Clinical profile of hypernatremia in exclusively breast-fed neonates

Sahana Devadas, Ranjitha C. R., Sarala Sabapathy, Mallesh K.


Background: Neonatal hypernatremia is a potentially lethal condition. This study was planned to find out the predisposing factors and outcome of hypernatremia in breast feed late preterm and term neonates.

Methods: In defined study period, neonates with serum sodium level >145mmol/L, who satisfies all the inclusion criteria are included in the study.  The data was collected using a proforma which included clinical symptoms, risk factors for neonatal hypernatremia in addition to laboratory data.

Results: The results demonstrated hypernatremia in 63 neonates with mean age of presentation being 4.5 days, mean sodium level of 154.2 and average weight loss was 13.2%. Neonates admitted at older age >7days had higher sodium concentration with mean of 162.5mmol/L. Serum sodium levels correlates positively with percentage of weight loss and correlates negatively with birth weight and was statistically significant with p value <0.05. 41(65%) of mothers were primipara, 37(58%) had delivered by LSCS and 39(62%) had lactation issues postnatally. Most common presenting symptom was jaundice in 44(71%), followed by fever in 38(61%).

Conclusions: Hypernatremic dehydration can be prevented by counselling about importance of breast feeding for the mothers starting from antenatal period, early initiation of breast feeding, addressing lactation issues and monitoring daily weight.


Dehydration, Exclusive breast feeding, Hypernatremia

Full Text:



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;19:19‑22.

Livingstone VH, Willis CE, Abdel-Wareth LO, Thiessen P, Lockitch G. Neonatal hypernatremic dehydration associated with breast-feeding malnutrition: a retrospective survey. CMAJ. 2000;162:647-52.

Martin RJ, Fanaroff AA, Walsh MC. Fanaroff and Martin's neonatal-perinatal medicine: diseases of the fetus and infant. New York: Elsevier Health Sciences. 2014.

Laing IA, Wong CM. Hypernatraemia in the first few days: is the incidence rising? Arch Dis Child Fetal Neonatal Ed. 2002;87: F158-62.

Iyer NP, Srinivasan R, Evans K, Ward L, Cheung WY, Matthes J. Impact of an early weighing policy on neonatal hypernatremic dehydration and breast feeding. Arch Dis Child. 2008;93:297-9.

Subramanian S, Agarwal R, Deorari A, Paul V, Bagga A. Acute renal failure in neonates. Indian J Pediatr. 2008;75:385-91.

Buhimschi CS. Endocrinology of lactation. Obstet Gynecol Clin North Am. 2004;31:963-79.

Volk AA. Human breastfeeding is not automatic: Why that’s so and what it means for human evolution. J Soc Evol Cult Psychol. 2009;3:305-14.

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

Oddie S, Richmond S, Coulthard M. Hypernatraemic dehydration and breast feeding: a population study. Arch Dis Child. 2001;85:318-20.

Oddie SJ, Craven V, Deakin K, Westman J, Scally A. Severe neonatal hypernatraemia: a population based study. Arch Dis Childhood Fetal Neonatal Ed. 2013;98(5):F384-7.

Dommelen PV, Boer S, Unal S, Wouwe JP. Charts for weight loss to detect hypernatremic dehydration and prevent formula supplementation. Birth. 2014;41:153-9.

Iyer NP, Srinivasan R, Evans K, Ward L, Cheung WY, Matthes JW. Impact of an early weighing policy on neonatal hypernatraemic dehydration and breast feeding. Arch Dis Child. 2008;93:297-9.

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;19:301-7.

Neifert MR. Prevention of breastfeeding tragedies. Pediatr Clin North Am. 2001;48:273-97.

Lavagno C, Camozzi P, Renzi S, Lava SA, Simonetti GD, Bianchetti MG, et al. Breastfeeding associated hypernatremia: A systematic review of the literature. J Hum Lact. 2016;32:67-74.

Yang WC, Zhao LL, Li YC, Chen CH, Chang YJ, Fu YC, et al. Bodyweight loss in predicting neonatal hyperbilirubinemia 72 hours after birth in term newborn infants. BMC Pediat. 2013;13:145.

Korgali EU, Cihan MK, Oguzalp T, Sahinbas A, Ekici M. Hypernatremic dehydration in breastfed term infants: Retrospective evaluation of 159 cases. Breastfeed Med. 2017;12:5-11.

Ahmed A, Iqbal J, Ahamad I, Charoo BA, Ahamad QI, Ahmad SM. Complications due to breast-feeding associated hypernatremic dehydration. J Clin Neontol 2014;3:153-7.