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Reference chart for relative weight change to detect hypernatraemic dehydration.

Paula van Dommelen¹, Jacobus P van Wouwe, Jacqueline M Breuning-Boers

¹TNO Quality of Life, Leiden, The Netherlands. P.vanDommelen@pg.tno.nl

Archives of Disease in Childhood

|August 2, 2006

Summary

The common 10% infant weight loss rule may yield too many false positives for detecting hypernatraemic dehydration. A relative weight change chart offers a more specific screening tool for breastfed infants.

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Area of Science:

Pediatrics
Neonatal Care
Clinical Nutrition

Background:

The widely used 10% infant weight loss rule's accuracy for detecting hypernatraemic dehydration is unverified.
Hypernatraemic dehydration is a serious condition in breastfed infants requiring accurate early detection.

Purpose of the Study:

To evaluate the validity of the 10% weight loss rule and other methods for identifying breastfed infants with hypernatraemic dehydration.
To develop and assess a more reliable screening tool for this condition.

Main Methods:

A retrospective cohort study constructed a reference chart for relative weight change in healthy, exclusively breastfed infants using the LMS method.
Data from 1544 infants (3075 measurements) and 83 literature cases of hypernatraemic dehydration were analyzed.

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Main Results:

The 10% rule showed 90.4% sensitivity but only 3.7% positive predictive value.
A chart-based method (<-2.5 SDS in the first week) combined with the 10% rule in the second week improved specificity to 99.4% with a 9.2% positive predictive value.

Conclusions:

The 10% weight loss rule is prone to false positives, making it less suitable for high-specificity screening.
A relative weight change chart is a more effective tool for detecting hypernatraemic dehydration in breastfed infants.