Abstract
Hypernatremic dehydration in neonates is a common condition in an exclusively breastfed infant but often underdiagnosed. Any newborn who has lost more than 10% of birthweight should be carefully evaluated and monitored for clinical features of dehydration. Efforts such as frequent follow-up for weight check, and formula supplementation, if needed, should be provided to a neonate at risk of developing complications of dehydration. Adequate lactation consultation, both inpatient and outpatient, should also be provided, especially to the primigravida mother. Here, we present a case of a neonate with severe hypernatremic dehydration caused by inadequate lactation in a primigravida mother, which resulted in cerebral venous sinus thrombosis leading to significant intracerebral hemorrhage. The infant suffered permanent neurologic damage and was sent home on technological devices (tracheostomy and gastrostomy tubes). Further, we provide a brief review of hypernatremic dehydration and sinus venous thrombosis in neonates.
Highlights
Hypernatremic dehydration in neonates is a common condition in an exclusively breastfed infant but often underdiagnosed
We present a case of a neonate with severe hypernatremic dehydration caused by inadequate lactation in a primigravida mother, which resulted in cerebral venous sinus thrombosis leading to significant intracerebral hemorrhage. e infant suffered permanent neurologic damage and was sent home on technological devices
Boskabadi et al followed 65 neonates admitted for mean serum sodium levels of 158 mEq/L (158 mmol/L) over 2 years and found a correlation between developmental delay at early ages and severity of hypernatremia [14]. ey found a lag in weight gain which is corrected by 12 to 18 months of age [14]
Summary
A 7-day-old female infant was brought to the emergency department with decreased responsiveness and poor feeding She was born at 384/7 weeks’ gestation, with a birthweight of 2770 g (10th–25th percentile) to a 38-year-old primiparous woman with adequate prenatal care. At the primary care physician visit on day 3 of age, the infant’s weight was 2,475 g (∼11% lower than birthweight) She was noted to be otherwise well appearing though the mother continued to report difficulty with latching and breast milk supply. On initial physical examination at the ED, the infant was lethargic and minimally responsive, with a prolonged capillary refill time and appeared grossly dehydrated with standing skinfolds Her vital signs were as follows: temperature, 34.2°C (93.5°F); heart rate, 184 beats/min; Case Reports in Pediatrics respiratory rate, 64 breaths/min; and oxygen saturation, 100% in room air.
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