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Preventing breastfeeding-associated hypernatraemia: an argument for supplemental feeding
  1. Michael L Moritz
  1. Correspondence to Dr Michael L Moritz, Division of Nephrology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, One Children's Hospital Drive, 4401 Penn Ave, Pittsburgh, PA 15224, USA; moritzml{at}upmc.edu

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The benefits of breastfeeding are unquestionable. Breast milk provides the ideal nourishment for infant growth and development. In addition, it has numerous health benefits for both infant and mother. Breastfeeding decreases the incidence of acute infections such as otitis media, respiratory tract infections and gastroenteritis; chronic diseases such as type 1 diabetes, asthma and inflammatory bowel disease, and childhood leukaemia and lymphoma; and sudden infant death syndrome. In addition, it improves neurodevelopmental outcomes for the infant. Breastfeeding benefits the mother by improving infant-maternal bonding, facilitating maternal weight loss, promoting postpartum uterine contractions, serving as a natural form of birth control, and reducing the risk for developing breast cancer, ovarian cancer and type 2 diabetes. Therefore everything should be done to promote, encourage, facilitate and support breastfeeding. This does not mean, however, that the complications that are sometimes associated with breastfeeding should be ignored. On the contrary, addressing and resolving these issues is a necessary part of making breastfeeding successful. One of the most serious complications of breastfeeding is neonatal hypernatraemic dehydration resulting from insufficient lactation. Prospective studies with full lactation support consistently show that approximately 15% of exclusively breastfed infants develop excessive weight loss, exceeding 10% of birth weight, within the first week of life.1 Approximately one-third of these infants will be hypernatraemic (sodium ≥150 mEq/L). The incidence of breastfeeding-associated hypernatraemia among hospitalised term and near-term neonates is 2%, which is significantly greater than the all-cause incidence of hypernatraemia among hospitalised children, …

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