Hypernatraemia in infants as a cause of brain damage.

Macaulay, Duncan; Watson, Mando

doi:10.1136/adc.42.225.485

Cited by 123 publications

(33 citation statements)

References 9 publications

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“…Macaulay's studies (8,9) defined hypernatremia as a serum sodium ≥150 mEq/L, although Maisels's work supports the notion that losing ≥12% of birth weight is excessive. (23) To be included as a case in our study, infants had to meet the following criteria: 1) rehospitalized within 15 days of discharge from the birth hospitalization; 2) diagnosis of dehydration by the treating physician; and 3) weight loss ≥12% of birth weight or serum sodium ≥150 mEq/L.…”

Section: Definition Of Dehydrationmentioning

confidence: 99%

“…We also searched KPMCP electronic records for these ICD neurological diagnosis codes: 320-360 (nervous system disorders); 378-378. 9 (26), and the BeeryBuktenica Developmental Test of Visual-Motor Integration-Fourth edition (VMI-4). (27) Child neurologists and a child neurology clinical nurse specialist (2 examinations) conducted standard neurological examinations and entered an overall impression on a 5-point scale: 1: "normal"; 2: "normal/questionable"; 3: "abnormal with minimal functional disability"; 4: "abnormal with moderate functional disability"; 5: "abnormal with severe functional disability."…”

Section: Outcome Variablesmentioning

confidence: 99%

“…Infants with diarrheal dehydration have had high rates (8 to 16%) of long-term neurological damage. (8)(9)(10)(11) In developed nations, neonatal dehydration is likely to develop more slowly than diarrheal dehydration, because it is most often due to insufficient fluid intake and/or abnormally high levels of sodium [A1] in breast milk. (12)(13)(14)(15) For this reason, long-term sequelae of neonatal dehydration in developed nations may be less frequent or less severe than previous case series would suggest.…”

Section: Introductionmentioning

confidence: 99%

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Five-Year Neurodevelopmental Outcome of Neonatal Dehydration

Escobar¹,

Liljestrand²,

Hudes³

et al. 2007

The Journal of Pediatrics

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Objective-To determine the long-term outcome of neonatal dehydration.Study design-We identified 182 newborns rehospitalized with dehydration (weight loss ≥12% of birth weight and/or serum sodium ≥150 mEq/L) and 419 randomly selected controls from a cohort of 106,627 term and near-term infants ≥2000 g born from 1995 through 1998 in Northern California Kaiser Permanente hospitals. Outcomes data were obtained from electronic records, interviews, questionnaire responses, and neurodevelopmental evaluations performed in a masked fashion.Results-Follow-up data to the age of at least two years were available for 173/182 children with a history of dehydration (95%) and 372/419 controls (89%) and included formal evaluation at a mean (±SD) age of 5.1±0.12 years for 106 children (58%) and 168 children (40%) respectively. None of the cases developed shock, gangrene, or respiratory failure. Neither crude nor adjusted scores on cognitive tests differed significantly between groups. There was no significant difference between groups in the proportion of children with abnormal neurologic examinations or neurologic diagnoses. Frequencies of parental concerns and reported behavior problems also were not significantly different in the two groups.Conclusions-Neonatal dehydration in this managed care setting was not associated with adverse neurodevelopmental outcomes in infants born at or near term. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. In this report, we focus on non-diarrheal neonatal dehydration. We studied a cohort from the Northern California Kaiser Permanente Medical Care Program (KPMCP), a mature managed care organization with integrated information systems. (6,(16)(17)(18)(19)(20) Given the pathophysiology of dehydration, which does not appear to affect any one particular part of the brain, we did not expect to find discrete neurological deficits among our cohort. We expected to find non-specific neurodevelopmental problems affecting multiple domains (i.e., decreases in performance across multiple areas measured). NIH Public Access METHODSThis report covers two of the three cohorts in the Jaundice and Infant Feeding ("JIFee") study, a follow-up study of infants with neonatal jaundice or dehydration and randomly selected controls. We identified subjects born in 1995-96 in previous nested-case-control studies. (6,19,21) Study participants were drawn from 1995-98 KPMCP live births (N=106,627) with birth weights of at least 2000 grams and gestational age of at least 36 weeks (1995-96 cohorts) or 34 weeks (1997-98 cohorts). Eligible subjects had to meet the dehydration d...

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Section: Definition Of Dehydrationmentioning

confidence: 99%

Section: Outcome Variablesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Five-Year Neurodevelopmental Outcome of Neonatal Dehydration

Escobar¹,

Liljestrand²,

Hudes³

et al. 2007

The Journal of Pediatrics

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“…Previous studies on the prevalence of hypernatraemia in hospitalised patients have focused on geriatric and adult patients (2, 4, 9, 12), as well as that has been published in pediatric patients (3,(5)(6)(7)13). We aimed to evaluate the incidence, causes and treatment of hypernatraemia in a pediatric population.…”

Section: Discussionmentioning

confidence: 99%

“…If something about the reason of hypernatraemia is not clear, measurement of urine osmolality in relation to plasma osmolality and urine sodium concentration may help for differential diagnosis (5). Hypernatraemia has serious complications such as brain injury, brain oedema and seizure, with a reported mortality rate of 40%-60% (6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Hypernatremia in hospitalized children

et al. 2017

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Objective: Hypernatraemia has serious complications such as brain injury, brain oedema and seizure. In this study, the incidence among children hospitalized hypernatremia, causes, development time, clinical features, and morbidity, and aimed to reveal the effect on mortality. Method: In this retrospective study, clinical and laboratory data from patients with hypernatremic were recorded. The study period was 33 months. The groups were separated into two groups; group I: Hypernatremia was present at hospital admission, group II: Hypernatremia was acquared after the hospitalization. Results: Overall incidence of hypernatraemia was 1.3% of all hospitalised children. While 42% of patients were from group I, 58% of patients had acquired hypernatremia during hospital stay. In group I, 61% of patients had infections on hospital admission. The most common cause of hypernatraemia in group II was neurological disorders (53%). The mortality rate was 30.5% (11/36) in patients with hypernatraemia on admission, 67.3% (33/49) in those with hospital-acquired hypernatraemia (P<0.05; significantly greater than for those with hypernatraemia on admission), and 51.7% (44/85) overall. Mean serum sodium level was higher in non-survivors than in survivors (161.7±8.3 mg/dL vs. 160±7.4 mg/dL), but the difference was not statistically significant. Similarly, there was no significant difference in peak serum sodium levels in survivors versus non-survivors, P>0.05. Conclusion: Hypernatraemia in pediatric age is associated with mortality and morbidity, and should be closely monitored in pediatric patients hospitalized for any reason in order to prevent complication.

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