are the main etiologies for hypernatremia in
neonates. Hypernatremia may cause intracerebral edema, hemorrhage, and
gangrene, resulting in death or long-term morbidity [1,2]. Data on
management and outcome of hypernatremic dehydration from developing
world is limited. There is no universally accepted fluid regimen for
management of hypernatremic dehydration [3].
Between January 2014 to August 2015, 1510 neonates
were admitted in the out born neonatal intensive care unit of our
hospital. Chart review of neonates with moderate and severe
hypernatremic dehydration (serum sodium >150 meq/L) was done. Neonates
with documented hypernatremia and presenting without any prior treatment
were included; those with proven sepsis were excluded. Hypernatremia was
corrected using formula based on water deficit and solute deficit [4].
Forty-nine neonates were admitted with hypernatemic
dehydration. The presenting complaints were fever (34.6%), poor feeding
(42.8%), loose stools (40.8%), lethargy (26.5%), decreased urine output
(8.2%), and weight loss (75.5%); 24.5% neonates presented with
neurological complaints and examination revealed a doughy feel of skin
in 90 % of the neonates. Thirty-three (67.3%) neonates were
hospital-delivered and 6 (12.2%) had history of birth asphyxia. Seven
neonates (14.8%) required ionotropes and five had culture positive
sepsis. The mean (SD) time needed for correction of hypernatremia was
38.6 (15.1) hours. Mean (SD) percentage of dehydration on presentation
was 16.3 (11.03). Mean (SD) sodium on admission was 157.7 (9.41) mEq/L.
Hyperkalemia and metabolic acidosis was present in 21 (42.8%) and 39
(79.6%) neonates, respectively. The mean (SD) duration of hospital stay
was 7.1 (4.8) days. Clinical and laboratory characteristics of neonates
with hypernatremia compared to feeding status is shown in Table
I. Exclusively top fed neonates had higher percentage
of acute kidney injury, mean sodium level, mean creatinine value at
presentation and were more dehydrated compared to other groups.
TABLE I Clinical and Laboratory Characteristics in Neonates With Hypernatremic Dehydration (N=49)
Parameter |
Exclusively breastfed (n=16) |
Exclusively top fed (n=17) |
Mixed fed (n=16) |
*Acute kidney injury |
11 (68.7%) |
14 (82.3%) |
8 (50%) |
Serum Sodium (meq/L) |
150 (148-159) |
164.5 (145-165) |
158 (149-163) |
Serum Potassium (meq/L) |
5.3 (4-6) |
4.9 (4-5.9) |
6.9 (5-7.1) |
Serum Creatinine
|
2.5 (2-4.2) |
4.1 (2-5.1) |
3.1 (2.5-5.2) |
Correction time for Hypernatremia (h) |
30 (20-40) |
42 (24-56) |
30 (24-42) |
Duration of hospitalization (d) |
6 (4.75-8) |
7 (4.5-8.75) |
6.5 (4.1-8) |
*Neonates with signs of dehydration |
1 ( 6.25%) |
2 (12.5%)
|
3 (17.6%) |
All values in median(IQR) except *No.% |
Oddie, et al. [4] have reported an incidence
of hypernatremic dehydration as 2.5/10000 live births and Moritz, et
al. [5] found a 5-year incidence of breastfeeding associated
hypernatremia among hospitalized neonate to be 1.9%. The mean (SD) age
of presentation was 14.8 (8.3) days, which is comparable to previous
studies (4-21 days). We found 61.2% neonates with >10% weight loss,
which is comparable to study by Uras, et al. [5].
We did not find caesarian section (18.3%) to be a
risk factor for hypernatremic dehydration as has been reported in
previous studies [6,7]. A large number of home deliveries in the study
population may account for this difference. Our study confirmed more
cases of hypernatremic dehydration in primigravida mothers (46.9%) as
previously also reported [8].
The mean (SD) time taken to correct hypernatremia was
38.6 (15.1) hours.
Contributors: MJ: Concept and design, analysis of
data and manuscript drafting; SN: Collected the data and helped in data
analysis, drafted the manuscript; AS: collected and analyzed the data,
reviewed the literature, drafted the manuscript.
Funding: None; Competing interest: None
stated.
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