The Study of the Relationship between Hypernatremia in Neonates and Mode of Maternal Breast Feeding in Hospitalized Infants in Ghaem Hospital of Mashhad, Iran

Document Type : Original Article


1 Associate Professor, Department of Pediatrics, Neonatal Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 M.Sc. of Midwifery, Department of Midwifery, Borujerd Branch, Islamic Azad University, Borujerd, Iran.

3 Lecturer of Midwifery, School of Medicine, Tonekabon Branch, Islamic Azad University Tonekabon, Tonekabon, Iran.

4 M.Sc. of Nursing, Department of Pediatrics, Mashhad Branch, Islamic Azad University, Mashhad, Iran.


Introduction: The extreme reduction in breast milk intake during the first days of life leads to weight loss, kidney failure and hypernatremia. The aim of this study was to examine the relationship between hypernatremia in neonates and the mode of maternal breastfeeding.
Methods: This cross-sectional study was conducted on 670 infants who referred to the neonatal ward and clinic of Ghaem hospital of Mashhad, Iran during 2006 to 2012. First, complete history of the mother and baby were obtained regarding pregnancy and delivery problems, mode of breastfeeding, and the first time of lactation beginning. Then neonates were divided into two groups according to the amount of blood sodium, isonatremic and hypernatremic (sodium ≥ 150 mg/dl). Data were analyzed using t-test and chi-square tests with SPSS software (version 11.5). P value less than 0.05 was considered significant.
Results: The average age (p=0.911), Apgar scores (p=0.192), time of the first lactation (p=0.081) and breast feeding duration (p=0.108) showed no statistically significant differences between isonatremic and hypernatremic groups. But the admission weight (p=0.021), times of lactation (p<0.001), breast-feeding status (p<0.001), let down reflex in mother’s breast (p<0.001), kind of nutrition (p<0.001), breast filling after childbirth and lactation (p<0.001), and breast softening after breast-feeding (p<0.001), urination frequency (p<0.001), defecation frequency (p<0.001) and duration of maternal hospitalization (p=0.007) showed statistically significant differences between two groups.
Conclusion: Neonatal weight control, times of lactation, lactation status, breast changes during breast feeding and frequency of urination and defecation may be effective in early detection of reduced breast milk intake and control of related complications.


