Clinical Profile and Outcome of Neonates with Hypernatremic Dehydration - A Tertiary Care Hospital based Study

Abstract

Introduction: Neonatal hypernatremic dehydration is a medical emergency. Early diagnosis and appropriate treatment is crucial for survival and better prognosis. However, diagnosis is often difficult due to apparent well being and dehydration is underestimated. The aim of our study was to see the outcome of neonates admitted with hypernatremic dehydration in our hospital Material and Methods: The study was conducted in neonatology of Postgraduate Department of Pediatrics, in GB Pant Hospital, an associated hospital of Government Medical College Srinagar. It was a hospital based prospective observational study conducted for 1 year, from March 2016 to February 2017. A total of 67 neonates were enrolled in our study. Results: The results showed mean age of presentation 18 days, females were 37(55.5%), mean birth order was 1.6,44 (65.7%) cases were from rural background,62 (92.5%) of our cases were term babies, an average weight loss of 14.6% was found. There was a significant statistical relation in the percentage of weight loss, incidence of shock, incidence of AKI and sodium levels(p value<0.001). Conclusion: Women should be educated about the proper technique of breast feeding during prenatal visits and after the delivery of the newborn. Mothers should be informed about 'ten steps of successful breast feeding'. All breast-fed infant should be weighed at least once several days after discharge.

Clinical profile and outcome of neonates admitted in sick newborn care unit with hypernatremic dehydration and association with breastfeeding in a tertiary care hospital in Northern India

“…Our observation is similar to other studies. 14 Mean weight loss was observed to be 15.6% and 57.7% of newborns had weight loss more than 15% which is in concordance with studies reporting that newborn presenting at a later age have more severe weight loss and hypernatremia. 15 At admission poor feeding, fever, jaundice, and dehydration were common symptoms in 85% of newborns.…”

Clinical Profile and Outcome of Young Infants With Hypernatremic Dehydration Presenting to the Emergency Department

“…Fever and lethargy were the other 2 commonly noted symptoms. Studies done in the past 10,18,20 also observed similar signs and symptoms in these infants. However, acute kidney injury was observed in most infants, but decreased urine output was a symptom only in 7.3% of cases.…”

“…The prevalence noted in our study was much higher as compared with the previous studies, which reported the prevalence as 1.3% and 3.4%, respectively. 2,10 The varied prevalence is attributed to variable inclusion criteria in different studies. The study done by Bhat et al 10 included all neonates admitted to the hospital (noncritical as well those with critical illness) as the denominator to calculate the prevalence, unlike our study in which we included those infants who met the screening signs and symptoms of hypernatremic dehydration.…”

“…Dehydration was defined by any 2 of the following signs: lethargy, sunken eyes, depressed anterior fontanelle, prolonged capillary refill time, doughy skin, decreased urine output, weight loss more than 10% of the birth weight in infants aged younger than 7 days, and/or weight loss of more than 5% in a 24-hour period. 10 Acute kidney injury (AKI) was defined and staged according to modified neonatal Kidney Disease Improving Global Outcome guidelines. 11 In those infants where baseline creatinine was not available, creatinine was taken from reference serum creatinine values.…”

“…It was further classified as mild (146–149 mEq/L), moderate (150–169 mEq/L), and severe (>170 mEq/L). Dehydration was defined by any 2 of the following signs: lethargy, sunken eyes, depressed anterior fontanelle, prolonged capillary refill time, doughy skin, decreased urine output, weight loss more than 10% of the birth weight in infants aged younger than 7 days, and/or weight loss of more than 5% in a 24-hour period 10 . Acute kidney injury (AKI) was defined and staged according to modified neonatal Kidney Disease Improving Global Outcome guidelines 11 .…”