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Hypernatraemia in the first few days: is the incidence rising?
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  1. I A Laing,
  2. C M Wong
  1. Simpson Memorial Maternity Pavilion, Lauriston Place, Edinburgh EH3 9YW, Scotland, UK
  1. Correspondence to:
    Dr Laing, Simpson Centre for Reproductive Health, Royal Infirmary at Little France, 51 Little France Crescent, Edinburgh EH16 4SU, Scotland, UK;
    ian.laing{at}luht.scot.nhs.uk

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Hypernatraemic dehydration in breast fed infants needs to be resolved so that mothers are not discouraged from breast feeding

Hypernatraemic dehydration is a potentially lethal condition and is associated with cerebral oedema, intracranial haemorrhage, hydrocephalus, and gangrene.1 The infant’s plasma sodium concentration is raised predominantly because of loss of extracellular water. In the past, hypernatraemia occurred most often when artificial feeds of too high a sodium concentration were fed to babies.2 This was more common in infants who were fed powdered milk, especially if the mother added extra scoops of powder and failed to provide enough water in the mixture. The resultant hypernatraemia may have stimulated the child’s thirst, and further feeds high in sodium would exacerbate the problem. Manufacturing reductions in the solute load of infant formulae, brought about by reports from the Department of Health and Social Security on Present day practice in infant feeding (1974)3 and Artificial feeds for the young infant (1980),4 did much to reduce the incidence of this problem. Education of the community and production of proprietary milks in liquid form may also have helped to solve this problem.

EPIDEMIOLOGY

Hypernatraemia was previously thought to be unusual in breast fed babies. Nevertheless, from 1979 to 1989 there were sporadic reports of hypernatraemic dehydration occurring in breast fed babies.5–10 In the 1990s there was an increase in the number of breast fed infants reported to have hypernatraemic dehydration.11–17 Cooper et al14 described five such infants born between 1991 and 1994 in Ohio, van der Heide et al15 two further cases from the Netherlands, Ng et al11 described five cases in Hong Kong, Livingstone et al13 reported 21 cases in British Columbia between 1991 and 1995, and Paul et al16 identified a further two …

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