Hypernatraemic Dehydration in Infantile Gastro-enteritis

Macaulay, Duncan; Blackhall, Margaret I.

doi:10.1136/adc.36.189.543

Cited by 35 publications

(18 citation statements)

References 8 publications

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“…27 Hypernatremic dehydration among infants has been associated historically with high mortality rates. [28][29][30][31] Serious vascular complications and death were reported in previous studies of breastfeeding-associated hypernatremia 8,14 and in a our institution. 32 The number of central nervous system complications in this study was likely underestimated, because only 4 patients underwent neuroimaging studies.…”

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confidence: 88%

Breastfeeding-Associated Hypernatremia: Are We Missing the Diagnosis?

Manole²,

et al. 2005

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ABSTRACT. Objectives. To assess the incidence and complications of breastfeeding-associated hypernatremic dehydration among hospitalized neonates.Study Design. A retrospective study was conducted at Children's Hospital of Pittsburgh over a 5-year period, to identify otherwise healthy term and near-term (>35 weeks of gestation) breastfed neonates (<29 days of age) who were admitted with serum sodium concentrations of >150 mEq/L and no explanation for hypernatremia other than inadequate milk intake.Results. The incidence of breastfeeding-associated hypernatremic dehydration among 3718 consecutive term and near-term hospitalized neonates was 1.9%, occurring for 70 infants. These infants were born primarily to primiparous women (87%) who were discharged within 48 hours after birth (90%). The most common presenting symptom was jaundice (81%). Sixty-three percent of infants underwent sepsis evaluations with lumbar puncture. No infants had bacteremia or meningitis. Infants had hypernatremia of moderate severity (median: 153 mEq/L; range: 150 -177 mEq/L), with a mean weight loss of 13.7%. Nonmetabolic complications occurred for 17% of infants, with the most common being apnea and/or bradycardia. There were no deaths. Diseases, Ninth Revision, Clinical Modification; MWH, Magee-Womens Hospital. T he benefits of breastfeeding to children are well established and include decreased incidence of a wide variety of acute infections and chronic diseases, as well as improved neurodevelopmental outcomes. 1,2 A serious potential complication of insufficient breastfeeding is severe hypernatremic dehydration. 3 Neonatal hypernatremic dehydration results from inadequate transfer of breast milk from mother to infant. Furthermore, poor milk drainage from the breasts results in persistence of high milk sodium concentrations. 4 This may exacerbate neonatal hypernatremia. 5,6 We refer to this as "breastfeeding-associated hypernatremia," with the clear understanding that this results only when breastfeeding is not properly established. Hypernatremic dehydration is assumed to be a rare complication of breastfeeding, 7 but recent reports have suggested that the incidence is increasing. [8][9][10][11] The failure to diagnose hypernatremic dehydration can have serious consequences, including seizures, intracranial hemorrhage, 12 vascular thrombosis, 13 and death. 14,15 The purpose of this study was to assess the incidence and complications of breastfeeding-associated hypernatremia among hospitalized neonates at a large pediatric tertiary care center in the United States. Conclusion. Hypernatremic dehydration requiring ABBREVIATIONS. ICD-9-CM, International Classification of METHODSChildren's Hospital of Pittsburgh is a 235-bed freestanding hospital with ϳ12 000 admissions per year. After approval was obtained from the institutional review board, a retrospective study was conducted to identify otherwise healthy term and near-term (gestation of Ն35 weeks) neonates admitted during a 5-year period with serum sodium concentrations of Ն150 mEq/L...

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Breastfeeding-Associated Hypernatremia: Are We Missing the Diagnosis?

Manole²,

et al. 2005

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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%

“…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.…”

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confidence: 99%

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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“…When our experience of infants with hypernatraemic dehydration was reported 6 years ago from this hospital, the comment was made that, 'the follow-up period was, for many patients, too short to permit any evaluation of ultimate neurological status' (Macaulay and Blackhall, 1961). As far as we are aware no long-term studies of such patients have yet been published.…”

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confidence: 99%