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Severe neonatal hypernatraemia

When there is prolonged failure of lactation, babies always lose weight and sometimes become very hypernatraemic; their resilience in the face of such stress is extraordinary. Oddie et al used the British Paediatric Surveillance Unit methodology to identify cases of severe hypernatraemia (at least 160 mmol/L), almost all of which were secondary to lactational failure with significant weight loss. Although some had lost more than a quarter of their body weight, and some had truly eye-watering plasma sodium concentrations, all of these babies did very well. That they did not come to harm may well be due to the effectiveness of monitoring by the community midwifery and health visiting services in the UK, and the public health nurses in the Republic of Ireland. It seems to be safe simply to feed starved babies: though some of them were given intravenous fluids, probably most of them did not need this and the enteral route is generally safer and kinder. Readers may find the accompanying editorial by Moritz rather controversial, but so is another recently published …

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