Thirst and vasopressin secretion counteract dehydration in newborn infants

doi:10.1016/S0022-3476(97)80015-7

The Journal of Pediatrics

Volume 130, Issue 5, May 1997, Pages 736-739

https://doi.org/10.1016/S0022-3476(97)80015-7 Get rights and content

Objective and study design: Our goal was to study the water balance in healthy breast-fed infants (n=139) during their first 5 days, by cross-sectional measurements of body weight, serum sodium, serum osmolality, and hematocrit. We also investigated infants' capacity to conserve body water by increased secretion of vasopressin, the main antidiuretic hormone in human beings.

Results: The maximal body weight reduction was 5.7%±1.7% (mean±SD) of birth weight and most infants started to gain weight when they were 3 days old. The serum sodium level at 16±4 hours (on day of birth) was 142 mmol/L; the level increased after 1 day (p<0.01) and remained constantly high for the following 2 days (p<0.05). The serum osmolality was increased at 1 day (p<0.01) and 2 days (p<0.05) compared with the value on the day of birth (296 mOsm/kg). The plasma vasopressin level was constant up to 24 hours (1 day), but decreased during the next 2 days (p<0.01). Infants with body weight reduction exceeding 10% (n=15) had a further elevation of the serum sodium level (p<0.0001) and serum osmolality (p<0.0001), and the plasma vasopressin level was twofold higher (p<0.0001) compared with corresponding levels in infants with less weight reduction. These infants also had a reduced interval between two subsequent feedings (p<0.001). The hematocrit remained unchanged irrespective of the degree of weight reduction.

Conclusions: When the reduction of body weight exceeds 10%, the newborn infant releases vasopressin in response to fluid hypertonicity. This state also affects feeding behavior, perhaps as an expression of thirst. It is likely that hormone release is also stimulated in parallel with a weight reduction of less than 10%, because it is also accompanied by a hyperosmotic state.

Section snippets

METHODS

The study was approved by the local ethics committee of the Karolinska Hospital and parents gave their informed consent for their infants to participate in the study. A total of 139 infants were included. All were born at term (40 ± 1 gestational weeks; mean ± SD) after normal pregnancy and delivery and had an uneventful neonatal period. Birth weight was appropriate for gestational age (3571 ± 369 gm). Eighty infants were girls and 59 were boys; 54 of the mothers were primiparas and 85 were

RESULTS

A progressive decrease in body weight as a percentage of birth weight occurred, reaching its maximum decrease (5.7% ± 1.7%) at 1 to 2 days, after which the infant started to regain weight. The serum sodium level increased at 1 day (p <0.01), as well as at 2 and 3 days old (p <0.05), compared with the level on day 0 (day of birth; 16 ± 4 hours). The serum osmolality was increased when the infant was 1 day (p <0.01) and 2 days old (p <0.05) compared with the value on day 0. There was no

DISCUSSION

This study shows that the maximal body weight reduction averages 6% of birth weight in infants who are exclusively breast fed, and that most infants start to regain weight when they are 3 days old. The serum sodium level increased significantly at 1 day of age and remained at a constant level during the following 2 days. In addition, the serum osmolality increased significantly between 1 and 2 days of age. The plasma vasopressin level was constant at from birth to 1 day of age but decreased

Acknowledgements

We thank Veronika Berggren, RN, for her skillful assistancein the collection of the patient material, Eva Segersteen fortechnical assistance, and Prof. Jan Winberg for reviewing the manuscript.

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Nutrition and growth are inextricably linked, especially in neonates. The point at which food intake exceeds postnatal fluid and fat loss marks the weight loss nadir and the onset of weight gain [1,2]. Excessive weight loss, usually defined as >10% birth weight (WT0), increases the risk of serious clinical complications such as exaggerated jaundice and hypernatremia [3,4].
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^*: Supported by grants from the Mjölkdroppen, Sällskapet Barnavrd, and Svenska Läkarsällskapet foundations.

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Thirst and vasopressin secretion counteract dehydration in newborn infants*

Section snippets

METHODS

RESULTS

DISCUSSION

Acknowledgements

Kidney Int

Thirst and vasopressin function in normal and disordered states of water balance

J Lab Clin Med

Antidiuretic hormone and factors which determine its release

Proc R Soc Lond B

The normal antidiuretic mechanism in man and dog: its regulation by extracellular fluid tonicity

J Clin Invest