  1. Iyer NP, Srinivasan R, Evans K, Ward L, Cheung WY, Matthes JW. Impact of an early weighing policy on neonatal hypernatremic dehydration and breast feeding. Arch Dis Child 2008 Apr;93(4):297-9.
  2. Scariati PD, Grummer-Strawn LM, Fein SB. A longitudinal analysis of infant morbidity and the extent of breastfeeding in the United States. Pediatrics 1997 Jun;99(6):E5.
  3. Reynolds A. Breastfeeding and brain development. Pediatr Clin North Am 2001 Feb;48(1):159-.17
  4. Tarcan A, Tiker F, Vatandas NS, Haberal A, Gurakan B. Weight loss and hypernatremia in breast-fed babies:
  5. frequeBoskabadi H, Maamouri G, Mafinejad S. The effect of traditional remedies (camel's thorn, flixweed and sugar ncy in neonates with non-hemolytic jaundice. J Pediatr Child Heath 2005 Sep-Oct;41(9-10):484-.7 water) on idiopathic neonatal jaundice. Iran J Pediatr 2011 Sep;21(3):325-30.
  6. Moritz ML, Manole MD, Bogen DL, Ayus JC. Breastfeeding-associated hypernatrenia: are we missing the diagnisis? Pediatrics 2005 Sep;116(3):e343-7.
  7. Kaplan JA, Siegler RW, Schmunk GA. Fatal hypernatremic dehydration in exclusively breast-fed newborn infants due to maternal lactation failure. Am J Forensic Med Pathol 1998 Mar;19(1):19-22.
  8. Bhat SR, Lewis P, David A, Liza SM. Dehydration and hypernatremia in breast-fed term healthy neonates. Indian J Pediatr 2006 Jan;73(1):39-41.
  9. Uras N, Karadag A, Dogan G, Tonbul A, Tatli MM. Moderate hypernatremic dehydration in newborn infants: retrospective evaluation of 64 cases. J Matern Fetal Neonatal Med 2007 Jun;20(6):449-52.
  10. Ergenekon E, Unal S, Gucuyener K, Soysal SE, Koc E, Okumu N, et al. Hypernatremic dehydration in the newborn period and long-term follow up. Pediatr Int 2007 Feb;49(1):19-23.
  11. Trotman H, Antoine M, Barton M. Hypernatremic dehydration in exclusively breastfed infants: a potentially fatal complication. West Indian Med J 2006 Sep;55(4):282-5.
  12. Iglesias Fernandez C, Chimenti Camacho P, Vazquez Lopez P, Guerrero Soler M, Blanco Bravo D. [Aortic and cerebral trombosis caused by hypernatremic dehydration in an exclusively breast-fed infant] [Article in Spanish]. An Pediatr (Barc) 2006 Oct;65(4):381-3.
  13. Unal S, Arhan E, Kara N, Uncu N, Aliefendioglu D. Breast-feeding-associated hypernatremia: retrospective analysis of 169 term newborns. Pediatr Int 2008 Feb;50(1):29-34.
  14. Richmand S, coulthird M , OddieS. hypernatremic dehydration and breastfeeding,arch dis child2001; 85: 318.023
  15. Boskabadi H, Anvarifar F, Nourizadeh N. Could neonatal hypernatremia dehydration influence hearing status? Iran J Otorhinolaryngol 2014;26(74):13-.8
  16. Jarcan a , tiker f , nilgun s. weightloss and hypernatremia in breast-fed babies frequency in neonate with nonhemolytic jaundice. Pediatric child heath.2005:41(9).484-.784
  17. Behbahan Afshin Gh, Hosseini MB, Mehr Tahmineh F. [Study of dehydration and hypernatremia in infants and children hospitalized in Tabriz Child Hospital] [Article in Persian]. J Tabriz Univ Med Sci 2009;31(2):83- .8
  18. Michael L. Moritz, Mioara D. Manole, Debra L. Bogen and J. Carlos Ayus. Breastfeeding-Associated Hypernatremia: Are We Missing the Diagnosis? Pediatrics 2005; 116; e343-.743
  19. Livingstone VH, Willis CE, Abdel-Wareth LO, Thiessen P, Lockitch G. Neonatal hypernatremic dehydration associated with breast-feeding malnutrition: a retrospective survey. CMAJ 2000 Mar;162(5):647-.25
  20. Boskabadi H, Maamouri G, Majdi M, Mohmmadzadeh A, Parizadeh MJ, Pourjavad M , et al. [Breastfeeding unique jewel].Mashhad:Ghaph Publishers;2011;120-8. [in Persian].
  21. Buhimschi CS. Endocrinology of lactation. Obstet Gynecol Clin North Am 2004 Dec;31(4):963-.97
  22. Boskabadi H, Maamouri G, Ebrahimi M, Ghayour-Mobarhan M , Esmaeily H , Sahebkar A, et al. Neonatal hypernatremia and dehydration in infants receiving inadequate breastfeeding. Asia Pac J ClinNutr 2010;19(3):301-.7
  23. Boskabadi H, Maamouri Gh, Abollahi A, Esmaeily H. [Factors associated with hypernatremia in infants with jaundice] [Article in Persian]. Iran J Obstet Gynecol Infertil 2013;16(63):1-.7
  24. Avery GB, MacDonald MG, Seshia MK, Mullett MD. Avery's neonatalogy: pathophysiology & management of the newborn. 6th Philadelphia:Lippincott Williams & Wilkins;2005:8-846.
  25. Breuning-Boers JM, van Dommelen P, van Wouwe JP, Verkerk PH. [Weight loss, serum sodium concentration and residual symptoms in patients with hypernatremic dehydration caused by insufficient breastfeeding] [Article in Dutch]. Ned Tijdschr Geneeskd 2006 Apr;150(16):904-8.