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New born started losing weight. Weight gain after IV drips. Again losing weight. Worrisome

DOCTOR OF THE MONTH - Feb 2013
Feb 2013
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Pediatrician
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My baby was born on 9th January 2013 (Normal delivery at 36weeks ). weight at birth - 2.7kg. Baby was breast fed for about 11 days during which he lost a lot of weight and was admitted in a child hospital with a weight of 1.7 kg on 21st january. He was administered IV drips which led to increase in the weight and was discharged on 27th weighing 2.34 kg. 2 days later he was checked for weight and was weighing 2.6 kg. However today the weight has come down to 2.52kg. As per the doctor, he should only be gaining and not losing weight. During admission in the hospital he was screened for a lot of tests and few of the concerns were - High Sodium Level, high urea, Kidney enlargement, creatine serum - 0.9mg/dL(slightly above range), low platelet count, 114 thou/mm3. He was discharged with all stable results.
Request your feedback on this case and reason for the ups and downs in weight gain
Posted Sat, 23 Feb 2013 in Child Health
 
 
Answered by Dr. E Venkata Ramana 1 hour later
Hi Dr XXXXXXX
Thank you for your query on Healthcare Magic,
Newborns will loose weight 10 percent below birthweight in the 1st week of life as a result of excretion of excess extravascular fluid and limited oral intake.
And they regain or exceed birthweight by 2 week of age and should grow at approximately 30g/day during first month of life.
This weight loss is more in preterm newborns.
Was the child dehydrated at the time of admission?
What about the feeding activity and feeding pattern, his sucking and other neonatal reflexes, activity and urine output during this period?
Any significant maternal antenatal history?
Any newborn septic screen done during hospitalisation? And their results?
What was the impression of the treating doctor on the abnormal concerned results of reports you mentioned in your query?
This information is important to give you feedback and to come to a conclusion regarding the reason for the ups and downs in weight gain.
So kindly provide the above information , so that I will try to address your concerns.
Regards.
Above answer was peer-reviewed by
 
Follow-up: New born started losing weight. Weight gain after IV drips. Again losing weight. Worrisome 13 hours later
Hi Dr ,
i have answered the queries against the Questions in brackets.
Was the child dehydrated at the time of admission? – he was admitted with severe dehydration ( Diagnosis-Severe hypernatremic dehydration)
What about the feeding activity and feeding pattern, his sucking and other neonatal reflexes, activity and urine output during this period? (15 times urine, had not passed stool for 7 days at the time of admission, breast fed every three hours and was drinking not as much as what it is doing post discharge)
Any significant maternal antenatal history? (none)
Any newborn septic screen done during hospitalisation? And their results? (no)
What was the impression of the treating doctor on the abnormal concerned results of reports you mentioned in your query? (kidney swelling and sodium levels were the only concern which was concluded to be normal during discharge)
This information is important to give you feedback and to come to a conclusion regarding the reason for the ups and downs in weight gain.
So kindly provide the above information , so that I will try to address your concerns.
Regards.
 
 
Answered by Dr. E Venkata Ramana 2 hours later
Hi Dr XXXXXXX
Thank you for providing me the information,
My concern is severe hypernatremic dehydration at the time of admission. And the causes will be:
1. Newborns, especially if premature, have high insensible water losses.
2. Ineffective breast feeding, often in a primiparous mother.
2. Diabetes Insipidus either Central or Nephrogenic : In this there will be massive
water losses and very dilute urine.
Infants are at high risk because of their inability to control their own water
intake.
3. Secondary nephrogenic Diabetes insipidus due to obstructive uropathy,
renal dysplasia.
So the above things should be kept in mind in a child with a severe hypernatremic dehydration with ups and downs of weight gain.
So regularly monitor the weight, hydration status, oral intake & urine output, activity of the child and his breast feeding pattern & its adequacy.
If you find any problems in the above clinical parameters like decrease in weight, dehydration, decreased feeding or excessive diluted urination consult your Pediatrician for further evaluation.
Hope I have answered your query up to your satisfaction and thank you for consulting me on Healthcare Magic.
Hope your baby a good health and happy parenting,
Regards.
Above answer was peer-reviewed by
 
Follow-up: New born started losing weight. Weight gain after IV drips. Again losing weight. Worrisome 8 hours later
How do you detect dilute urine?? What lab tests should one be looking for?? WHat should be the ideal report to rule out the above mentioned. My baby passes urine almost immediately after feeding mostly and passes urine about 15 times a day. Doctors said that is a healthy sign. How regular should we be checking his weight. What should be the ideal urine movement for a 25 day old baby and how should this be progressing. My wife says that her breast milk has tremendously increases and the baby sometime lets some milk due to my assumption of over fed.

What should i be checking at home on daily basis??

thanks
 
 
Answered by Dr. E Venkata Ramana 14 hours later
Hi Dr XXXXXXX
Thank you for your query,
The dilute urine is detected by measuring its total quantity in a 24 hour period and by measuring urine osmolality by lab investigation.
The measurement of 24 hour urine in an infant is very difficult, but it can be measured by using XXXXXXX condom or by measuring the diapers weight(before and after urination).
If the 24 hour urine output is more than 2 liters/meter square/24 hour, then it is pathological polyuria.
The lab tests used to detect the mentioned abnormality are 1. Serum osmolality, 2. Urine osmolality. And they should be done after consulting and discussing with the Pediatrician.
Frequent passing of urine in a newborn is a healthy sign and it indicates the adequacy of breastfeeds. The frequency of urination movement in newborn will be around 6 to 10 times, but it will vary.
Check his weight at least once in a week.
Baby can be fed as and when baby wants or the mother wishes to feed.
Activity of the baby, signs of dehydration like sunken eyes, skin turgor to be checked regularly on daily basis.
Check his weight regularly at 1 week interval, on well baby visits and on vaccination visits to assess the weight gain.
Hope I have answered your query, if you have any clarification please write to me.
Regards.
Above answer was peer-reviewed by
 
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