Oral feeds with or without dextrose half normal saline for treatment of hypernatremia in breastfed late preterm and term neonates: A comparison study

Abstract

Aim: The aim of this study was to compare the effect of treatment with oral feeds alone or oral feeds and 5% dextrose in 0.45% normal saline (½ dextrose normal saline [DNS]) on the rate of decline in serum sodium in breastfed late preterm and term neonates with hypernatremia. Materials and Methods: The study was conducted using retrospective data from July 2013 to June 2016. Babies with gestational age ≥ 34 weeks, birth weight ≥2000 g, age at diagnosis ≤5 days, and serum sodium 150–160 mEq/L were included in the study. Babies with congenital anomalies, sepsis, prior intravenous (IV) fluid therapy, or diseases-causing dyselectrolytemias were excluded from the study. Oral feeds group (Group 1) received breastfeeds, and formula feeds liberally. Oral feeds and IV fluid group (Group 2) received ½ DNS in addition to liberal oral feeds. Decline in serum sodium ≤0.5 mEq/L/h was considered as safe. Results: The study population consisted of 77 babies in Group 1 and 78 in Group 2. Baseline characteristics and serum sodium at admission were comparable. Group 1 had slower decline in serum sodium (P = 0.002), more babies with safe decline in serum sodium (P = 0.02), and lesser weight gain (P = 0.000). A similar result was observed in babies with serum sodium 150–155 mEq/L. No difference in treatment outcome was seen in babies with serum sodium 156–160 mEq/L. No complications or death were seen. About three fourth of cases came for follow-up, and one baby in Group 1 had a developmental delay with seizure disorder. Conclusion: In hypernatremic breastfed neonates with serum sodium 150–155 mEq/L, more babies are likely to have a safe decline in serum sodium on treatment with liberal oral feeds alone.