The healthy newborn hydration model

The healthy newborn hydration model A new model for understanding newborn hydration immediately after birth

From Biological Research for Nursing

Promoting breast-feeding and preventing dehydration in the newborn are important, but often considered competing health objectives.  Formula supplementation is a common practice when newborn weight loss is _7% because this threshold is accepted as a strong indicator of a water deficit (hypohydration) due to inadequate breast milk intake in the newborn.

The purpose of this article is to propose a new model for examining and evaluating hydration status in the healthy newborn. Authors suggest that the use of weight loss in the first 24–60 hr following birth as a sign of hypohydration is confounded by the natural process of newborn diuresis, resulting in a large number of false-positive diagnoses of hypohydration. They also outline further research necessary to examine the diagnostic validity of any weight loss threshold, and the utility of laboratory measures of hydration is also delineated.


Concerns about adequate hydration in breast-fed newborns. These concerns are further magnified when breast-fed infants lose ≥7% of their birth weight within 2 days postnatally. Weight loss following birth is presumably mostly water loss that could result in hypohydration and subsequent hypernatremic dehydration. However, excess fluid loss immediately following birth is a normal and necessary process. Furthermore, newborns exposed to excess fluid intake during labor may need to lose ≥7% of birth weight in the first 2 days following birth in order to achieve euhydration. Normal newborn fluid loss following birth confounds the use of weight loss as the sole measure of newborn hydration. We thus propose the healthy newborn hydration model that highlights the normalcy of newborn weight loss immediately following birth and the healthy newborn’s compensatory mechanisms for preserving adequate hydration. We also recommend the use of serum sodium to measure intravascular osmolarity in addition to monitoring weight loss to obtain a more comprehensive newborn hydration assessment. Research is necessary in healthy newborns to identify relationships among fluids received in utero, newborn weight loss, and hydration, as evaluated with laboratory measures, in the first 2 days following birth. This information will guide clinicians in correctly identifying newborns with inadequate hydration who are in need of supplementary fluids versus newborns with adequate hydration for whom exclusive breast-feeding can be supported and encouraged.


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Article details
Pamela J. Mulder and Sue E. Gardner
The Healthy Newborn Hydration Model: A New Model for Understanding Newborn Hydration Immediately After Birth
Biol Res Nurs 1099800414529362, first published on April 15, 2014 doi:10.1177/1099800414529362



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