Chennai: How inadequate breast feed and dehydration land infants in ICUs

CHENNAI: The popular ‘breast milk is best’ theory is being put to test, with at least a dozen newborns being admitted to city hospitals with symptoms of dehydration. Insufficient feeding or inadequate breast milk can have serious consequences with some babies requiring dialysis and intensive care, say doctors.

Severe hypernatremic dehydration is usually seen in the peak of summer, but doctors say such cases are already being reported, mostly in babies less than two weeks old when the mother’s milk may not yet be adequate.

In newborns, percentage of total body water is at least 75%, 15% more than adults. In pre-term babies, it can go up to 90%. “This is one of the ways of nature to help babies cope with the fluid imbalance until they get adequate supply from their mother,” said neonatologist Dr N Chandra Kumar of Kanchi Kamakoti Childs Trust Hospital.

In the first few days, the percentage of water in breast milk is very less. The first milk or colustum is rich in fat and sodium. “All babies lose 5%-10% of body weight for up to 10 days. But anything more could be dangerous. By the second week, the baby should gain weight,” said Dr Kumar Paediatric nephrologist Dr N Prahlad of Rainbow Children’s Hospital says complete kidney function kicks in children after about two years of age. In most newborns, it is about 25%. Besides losing water through excretion, body loses water through sweating. “Some infants are kept under the sun as treatment for jaundice and when temperature is high there is heavy water loss. The sodium level can shoot up causing series of complications,” he said.

In the past month, two babies, both less than two weeks old, with breathing difficulty and high body temperature recovered at Rainbow Hospital after IV fluids were administered. Four infants at Sooriya Hospitals required intensive care, including dialysis.

They had reduced urine output, dry mouths, sunken eyes, were fatigued and tests showed severe weight loss and high levels of sodium, said neonatologist Dr Deepa Hariharan.

Paediatrician Dr S Balasubramanian says doctors should counsel parents on telltale symptoms of dehydration, besides weight gain. “A child should pass urine at least six times a day. The dark stools a child passes in the first 2-3 days should turn yellow. If the baby has high temperature and is crying unstoppably, it’s time to consult the doctor.”