Consultations & Comments, December 2014

Reader Reaction and Timely Answers From Experts

The Importance of Teaching Moms About Newborns’ Input and Output

In response to October’s article, Breastfeeding Hypernatremic Dehydration: A Potentially Grave Threat to Breastfed Newborns, by Naresh Reddivalla, MD, Nithi Fernandes, MD, Thais Queliz, MD, and Gerard Prosper, MD:

The article mentions that hypernatremia has a strong association with primaparae. I believe it also relates to a baby being “late preterm,” that is, less than 38 weeks (weeks of prematurity based on a Dubowitz assessment). The baby in the case at the beginning of the article was faking us out with her 38 weeks of gestation and decent 7-pound birth weight. But she already was at risk at discharge because she had lost 7% of her birth weight by day 2 and was only feeding for 5 minutes on one breast every 3 hours.

At home, the newborn’s 5 wet diapers including one stool each day was poor. A healthy breastfed baby stools a lot in the first few days of life, switching from tarry, dark stools to yellow stools by day 3 or 4. Also, a newborn typically has one wet diaper per day of life, so by day 6 we expect 6 to 8 wet diapers. And a healthy breastfed baby nurses 8 to 12 times a day for 15 minutes or more at each feeding on one breast and is looking for the second side by day 6.

We need to pay more attention to babies born before term. Mothers need more information on what to expect and how to monitor intake and output.

Patricia Young, APN, IBCLC

Sewell, New Jersey

More on the Link Between Infant Colic and Migraine

In response to October’s “Top Papers of the Month” column, Are Colicky Infants Telling Us Their Mother’s Past … And Their Own Future?

In recent years I have found that most infant colic responds dramatically to the Lactobacillus reuteri probiotic, first sold as oral drops and now also incorporated into Gerber formula. 

I wonder if the data presented in this article might suggest that this probiotic could have a salutary effect on migraine later in childhood.

Abraham Nussbaum, MD

Rhinebeck, New York

The author responds:

I thank Dr. Nussbaum for his response. His is an interesting thought, since a limited number of prophylactic medications are available for children with migraines. Probiotics have been proposed to have both direct and indirect effects on the immune system through various pathways. I was unsuccessful in finding literature related to probiotics having vasoconstrictive properties. I agree, it is worth investigating.

Chalanda Jones, MD

Nemours/Alfred I. duPont Hospital for Children

Wilmington, Delaware

An Unimmunized Boy With a Dog Bite to the Head: Correction

An astute reader spotted an error in October’s “Photoclinic” article on an unimmunized 11-month-old boy who sustained a dog bite to the head, by Kevin Jones, MD, and Pisespong Patamasucon, MD:

On page 479, the article states, “Because of wound contamination from canine mouth flora, a child with dog bite wounds should receive tetanus toxoid prophylaxis unless he or she does not have prior tetanus vaccination, or if the last vaccination was longer than 10 years previously.”

The corrected sentence should read, “… a child with dog bite wounds should receive tetanus toxoid prophylaxis ifhe or she does not have prior tetanus vaccination, or if the last vaccination was longer than 10 years previously.”

Kelly Bradley-Dodds, MD

Crozer-Chester Medical Center

Upland, Pennsylvania

To comment on articles published in print in Consultant for Pediatricians and online at www.PediatricsConsultant360.com, login at the site and use the “add new comment” feature at the bottom of each online article, or send an email to Editor@PediatricsConsultant360.com.