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Published on: November 9, 2016
Clinical Profile and Outcome of Young Infants With Hypernatremic Dehydration Presenting to the Emergency Department
Priya Tanwar1, Kanika Kapoor1, Ajay Kumar1
1From the Department of Paediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Insights
Hypernatremic dehydration in young infants is a serious condition with a high fatality rate. Acute kidney injury, shock, and ventilation needs are linked to poor outcomes in these infants.
Area of Science:
- Pediatrics
- Neonatology
- Emergency Medicine
Background:
- Hypernatremic dehydration is a critical condition in young infants.
- Early identification and management are crucial for improving outcomes.
Purpose of the Study:
- To evaluate the clinical profile and outcomes of young infants with hypernatremic dehydration.
- To identify factors associated with mortality in this population.
Main Methods:
- Prospective observational study of 55 infants aged ≤2 months with hypernatremic dehydration.
- Data collected on clinical presentation, laboratory parameters, and comorbidities.
- Outcomes compared between survivors and non-survivors.
Main Results:
- Prevalence of hypernatremic dehydration was 4.89%.
- Median age of presentation was 17 days; 41.8% case fatality rate.
- Severe hypernatremic dehydration, acute kidney injury, sepsis, and need for ventilation were associated with mortality.
Conclusions:
- Acute kidney injury stage 3, shock, and need for ventilation predict poor outcomes.
- Highlights the severity and risk factors associated with hypernatremic dehydration in infants.
Objectives:
The aim of this study was to evaluate the clinical profile and outcome of young infants presenting to the pediatric emergency department with hypernatremic dehydration.
Methods:
A prospective observational study was conducted at a tertiary care teaching hospital over a period of 18 months. All outborn sick young infants aged 2 months or younger who presented to the emergency department with symptoms and signs of possible sepsis and/or dehydration were screened, and those with hypernatremia were enrolled in the study. Those infants born at less than 37 weeks of gestation and gross congenital anomaly were excluded. Hypernatremic dehydration was defined as serum sodium levels (Se Na+)higher than 145 mEq/L. Variables used in the study were defined as per standard definitions. Acute kidney injury was defined and staged using serum creatinine as per modified neonatal Kidney Disease Improving Global Outcome guidelines. Clinical presentation, laboratory parameters, and comorbidities were compared among outcome groups (survived and died).
Results:
Of 1124 outborn young infants who met the eligibility criteria for screening, 63 were diagnosed to have hypernatremic dehydration and 55 were enrolled. The hospital-based period prevalence of hypernatremic dehydration in young infants was 4.89%. The median age of presentation was 17 days (10-30). Male-to-female ratio was 1.1:1. Seventy-three percent were first in birth order. Feeding pattern showed 61.8%, 30.9%, and 7.3% of infants were exclusively breastfed, top fed, and mixed fed, respectively. The median serum sodium at the time of admission was 160 (153.5-167) mg/dL. Three (5.5%) infants had mild, 39 (70.9%) had moderate, and 13 (23.6%) had severe hypernatremic dehydration. There was statistically significant correlation between median platelet count with severity of hypernatremic dehydration. The mean time taken to correct serum sodium level was 3.30 ± 1.60 days. The case fatality rate was 41.8%. Those who died had statistically more severe hypernatremic dehydration, acute kidney injury, sepsis, and need for ventilation.
Conclusions:
Acute kidney injury stage 3, shock, and need for ventilation are associated with poor outcome in infants with hypernatremic dehydration.
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