Correction of hypernatremic dehydration in neonates with supervised breast-feeding: A cross-sectional observational
Apoorv Saxena1, Suprita Kalra2, Subhash Chandra Shaw3
1Clinical Tutor, Department of Pediatrics, Armed Forces Medical College, Pune 411040, India.
Insights
Hypernatremic dehydration in exclusively breast-fed neonates is a serious concern. Quantified oral feeding effectively manages this condition without causing central nervous system complications.
Area of Science:
- Neonatal Medicine
- Pediatric Endocrinology
- Clinical Nutrition
Background:
- Hypernatremic dehydration is an uncommon but serious cause of neonatal readmission, particularly in exclusively breast-fed infants.
- Management is challenging due to potential complications from both the dehydration and its rapid correction.
Purpose of the Study:
- To investigate the clinical profile of neonates with hypernatremic dehydration.
- To determine the outcomes of these neonates following appropriate management strategies.
Main Methods:
- A prospective, cross-sectional observational study was conducted over 12 months in a tertiary care hospital.
- Inclusion criteria: neonates with serum sodium >145 mEq/l. Exclusion criteria: hypoglycemia, positive sepsis screen, congenital diseases.
- Treatment involved supervised quantified oral feeds (150 ml/kg/day) for serum sodium 145-160 mEq/l, and IV fluids for serum sodium ≥160 mEq/l.
Main Results:
- Hypernatremic dehydration occurred in 1.9% of admissions (46 neonates), all exclusively breast-fed, with 81.3% born to primigravidae.
- One neonate had seizures, one had metabolic acidosis, and over 50% presented with acute kidney injury (AKI).
- No central nervous system (CNS) complications were observed, and all neonates achieved complete recovery from AKI.
Conclusions:
- Hypernatremic dehydration poses a significant risk in term, healthy, exclusively breast-fed neonates, especially those born to primiparous mothers.
- Quantified oral feeding is an effective management approach, preventing severe CNS complications associated with rapid correction.
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.
Conclusion:
Hypernatremic dehydration can be a serious problem even in term healthy neonates especially in exclusively breast-fed neonates born to primiparous women. Our study shows that quantified oral feeding is effective in successful management of hypernatremic dehydration and not associated with the dreaded CNS complications due to rapid correction.
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