Dehydration and Newborns

A day after J’s birthday, my cousin’s girlfriend gave birth to their first child, Yumi. Just a week after her birth, she was rushed to the hospital because of her green-colored vomit. At the hospital, Yumi was diagnosed with extreme dehydration and blood sepsis (infection in the blood). My aunt, who is an OFW in Malta, especially went back home here in the Philippines to spend time with her granddaughter. Unfortunately, she spent her two-week vacation at the hospital taking care of her granddaughter and even my cousin, who coincidentally suffered from a mild heart failure due to enlarged ventricle.

It was an extremely difficult time for the whole family as it took time for the doctors to finally find a course of treatment for my niece. It took several blood transfusions and weeks of antibiotics for Yumi to heal. Dialysis was even considered when her kidneys don’t seem to function properly. Fortunately, before the deadline set by her doctor she was able to pee enough urine to deem her kidneys functioning well. We were all fraught with worry for her as well as for my aunt and cousin.

Due to what had happened, I want to raise awareness about dehydration in babies especially newborns and how to avoid this preventable condition. Dehydration occurs when one loses more fluid than intake. Babies are more susceptible to dehydration because of their tiny tummies, less reserved fluid in their bodies, and very fast metabolism. It can be mild and easily corrected, moderate, or severe and life threatening.

So, what are the symptoms of a dehydrated baby? According to www.babycenter.com , here are the signs:

• More than six hours without a wet diaper.
• Urine that looks darker and smells stronger than usual.
• Lethargy or lack of energy.
• Dry, parched mouth and lips.
• No tears while crying (Take note that babies generally start crying with tears at around 3 - 12 weeks of age because their tear ducts haven’t fully formed yet.)
• Sunken eyes.
• Hands and feet that feel cold and look splotchy (covered with irregular sized spots).
• Excessive sleepiness and fussiness.
• Sunken fontanels (the soft spots on a baby’s head).

If, unfortunately, your baby exhibits the given symptoms, immediately take him to the emergency room for treatment. He may be given liquids through an intravenous (IV) tube until he is rehydrated which was done to my niece. For older babies, especially those who vomit or have diarrhea, electrolyte liquids (like Pedialyte) may be recommended by their pediatricians.

As the saying goes, prevention is better than cure and the best step to avoid dehydration in babies especially newborns is frequent feedings or nursing. Within the first week of a baby, aim for nursing at least 10-12 times per day (at least every 2-2.5 hours in a 24 hour period). Frequent breastfeeding promotes good milk supply and reduces engorgement. Nurse at the first signs of hunger which includes stirring, rooting, and hands in mouth. Do not wait until the baby is crying because a good latch is more difficult to achieve when this happens. One can never nurse too much, only too little.

This poster was created by the Women's and Newborn Services of Royal Brisbane and Women's Hospital.

Indications of sufficient milk intake by a newborn within the first week includes from at least 1 wet diaper at the first day to 6-8 wet diapers by day 7, and from passing a meconium stool ( a  greenish, black, sticky, tarlike substance) in the first day to having 2-8 bowel movements in a 24 hour period by the 7^th day. Also by day 7, a breastfed baby’s stools may be golden yellow in color while soft and mustard-like in texture.

From the 2^nd up to the 6^th week, frequent nursing is still very important in establishing a good milk supply. Aim for 8- 12 feeding times per day. Again, nurse at the first signs of hunger and do not wait until the baby is crying. Let the baby have unlimited time at one breast when suckling actively, then offer the other one.

Most newborns are excessively sleepy like my Georgina. Wake them up if 2 hours (during the day) or 4 hours (at night) have passed since their last nursing session. Loosening or removal of clothing, holding the baby upright, and changing the diaper are some ways you can try to awaken your sleepyhead. When your baby dozed off during a feed, a strategy to jumpstart his sucking reflex that I have learned from the book Secrets of the Baby Whisperer is to “walk” your fingers up and down his spine. This worked all the time with my little Queen B.  

It is also a good idea to have a lactation consultant observe the baby’s position at the breast to determine whether or not the baby is latched on properly. Breastfeeding Pinays, a group of breastfeeding Filipino mothers, provides support and guidance for any troubled mom who worries if her baby is getting enough milk.

This photo is from www.diabeticpick.com . 

There are rare cases wherein an infant’s dehydration is because of the mother’s inability to produce sufficient milk. If a portion of the placenta was left behind the uterus, it may delay milk production. Previous breast surgery, birth defect, or injury to the breast may also limit lactation. If this is the case then your pediatrician can suggest alternatives or solutions to prevent dehydration from happening to your beloved baby.

Additional water is NOT recommended by the World Health Organization for infants below 6 months. Babies below 6 months should get all her nutrient and fluid needs from milk whether in the form of breastmilk or formula. Once the baby started on solids, fluids will also be received from fruits, vegetables, and other food given. Also, babies can now be given sips of water and fruit juices.

I strongly believe that dehydration that may lead to life-threatening situations is preventable. The mother as well as the father and any other person who will help in caring for the baby should be made knowledgeable about the basics of providing nutrients to a newborn. Caring for a baby is a job and like any other vocation one should come prepared for it. The 9 months our baby is in our womb should be put to good use by learning as much as you can about babies and this search of information must continue even when your baby is born. It is my hope that health care providers, the government and even us, private individuals, help one another in bringing to the uncertain, uninformed, and even isolated parents knowledge that may help save an infant’s life.

As I write this post, Yumi was just discharged from the hospital and is now continuing her recuperation at home. We are all glad that this nightmare is now behind them. We are first and foremost thankful to our Lord for extending His healing hands to the youngest member of our family. We are also grateful to all her doctors and nurses. Her primary doctor even waived a portion of her professional fee. Thank you also to all our friends and acquaintances who help us pray for her healing.

Our little fighter, Yumi. 

#xoxo