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Excessive weight loss in term infants

Presented at the Neonatal Society 2003 Summer Meeting (programme).

Deshpande S

Royal Shrewsbury Hospital, Mytton Oak Road, Shrewsbury SY2 6SP, UK

Aims: To determine the incidence and associated factors of excessive weight loss (10% of birth weight) and hypernatremic dehydration among term and near-term infants in a defined population.

Methods: All infants born in Shropshire are weighed at birth and again on day 5-6 at the time of Guthrie test. I retrospectively reviewed the discharge records of the neonatal service between 1 January 2001 and 30 April 2003 to identify the infants with weight loss of 10%. Maternal (age, parity, and occupation) and neonatal (gestational age, birth weight, condition of birth, feeding at initial discharge, weight loss, symptoms and laboratory test results) details were extracted into a purpose-built database.

Results: During this period, there were 10,904 births in the catchment area with breast-feeding rates of 61% and 36% at 1 and 6 weeks, respectively. Fiftynine (0.54%) infants were admitted with weight loss of 10% or more. Their mean (SD) gestational age and birth weight were 38.8 (1.5) weeks and 3341 (508) g, respectively. Mean (SD) maternal age was 31.5 (5.2) years, and 42 were primiparous. Sixteen (27%) infants were born by caesarean section. Four infants needed face mask ventilation.

Median (range) weight loss and age at readmission were 12.4 (10-25.4)%, and 5 (2-10) days, respectively. Fifty infants were readmitted before 7 days of age. All infants were exclusively breast fed at readmission. Thirteen infants were asymptomatic whilst the common symptoms in others included jaundice (27), poor feeding (18), lethargy (6), irritability (5), and seizures (2). Median (range) serum sodium, urea and haematocrit were 145 (130-154), and 6.6 (1.8-19.7) mmol/, and 55.4% (43-73) respectively. Nine (15%) infants were hypernatremic (s sodium >149 mmol/l). Hyperbilirubinaemia (s bilirubin >340 mmol/l) and hypoglycaemia (blood glucose <2.6 mmol/l) were found in 17 (29%) and 4 (7%) of infants on admission. One infant had clinical and neuroimaging evidence of cerebral venous sinus thrombosis.

Intravenous fluids and complementary feeds were instituted in 12 and 39 infants respectively whilst 21 infants needed phototherapy. Median (range) duration of rehospitalisation was 2 (1-22) days. At discharge, 20 infants were exclusively and 29 were partially breast fed whilst the remainder was formula fed.

Conclusions: Excessive weight loss and hypernatremic dehydration remain a significant problem in breast fed infants with minimum incidence of 9/1000 and 1.4/1000 breast fed infants, respectively. Older maternal age, primiparity, and birth by caesarean section were particularly associated with excessive weight loss in exclusively breast fed infants.

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