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Oral rehydration therapy in neonates and young infants with infectious diarrhoea
Insights
Neonates and young infants struggle to excrete excess fluid and salt during oral rehydration therapy (ORT). This immaturity increases their risk of fluid and salt retention, especially in newborns.
Area of Science:
- Pediatric Nephrology
- Gastroenterology
- Clinical Pediatrics
Background:
- Acute diarrhea is a common condition in infants, necessitating fluid and electrolyte management.
- Oral rehydration therapy (ORT) is the standard treatment for dehydration, but its efficacy and safety in very young infants require careful consideration.
Purpose of the Study:
- To investigate the clinical response and changes in water and salt homeostasis during ORT in infants under two months old.
- To compare fluid and salt excretion capacities between neonates, young infants (1-2 months), and older infants (>3 months).
Main Methods:
- Studied 15 infants (<2 months old) with acute diarrhea undergoing ORT using a solution with 60 mmol sodium/litre.
- Monitored clinical response, fluid retention, serum sodium levels, and urinary sodium excretion.
- Compared outcomes with historical data from older infants treated similarly.
Main Results:
- Successful rehydration was achieved in all but one patient.
- Neonates and young infants exhibited significantly higher fluid retention compared to older infants.
- One neonate developed hypernatremia (162 mmol/l) 36 hours after ORT initiation; urinary sodium excretion was lower in neonates than in young infants.
Conclusions:
- Neonates and young infants possess a diminished capacity for excreting excess water and salt compared to older infants.
- There is a substantial risk of fluid and salt retention during ORT in this age group, particularly pronounced in neonates due to immature renal function.
- Careful monitoring of fluid and electrolyte balance is crucial when administering ORT to neonates and young infants.
Abstract:
The clinical response and changes in water and salt homeostasis during ORT was studied in 15 infants less than 2 months old (range 2-50 days) with acute diarrhoea. Eight patients were neonates and 7 were 1-2 months old. The oral rehydration solution contained 60 mmol sodium per litre. All patients except one were successfully rehydrated. The fluid retention was significantly higher in neonates and young infants than in infants above 3 months of age treated in the same way. One patient in the group of neonates who had a normal sodium level on admission developed hypernatremia with a sodium level of 162 mmol/l 36 hours after the start of ORT. The urinary sodium excretion was lower in the neonates than in the young infants. The results show that neonates and young infants have a lower capacity than older infants to excrete water and salt and therefore run a great risk of developing fluid and salt retention during ORT. The risk is most pronounced in neonates who, due to immaturity of the renal function, are unable to excrete excess fluid and salt.