Neonatology: hypernatraemic dehydration in a breastfed baby: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Neonatology: hypernatraemic dehydration in a breastfed baby

Sample item

A 5-day-old exclusively breastfed baby has fallen from 3.2 kg to 2.7 kg. The baby is jaundiced with dry mucosa, has few wet nappies, and serum sodium is 158 mmol/L. What is the best management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Assess latch and give expressed breast milk, rehydrating gradually

Weight loss of this degree with hypernatraemia reflects inadequate milk transfer. Management is to improve breastfeeding technique, supplement with expressed breast milk and correct the deficit gradually, since rapid fall in sodium risks cerebral oedema.

Option by option

  • A. Phototherapy alone

    Phototherapy treats the jaundice but leaves the dehydration untreated.

  • B. Rapid bolus of 5 percent dextrose

    Rapid hypotonic fluid lowers sodium too fast and can cause convulsions from cerebral oedema.

  • C. Assess latch and give expressed breast milk, rehydrating gradually (correct)

    Correct. Treat the cause and rehydrate slowly to avoid cerebral oedema.

  • D. Stop breastfeeding and start undiluted cow's milk

    Cow's milk is unsuitable in a newborn and does not address breastfeeding failure.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is C, Assess latch and give expressed breast milk, rehydrating gradually. Weight loss of this degree with hypernatraemia reflects inadequate milk transfer.

Why is "Phototherapy alone" not the answer?

Phototherapy treats the jaundice but leaves the dehydration untreated.

Why is "Rapid bolus of 5 percent dextrose" not the answer?

Rapid hypotonic fluid lowers sodium too fast and can cause convulsions from cerebral oedema.

Why is "Stop breastfeeding and start undiluted cow's milk" not the answer?

Cow's milk is unsuitable in a newborn and does not address breastfeeding failure.

What concept does this question test?

It tests Neonatology: hypernatraemic dehydration in a breastfed baby in Pediatrics. Management is to improve breastfeeding technique, supplement with expressed breast milk and correct the deficit gradually, since rapid fall in sodium risks cerebral oedema.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neonatology: hypernatraemic dehydration in a breastfed baby?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.