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Prevalence and Risk Factors of Hypernatremic Dehydration in Exclusively Breastfed Neonates: A Systematic Review and
María José Maldonado1, Eduardo Tuta-Quintero2, Isabella Criado Quintero3
1Department Pediatrics, School of Medicine, Universidad de La Sabana, Chía 250001, Colombia.
Journal of Clinical Medicine
|July 15, 2026
Summary
Neonatal hypernatremic dehydration (NHD) affects 1.4% of exclusively breastfed newborns. Key risk factors include delayed breastfeeding, excessive weight loss, and low urine output, highlighting the need for early assessment and support.
Area of Science:
- Neonatalogy
- Pediatrics
- Public Health
Background:
- Exclusive breastfeeding is crucial for infant health.
- Suboptimal breastfeeding increases risks of hyperbilirubinemia and neonatal hypernatremic dehydration (NHD).
Purpose of the Study:
- Estimate the prevalence of NHD in exclusively breastfed term newborns.
- Identify maternal and neonatal risk factors for NHD.
Main Methods:
- Systematic review and meta-analysis following PRISMA 2020 guidelines.
- Searched multiple databases (PubMed, Scopus, Web of Science, LILACS, Cochrane) without restrictions.
- Included observational studies on exclusively breastfed term neonates diagnosed with NHD within 28 days.
Main Results:
- Pooled prevalence of NHD was 1.4% (95% CI: 0.0-5.0%) with high heterogeneity.
- Identified risk factors: delayed breastfeeding (OR 6.02), excessive neonatal weight loss >10% (OR 69.28), low urine output (OR 8.51), and maternal primiparity (OR 3.66).
- Poor breastfeeding technique, inadequate latch, and lack of postnatal follow-up were consistently associated with NHD.
Conclusions:
- NHD is a clinically significant condition in exclusively breastfed term newborns.
- Early breastfeeding assessment and monitoring of neonatal weight and hydration are essential.
- Strengthened maternal support is vital for preventing severe NHD complications.
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