours of life in full-term newborns. Birth Berkeley Calif. 2014;41(2):160-8.

Martens PJ, Romphf L. Factors Associated with newborn in-hospital weight loss: comparisons by feeding method, demographics, and birthing procedures. J Hum Lact. 2007;23(3):233-41.

Bhat SR, Lewis P, David A, Liza SM. Dehydration and hypernatremia in breast-fed term healthy neonates. Indian J Pediatr. 2006;73(1):39-41.

Bajpai A, Aggarwal R, Deorari AK, Paul VK. Neonatal hypernatremia due to high breast-milk sodium. Indian Pediatr. 2002;39(2):193-6.

Chilton LA. Prevention and management of hypernatremic dehydration in breast-fed infants. West J Med. 1995;163(1):74-6.

Cooper WO, Atherton HD, Kahana M, Kotagal UR. Increased incidence of severe breastfeeding malnutrition and hypernatremia in a metropolitan area. Pediatr. 1995;96(5)(1):957-60.

Kaplan JA, Siegler RW, Schmunk GA. Fatal hypernatremic dehydration in exclusively breast-fed newborn infants due to maternal lactation failure. Am J Forensic Med Pathol. 1998;19(1):19-22.

Kini N, Zahn S, Werlin SL. Hypernatremic dehydration in breast-fed infants. Wis Med J. 1995;94(3):143-5.

Manganaro R, Mamì C, Marrone T, Marseglia L, Gemelli M. Incidence of dehydration and hypernatremia in exclusively breast-fed infants. J Pediatr. 2001;139(5):673-5.