Hypernatremic Dehydration Research Articles

Etiological Profile and Short-Term Outcomes of Acute Kidney Injury in Term Neonates at a Tertiary Care Centre in Western Maharashtra, India.

Background Acute kidney injury (AKI) is characterized by a sudden decline in kidney function, leading to a reduced glomerular filtration rate (GFR). This decline results in the accumulation of nitrogenous waste products in the blood, disturbs electrolyte balance, and disruptsfluid regulation. Objective To determine the etiological profile of AKI in term neonates. Methods Aprospective observational study was conducted at the Neonatal Intensive Care Unit (NICU) of our tertiary care hospital and referral and teaching center. The study spanned a period of two years, from August 2022 to July 2024, and comprised a total of 78 term babies diagnosed with AKI, all of whom were enrolled after obtaining consent using a predefined proforma. The neonatal period was defined as the time from birth up to 44 weeks of postmenstrual age (PMA), encompassing a critical developmental phase in newborns. Results In our study of 78 term neonates with AKI, we found a predominant occurrence in males (53, 67.9%) and a significant proportion with low birth weights (41, 52.6%). The most common cause of AKI was sepsis or multiple organ dysfunction syndrome (MODS) (32, 41%), followed by perinatal hypoxia (14, 17.9%) and urinary tract obstructions (12, 15.3%). Urinary tract infections (UTIs) accounted for nine cases (11.5%), hypernatremic dehydration for six cases (7.6%), acute tubular necrosis for three cases (3.8%), and congenital polycystic kidney disease for two cases (2.9%). Mortality was notably high, with 20 neonates (25.7%) dying from AKI, particularly those with sepsis/MODS and perinatal hypoxia. However, conditions such as urinary tract obstructions and UTIs generally had better outcomes. The statistical analysis revealed a significant association between the underlying etiology and outcomes (p<0.001), underscoring the importance of prompt and targeted interventions for different AKI causes in neonates. Conclusion Our findings highlight the diverse etiological spectrum of AKI in term neonates and its significant impact on mortality. Early recognition, appropriate management, and targeted interventions tailored to the underlying cause are crucial in improving outcomes for neonates with AKI.

Neonatal hypernatremic dehydration. Clinical cases

Inadequate breastfeeding can lead to malnourishment, neonatal hypernatremic dehydration (NHD), and catastrophic results. The correction of hypernatremia involves a slow decrease of the sodium level because a rapid correction can be associated with complications such as seizures and death. We present two clinical cases of hypernatremia as a result of dehydration in breastfed term neonates. The first case is a neonate with a weight loss of 31.1% and a sodium level of 179 mmol/L. In the second case, of a neonate with a weight loss of 35.6% (1,350 grams) and extreme hypernatremia (sodium 195 mmol/L), the acute renal failure, the metabolic disorders (hyperglycemia, decompensated metabolic acidosis), the neurological symptoms, and the signs of infection led to difficulties in correcting the hypernatremia that resulted in the patient’s death.

Frequency and outcome of sodium disturbances in children admitted with acute watery diarrhea in a tertiary hospital of Bangladesh

Background: Acute watery diarrhea (AWD) is one of the common causes of hospital admissions in pediatric age group. Majority of children with dehydration suffer from different electrolyte abnormalities which needs to be identified and treated. Objectives: To investigate the frequency and outcome of sodium disturbances in AWD among children admitted in a tertiary hospital in Bangladesh. Method: In this prospective observational study, 121 children of 2 months to 5 years of age admitted in the Department of Pediatrics, Chittagong Medical College Hospital with AWD were included. Clinical features and sodium levels on admission were recorded. Patients were followed up during their hospital stay to record the outcomes. Children were grouped in hyponatremia (serum sodium &lt;135mmol/l), hypernatremia (serum sodium &gt;145mmol/l) and normonatremia (serum sodium 135–145mmol/l) and compared. Results: Of the 121 children, 38.0% and 62.0% had moderate and severe dehydration, respectively. The majority (58.7%) had normal sodium levels. Sodium disturbances was found in 41.3% cases. There were 26.4% cases of hypernatremia and 14.9% cases of hyponatremia among them. Out of 18 hyponatremic patients, 77.8% had mild hyponatremia and the rest 22.2% had moderate hyponatremia. Among 32 hypernatremic children, 62.4% had mild, 18.8% had moderate and 18.8% had severe hypernatremia. The case fatality rate was 2.6% and all of them had hypernatremic dehydration at admission. Conclusion: Sodium disturbances particularly hypernatremia is more frequent and is associated with high case fatality rate among children hospitalized with acute watery diarrhoea. BANGLADESH J CHILD HEALTH 2022; VOL 46 (3) : 110-114

