Abstract
Breast-feeding is regarded as the most appropriate source of nutrition for healthy,
full-term newborns and infants. Here, we present the case of a full-term, seven week
old male infant who was exclusively breast-fed but who developed severe hypernatremic
dehydration as a result of declined breast milk volume that was not recognized by
the parents. In order to prevent serious therapy-associated side effects due to rapid
rehydration, we performed a rehydration regime providing a slow decrease of serum
sodium levels by carefully infusing hypertonic saline solution. Following this approach,
the patient could be discharged without any noticeable disorder. As the incidence
of breast-feeding associated hypernatremic dehydration in the developed countries
is increasing, strategies of prevention are discussed.
Zusammenfassung
Die Vorteile der Muttermilchernährung für die bedarfsgerechte Ernährung gesunder Neugeborener
sind allgemein akzeptiert. Wir präsentieren den Fall eines reifen, 7 Wochen alten,
voll gestillten Säuglings, der infolge abnehmender Mengen an Muttermilch unbemerkt
eine schwere hypertone Dehydratation entwickelte. Um einem schnellen Abfall des Serumnatriums
entgegen zu wirken, wurde mit der Infusion hypertoner Kochsalzlösung einem strikten
Rehydratationsregime gefolgt. Parallel wurde mit dem enteralen Nahrungsaufbau begonnen.
Der Patient konnte ohne Residuen nach Hause entlassen werden. Aufgrund der zunehmenden
Inzidenz von mit dem Stillen assoziierten Zuständen hypertoner Dehydratation in den
entwickelten Ländern werden Möglichkeiten der Prävention diskutiert.
Key words
hypernatremic dehydration - lactation failure - breast-feeding - prevention
Hypertone Dehydratation - Stillprobleme - Stillen - Prävention
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Correspondence
Dr. Marc BoenschMD
Children's Hospital
Department of Neonatology
and Pediatric Intensive Care
University of Cologne
Kerpener Straße 62
50924 Cologne
Germany
Telefon: +49/221/478 6812
Fax: +49/221/478 6801
eMail: Marc.Boensch@uk-koeln.de