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Excess neonatal weight loss — DCH MCQ

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HardNeonatologyExcess neonatal weight lossDCH

A 4-day-old term, exclusively breastfed baby has lost 11% of birth weight. He is sleepy during feeds and has had three wet nappies in the preceding 24 hours. His mucous membranes are dry, but he becomes alert when roused and has normal temperature, heart rate, respiratory rate and peripheral perfusion. There is no jaundice, focal abnormality or perinatal risk factor for infection. What is the most appropriate immediate assessment?

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Correct answer: E — Measure plasma urea, electrolytes, creatinine and glucose, with urgent expert observation of a feed

The correct answer is E. Loss of more than 10% of birth weight requires clinical and feeding assessment. Here, dry mucous membranes, reduced urine output and sleepiness during feeds provide additional evidence of clinically important dehydration and possible hypernatraemia, so plasma electrolytes—particularly sodium—renal function and glucose should be checked promptly. An expert-observed feed is needed to identify ineffective attachment or milk transfer and guide immediate feeding support. Reweighing alone is insufficient because the baby is symptomatic. Sepsis investigations and antibiotics would become appropriate if clinical illness or infection risk factors were present, but these are specifically absent. Bilirubin testing is not the primary assessment without jaundice, while urine osmolality and renal imaging are not first-line tests for likely inadequate milk intake.

Reference: University Hospitals Coventry and Warwickshire NHS Trust. Babies Factsheet, section: Weight loss, approximately 2024. https://uhmeded.uhcw.nhs.uk/Portals/0/AssetUploads/Babies%20Factsheet.pdf?ver=4n7KaohUj_1ggkhhbMinSw%3D%3D