BREASTFEEDING COMPLICATIONS IN HEALTHY TERM NEWBORNS
Siu K-L, Lee W-H
Queen Elizabeth Hospital, Hong Kong SAR,
China
Objective: To report the
presenting symptoms, diagnoses and outcomes of healthy full term newborns
who developed complications of breastfeeding in Queen Elizabeth Hospital
(QEH) and to identify risk factors which may cause these complications.
Methods: Healthy breastfed term newborns greater than 2.5
Kg who had developed complications of breastfeeding were cohort. Their
hospital notes were reviewed to report their symptoms, diagnoses and
outcomes. Their mothers' records were checked for any risk factors for
development of these complications.
Results: Twelve breastfed
newborns (6 male, 6 female) developed complications of breastfeeding.
Presentations included severe jaundice (11/12), decreased voiding frequency
(3/12), poor feeding (2/12) and fever (1/12). Eleven out of total 12
newborns (91.6%) developed these symptoms or signs within the first 5 days
of life while all 12 newborns presented within the first week. Diagnoses
included severe jaundice requiring phototherapy (7/12:58.3%), dehydration
with high serum sodium (6/12:50%), breastfeeding malnutrition (3/12:25%),
and their combination (5/12: 41.6%). One severe jaundiced infant (serum
bilirubin 570umol/L) required exchange transfusion. The one with
temperature > 38 C was an infant with severe hypernatriaemic
dehydration. Her fever subsided and serum sodium normalized after
rehydration but no sepsis was identified. They were well after treatment.
Ten out of 12 mothers' records were retrieved for evaluation. Sixty
percents (6/10) of mothers had attended antenatal breastfeeding class and
(30%:3/10) had previous breastfeeding history. Midwives only used the terms
well/ fair/ poor for breastfeeding assessment. Newborns were not weighed at
fixed interval.
Conclusion: This 9 months cohort
study revealed 12 breastfed newborns who had developed complications of
breastfeeding. All manifested themselves within first week of life.
Caretakers should look for jaundice, infrequent voiding, poor feeding and
fever in breastfed babies and evaluate them for severe jaundice,
dehydration and breastfeeding malnutrition. Breastfeeding class and past
breastfeeding experience seemed to be insufficient in preventing these
complications. Breastfeeding mothers should be assessed for adequate
knowledge on breastfeeding. Simple, accurate, objective methods for baby
evaluation and breastfeeding assessment are important. Action guidelines
should be adopted by health personnel and parents for early detection of
these complications and high- risk mother-baby dyad identification.