Exclusively Breastfeeding and Hypernatremic Dehydration

There is no doubt that breast-feeding is the best and safest way of feeding infants. Physiological weight loss occurs in the first two or three days of life, and the achievement of birth weight is expected towards the end of the first week. Hypernatremic dehydration may occur in exclusively breast-fed infants if milk supply is low during these first few days. It is not because of the high sodium content in breast milk; it is because of insufficient lactation. That is, the main cause of hypernatremic dehydration is water deprivation. There are many causes for low milk intake. Since most causes are preventable or able to be improved, mothers, particularly first time mothers, should receive more reassurance and practical advice in the technique of breast-feeding. Before their discharge from the hospital, they should be educated about the associated features of unsuccessful breast-feeding, such as going to the breast infrequently or for short times, infrequent passage of urine and stool, jaundice, lethargy, irritability and fever. Late diagnosis may cause catastrophic outcomes, such as a variety of palsies, apnea, bradycardia, seizures, hypertension, disseminated intravascular coagulation, necrotising enterocolitis after establishing full oral feeds, amputation of an extremity secondary to arterial thrombus, multiple cerebral infarctions, intracranial hemorrhages, massive intra ventricular hemorrhage, multiple dural thromboses. If babies are weighed on the day of the Guthrie test, those in the early onset of a disease and those who could not achieve their birth weight can be easily identified. The latter should be closely followed

Breastfeeding-Associated Hypernatremia: A Systematic Review of the Literature.

There are increasing reports on hypernatremia, a potentially devastating condition, in exclusively breastfed newborn infants. Our purposes were to describe the clinical features of the condition and identify the risk factors for it. We performed a review of the existing literature in the National Library of Medicine database and in the search engine Google Scholar. A total of 115 reports were included in the final analysis. Breastfeeding-associated neonatal hypernatremia was recognized in infants who were ≤ 21 days of age and had ≥ 10% weight loss of birth weight. Cesarean delivery, primiparity, breast anomalies or breastfeeding problems, excessive prepregnancy maternal weight, delayed first breastfeeding, lack of previous breastfeeding experience, and low maternal education level were significantly associated with breastfeeding-associated hypernatremia. In addition to excessive weight loss (≥ 10%), the following clinical findings were observed: poor feeding, poor hydration state, jaundice, excessive body temperature, irritability or lethargy, decreased urine output, and epileptic seizures. In conclusion, the present survey of the literature identifies the following risk factors for breastfeeding-associated neonatal hypernatremia: cesarean delivery, primiparity, breastfeeding problems, excessive maternal body weight, delayed breastfeeding, lack of previous breastfeeding experience, and low maternal education level

Combined searches for the production of supersymmetric top quark partners in proton-proton collisions at root s=13 TeV

A combination of searches for top squark pair production using proton-proton collision data at a center-of-mass energy of 13 TeV at the CERN LHC, corresponding to an integrated luminosity of 137 fb(-1) collected by the CMS experiment, is presented. Signatures with at least 2 jets and large missing transverse momentum are categorized into events with 0, 1, or 2 leptons. New results for regions of parameter space where the kinematical properties of top squark pair production and top quark pair production are very similar are presented. Depending on themodel, the combined result excludes a top squarkmass up to 1325 GeV for amassless neutralino, and a neutralinomass up to 700 GeV for a top squarkmass of 1150 GeV. Top squarks with masses from 145 to 295 GeV, for neutralino masses from 0 to 100 GeV, with a mass difference between the top squark and the neutralino in a window of 30 GeV around the mass of the top quark, are excluded for the first time with CMS data. The results of theses searches are also interpreted in an alternative signal model of dark matter production via a spin-0 mediator in association with a top quark pair. Upper limits are set on the cross section for mediator particle masses of up to 420 GeV

Search for charged Higgs bosons produced in vector boson fusion processes and decaying into vector boson pairs in proton-proton collisions at root s=13 TeV

A search for charged Higgs bosons produced in vector boson fusion processes and decaying into vector bosons, using proton-proton collisions at root s = 13 TeV at the LHC, is reported. The data sample corresponds to an integrated luminosity of 137 fb(-1) collected with the CMS detector. Events are selected by requiring two or three electrons or muons, moderate missing transverse momentum, and two jets with a large rapidity separation and a large dijet mass. No excess of events with respect to the standard model background predictions is observed. Model independent upper limits at 95% confidence level are reported on the product of the cross section and branching fraction for vector boson fusion production of charged Higgs bosons as a function of mass, from 200 to 3000 GeV. The results are interpreted in the context of the Georgi-Machacek model