Correction of hypernatremic dehydration in neonates with supervised breast-feeding: A cross-sectional observational study

Abstract

Background: Hypernatremic dehydration is an uncommon but a serious cause of readmission in neonates especially in the ones on exclusive breast-feeding. The management of such neonates is challenging as serious complications can occur both because of hypernatremic dehydration and its rapid correction. The aim was to study the clinical profile of neonates with hypernatremic dehydration and determine the outcome of these neonates after appropriate management.Methods: This is a prospective cross-sectional observational study of neonates readmitted with hypernatremic dehydration in a tertiary care hospital in a 12-month period from March 2017 to February 2018. The inclusion criterion was as follows: all neonates with serum sodium >145 mEq/l. The exclusion criteria were as follows: neonates with hypoglycemia, positive sepsis screen and any other congenital diseases. Neonates with serum sodium between 145 and 160 mEq/l were treated with supervised quantified oral feeds at 150 ml/kg/day, unless they had features of shock. Neonates who had serum sodium !160 mEq/l were given intravenous (IV) fluids initially.Results: A total of 2412 deliveries took place during the study period. Hypernatremic dehydration was reported in 46 (1.9%) of them, which required admission. We found that all these neonates were exclusively breast-fed, with 81.3% neonates born to primigravidae.One neonate presented with seizures, and one, with metabolic acidosis. More than 50% neonates had acute kidney injury (AKI) on admission. No neonates in our study developed central nervous system (CNS) complications such as cerebral venous thrombosis, convulsions or intracranial haemorrhage, and complete recovery from AKI was documented in all neonates.

Neuroimaging Spectrum of Severe Hypernatremia in Infants with Neurological Manifestations

“…Faulty feeding is the most frequently associated predisposing factor for hypernatremia, as seen in our study. [22][23][24] In older infants, gastrointestinal losses contribute to a significant proportion of hypernatremia. 25 Diabetes insipidus is a rare cause of hypernatremia and should always be suspected when a child has chronic hypernatremia, failure to thrive, and severe dehydration.…”

Caracterización de recién nacidos a término con deshidratación hipernatrémica

“…La literatura sugiere que entre los signos clínicos que se manifiestan en pacientes con DHN está ubicada en los primeros lugares la ictericia 14,16 . En este estudio la ictericia fue el signos más frecuente; un 83,7% de los recién nacidos presentó ictericia en el examen físico y requirió tratamiento con fototerapia a diferencia del estudio realizado por Saxena et al quienes encontraron menor porcentaje de niños con ictericia 18 .…”

Severe Hypernatremic Dehydration in a Neonate

“…ypernatremia consists of a serum sodium concentration exceeding 145 mEq/L, constituting a relatively infrequent condition in newborns [1][2][3][4][5][6][7]. The exact incidence of hypernatremia in newborns remains uncertain but is estimated to range between 1% to 5.6% [1,6,8].…”

“…In neonates, hypernatremic dehydration (HD) is more commonly observed in those exclusively breastfed or with excessive weight loss, with early discharge from the hospital being a significant risk factor. In these cases, HD is associated with ineffective lactation due to insufficient milk production or inadequate support [1][2][3][4][5][6][7][9][10][11].…”

“…Initial symptoms of HD are nonspecific, which can lead to delayed diagnosis and subsequent treatment. Consequently, many newborns with HD experience prolonged and severe hypernatremia, increasing the risk of serious complications such as seizures, thrombosis, intracranial hemorrhage, metabolic acidosis, acute kidney injury (AKI) and disseminated intravascular coagulation [1][2][3][4][5][6][7][8][9][10][11]. These complications are directly associated with hypernatremia and its treatment, and the severity of the symptoms does not correlate with blood osmolarity [1,2].…”