Van Dammelen et al developed criteria to identify newborn infants with hypernatremia dehydration due to inadequate breastfeeding by their mothers. The authors are from TNO Quality of Life in Leiden, The Netherlands.


Problem: If a mother's breast milk delivery is insufficient to meet the needs of the growing neonate, the infant will become dehydrated with weight loss and hypernatremia.


relative weight change in percent =

= ((current body weight in g) - (birthweight in g)) / (birthweight in g) * 100%


line describing -2.5 SDS over the period of 3 to 11 days after birth =

= (0.3272 * (day)) - 12.80


Monitoring of the neonate should include:

(1) number of wet diapers

(2) frequency and quality of stools

(3) pattern of breastfeeding


Reasons that an infant should be referred for evaluation:

(1) relative weight change < 2.5 standard deviations below the mean (-2.5 SDS) AND age 3 to 7 days

(2) weight loss > 10% AND age >= 7 days

(3) The infant shows clinical symptoms of severe dehydration.


Failure to regain birthweight by age 21 days was considered abnormal by MacDonald et al


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