The frightening prognosis of breastfeeding dehydration

Wilted Flower on Black

A new paper in The Journal of Maternal-Fetal and Neonatal Medicine, Predictability of prognosis of infantile hypernatremic dehydration: a prospective cohort study sheds light on the outcome of newborn dehydration due to insufficient breastmilk. It highlights the severity of the problem, the risk factors and the prognostic signs.

I find it particularly interesting because it describes almost exactly the clinical course of babies like Landon Johnson, who died of breastfeeding dehydration, and the son of Dr. Christie del Castillo-Hegyi, who suffered permanent brain injury. Lactation professionals have insinuated or even denied that those babies suffered and died as a result of insufficient breastmilk. This paper makes it clear that it is the lactation professionals who are woefully (and often willfully) ignorant of what is going on around them.

17.5% of babies suffered permanent brain injury including 7% who died.

The authors start by acknowledging what lactation professionals refuse to admit — the risk of newborn hypernatremic dehydration is increasing:

The prevalence of hypernatremic dehydration has increased in recent years most likely due to insufficient intake of breast milk as the most important factor. Other influencing factors include: early discharge of mothers from hospital after delivery, inadequate training, awareness on breast milk insufficiency and improper breastfeeding technique, breast congestion, inverted, big or flat nipple, previous breast surgery …

As breastfeeding promotion efforts have become more aggressive, more babies are suffering the serious impact of insufficient breastmilk.

In contrast to the claims of lactation professionals, breastfeeding dehydration is NOT easy to diagnose:

Infantile hypernatremic dehydration (IHD) is a life-threatening medical emergency in which the intracellular water is sucked into the extracellular space due to sodium chloride hypertonicity usually induced by free water loss or administration of excessive sodium solutions. As a result, the intracellular volume is extremely decreased while the intravascular volume and skin turgor are maintained, resulting in difficulty in early diagnosis…

Why are babies so vulnerable to dehydration?

Following low milk intake in neonates, kidneys start sodium reabsorption and fluid retention; however, kidneys in neonates have a weaker ability of urine concentration compared to adults and hence water is not reabsorbed sufficiently. Besides, insensible fluid loss through the lungs as well as immaturity of neonatal skin can amplify dehydration and hypernatremia. Due to the gradual development of the disorder, the diagnosis is very difficult and dehydration is usually undetected. Accordingly, most infants are referred to the physician when neonatal complications such as decreased urination, lethargy, weakness or brain symptoms have already been presented.

Hypernatremic means high salt concentration and it is the high salt concentration that leads to brain injuries.

Long-term follow-up has shown that neurological disorders occur in approximately one-third of infants with hypernatremic dehydration. Also, developmental delay has been shown to occurs in cases with severe hypernatremia. Monitoring birth weight, breastfeeding position and frequency, and breast changes during breastfeeding as well as defecation and urination frequency are effective measures in early diagnosis of hypernatremic dehydration and controlling its complications.

In an effort to determine prognosis, the authors looked at the impact of dehydration on 183 babies. The results are frightening:

The 36-month follow-up of infants with hypernatremic dehydration showed that 32 (17.5%) out of 183 studied cases had abnormal outcomes, out of whom 14 cases have passed away during the follow-up and 18 cases were diagnosed with developmental delay.

Remarkably, these results were BETTER than results from previous studies:

The lower incidence of developmental delay in our study can be attributed to the larger sample size, the longer duration of follow-up, and/or the difference in measurement tool for the developmental status in our study.

There were notable difference between the babies who suffered serious long term effects and those who did not:

Hypernatremic dehydrated infants with unfavorable prognosis had been referred 4 days later than those with favorable prognosis…

According to the results of this study, hypernatremic dehydrated infants with developmental delay had serum sodium levels significantly higher (176 mEq/l) than those with the normal outcome (157 mEq/l). Also of 32 hypernatremic dehydrated infants with abnormal outcomes, 26 cases (81%) had a sodium level of 167–200 mEq/l.

In addition:

Convulsion was seen almost 5 times more (34%) in infants with unfavorable prognosis compared to those with normal prognosis (7%)… Consciousness impairments were observed in 32% of infants with unfavorable prognosis, but none were observed in those with normal prognosis. Cerebral edema was observed in about one-third of infants with unfavorable prognosis… Cerebral edema can be irreversible and hence fatal in some patients.

The authors conclude:

According to the results of this study, hypernatremic dehydration is a major problem with a common occurrence in the first 2 weeks of life that leads to unfavorable outcomes such as infant mortality (7%)… [C]ombination of variables such as sodium, urea, creatinine, lethargy, state of fontanels, convulsion, loss of consciousness, state of breast during postpartum, inverted nipple and brain CT scan had a high predictive power (98.6%) for determination of unfavorable prognosis in infants with hypernatremic dehydration.

Breastfeeding dehydration leads to grievous outcomes … and the ultimate tragedy is that nearly every single one of these tragic outcomes can be avoided simply and easily by supplementing with formula at the first sign of problems.

Breastfeeding ISN’T best for every baby. For some it is brain damaging and life ending.