A nationwide study on hospital admissions due to dehydration in exclusively breastfed infants in the Netherlands: its incidence, clinical characteristics, treatment and outcome

AIMS

To estimate the incidence and clinical characteristics in hospital admissions due to dehydration or undernutrition and their laboratory evaluation and treatment outcome in exclusively breastfed infants.

METHODS

All hospital admissions during the first 3 months of life assessed by the Dutch Paediatric Surveillance Unit (DPSU) between mid 2003 and mid 2005.

RESULTS

Nationwide 158 cases reported, correspond to an incidence of 58/y/100,000 breastfed infants; it is lower for severe dehydration at risk for hypernatraemia; 20/y/100,000. Sixty-five per cent of cases were <2 weeks old, their median weight loss was 9.3% and median age at admission 5 days; Serum sodium value was measured in only 12% of all cases. Insufficient volume intake and inadequate growth were most frequently reported (61% and 41%). Lethargy, jaundice or clinical dehydration was scored in 11-25%, seizures or shock in 3%. A breast pump at home was used in only 31%. In the hospital breast pumps were available (82%) as lactation consultants (73%). For treatment 65% was offered formula, in 30% by nasogastric drip. Most admissions lasted up to 3 days, all recovered fully and 33% were breastfed exclusively at discharge.

CONCLUSION

The incidence of severe dehydration in the Netherlands is relatively low. With extended use of breast pumps at home it could be lower. To prevent complications, we recommend applying a reference weight chart, a full clinical examination and more extensive screening of serum sodium and glucose.

Sorghum-based oral rehydration solution in the treatment of acute diarrhoea

Sixty four children between 2.5 months and 5 years of age were randomly treated in a country hospital in Jos, Nigeria, with either the oral rehydration solution (ORS) as recommended by the World Health Organisation (WHO) or a cereal-based electrolyte solution, containing 60 g/l sorghum powder. Both groups were well comparable in many aspects, except for the nutritional status and the use of ORS before admission. In both aspects the sorghum-ORS group was at a disadvantage. During treatment there were no significant differences between the two groups in amount of fluid used, number of stools and duration of diarrhoea. Though weight gain in the two treatment groups was not significantly different, median weight gain in the sorghum-ORS group was 295 g, vs 155 in the WHO-ORS group. Seven children died, two (6%) in the sorghum-ORS group and five (17%) in the WHO-ORS group. Sorghum-ORS was well accepted and tolerated. This study suggests that sorghum-ORS can safely be used as an alternative in the treatment of diarrhoea.

Werdnig-Hoffmann disease in a Nigerian infant

A Nigerian infant with the classical features of Werdnig-Hoffmann disease is described. According to the literature the incidence in black Africans is very low. Attention is drawn to the fact that neurological illnesses are often overlooked in negroid races; several reasons are given.