In general, hypernatremic dehydration in breastfed newborns can be avoided by adequate lactation counseling. However, other factors may contribute to hypernatremic dehydration. For example, high environemental temperatures can lead to a significant increase in insensible loss without adequate water ingestion. In this case, water should be offer between breast feeding. Pathological conditions such as infectious diarrhea, insipidus diabetes, maternal drug use that affect renal water reabsorption may also be responsible for hypernatremic dehydration in breastfed newborns.

As with most things, avoidable outcomes are failures of the system at many levels. This starts with adequate access to help with no financial, practical or perceived barriers to aid. Appropriate pre and postnatal care should lead on to appropriate lactation advice and follow up measures as required for the individual ( not the population average) then add in pathology of mum or baby as required! To view this as a single problem with only one solution will never improve outcomes.

It will never be abolished due to there being so many human factors confounding the issues. We can educate and provide services but the reality often means things go wrong. Even experienced lactation consultants cane be fooled that a newborn is feeding well prior to discharge only for the infant to be readmitted one or two days later. We see infants get dry in hospital with all support services available. We see missed appointments and alternative advice offered in the community. We can only provide the knowledge and support services we can afford and make them as universally accessible as possible. I have have worked in many countries and it seems to be a universal problem.

Thanks everybody for your inputs. these are helpful

Poor feeding may be a cause and adequately skilled staff (and available at least daily) to assess feeding in the first few days can reduce occurrence of dehydration. Poor practices such as birth practices resulting in traumatized baby and mother, long wait before first feed, and restricted time at the breast, can also contribute to dehydration. Pathological conditions in mother or baby would be a less common cause than not enough effective feeding. According to WHO materials emphasized over the last twenty years - a baby with frequent access to the breast does not require additional water when there is a high environmental temperature; the baby will take more breast milk if he needs more fluid. Giving water rather than milk contributes to poor weight gain and the risks from contaminated water or the equipment used to give it.

Hi we have had in our Maternity some cases of hypernatremic dehydration, and in the study through the root cause analysis, which we have seen is that most of them had been instrumented deliveries (suction cup, forceps with epidural anesthesia) as well as some other contributing factors including unmotivated breastfeeding health personnel. I think the most important is to reinforce good BFHI practices and good control at 48 hours after discharge.