A growing body of evidence suggests breastfeeding difficulties are associated with weight loss, jaundice, and dehydration. Results from a recent study published in the February 2008 issue of Pediatrics International suggests that parents need most to know how to tell if their baby is getting enough to eat.

A group of researchers in Ankara, Turkey examined the medical records of 4136 term newborns admitted to the neonatal intensive care unit (NICU) between 1 January 2002 and 31 December 2005. Selection criteria included predominantly breastfed with little or no formula supplementation.

Results showed that 169 of the 4136 babies or 4 percent were admitted to the hospital during that time period with severe dehydration, reportedly due to inadequate breastfeeding. Age on admission ranged from 2 to 22 days, with 58.6 percent admitted between 2 and 5 days. Average weight loss was 15.9 percent (range 5.4 to 32.7). The major symptoms on admission were jaundice and feeding difficulty. There was no correlation between infant weight loss and mothers’ age, education level, employment status, delivery route, or first-born status.

Eighty-two percent of the infants suffered acute renal failure, 6.5 percent developed disseminated intravascular coagulation (DIC), 5.9 percent developed seizures, and two of the infants died. Only 47.3 percent of the parents complained about jaundice, but 74 percent of the infants required phototherapy. The extent to which parents fail to recognize early warning signs of inadequate breastfeeding and dehydration is cause for concern.

The authors concluded that, “These data highlight the importance of professional support for lactation, establishment of the mother-infant dyad in the early neonatal period, and early follow-up of infants after discharge.”

The American Academy of Pediatrics in its breastfeeding policy statement recommends that all breastfeeding newborn infants be seen by a pediatrician or other knowledgeable and experienced health care professional within 3 to 5 days of age—a standard of care that many pediatric care providers have yet to adopt.