Developmental Assessment in Neonatal Hypernatremic Dehydration Cohort at 18–30 months of Age Using DASII Score

Developmental Assessment in Neonatal Hypernatremic Dehydration Cohort at 18–30 months of Age Using DASII Score

Evaluation of Maternal Risk Factors for Neonatal Hypernatremic Dehydration: A Systematic Review.

Neonatal hypernatremic dehydration (NHD) is a severe condition associated with neonatal morbidity and mortality. The present study evaluated maternal risk factors, including duration of maternal hospitalisation, primiparity, caesarean section, and pregnancy complications, as well as social factors, such as depression, fatigue, and inadequate support for NHD. PubMed, Cochrane Library, International Scientific Indexing, Scopus, and Google Scholar were the databases searched until 2023. Articles written in English or Persian focusing on the relationship between maternal risk factors and NHD among neonates and providing sufficient information on NHD were included in this study. On the other hand, articles whose abstracts were only available were excluded. The extracted data were presented in Excel software with the following titles: authors' names, year, type of study, study location, and maternal risk factors. The methodological quality of the articles was determined using the quality assurance tool for the diagnostic accuracy score (QUADAS). Of the 58 searched articles, 16 were investigated, which included five prospective, seven cross-sectional, and four retrospective articles. Maternal risk factors for NHD included labour and delivery complications, childbirth complications, factors causing insufficient breast milk intake (including breast milk insufficiency, nipple problems, wrong breastfeeding techniques, breast disorders, types of feeding, and breastfeeding training/counselling in pregnancy), as well as delivery and the postpartum period. Maternal problems in pregnancy and delivery, breast disorders, breastfeeding status, maternal knowledge, and lactation skills are the most common maternal risk factors for NHD. Timely (antenatal) identification and proper management of maternal risk factors help reduce the incidence and severity of NHD complications.

Newborns with Collodion Skin Disorders

Collodion Baby is a descriptive term for newborns with the entire surface of the body wrapped in a rigid yellowish membrane that resembles solid and translucent parchment paper. A rare disorder that often occurs in preterm babies with low birth weight. Collodion babies can have defects in protein and fat metabolism due to genetic mutations. Management with emollients, fluid and electrolyte balance and overcoming infection. Case Report : Reported newborn came to the emergency room of Soeselo Hospital referral from Puskesmas with Collodion Baby and low birth weight. Yellowish skin is obtained throughout the body such as translucent thick parchment, fissures with some erosion and ecropions in both eyes. The patient is placed in an incubator with a temperature of 30-32o C, emollient therapy, topical antibiotics on fissures and erosions, prophylactic antibiotics and antibiotic creams for ectropion. Discussion : Collodion baby is a condition at risk of serious complications including: risk of infection, hypernatremic dehydration, fluid and electrolyte imbalances and temperature instability caused by epidermal lipid disorders and protein homeostasis, resulting in increased transepidermal water loss (TEWL) caused by mutations in the transglutaminase 1-TGM1, ALOXE3 or ALOX12B, ABCA12, HIPAL4/ichthyin, ABHD5 genes responsible for epidermal homeostasis. Conclusion: Collodion Baby is a disorder with severe corneal damage. The importance of proper and comprehensive management with the aim of minimizing complications can reduce morbidity and mortality.

Severe Hypernatremic Dehydration in a Neonate

Hypernatremia, a rare condition in newborns, is marked by elevated plasma sodium levels exceeding 150 mEq/L. It is more common in newborns who are exclusively breastfed or with excessive weight loss. Hypernatremic dehydration (HD) presents severe risks, including cerebral edema and other neurological complications. A female newborn, 12 days old (birth weight: 2800g), was brought to the Emergency Department due to a 30% decrease in birth weight and reduced urine output. The newborn was solely breastfed every 2 hours, with a good notion of adequate reflexes and tolerance. Physical examination revealed a skeletal appearance, jaundice, sunken eyes and skin turgor. Blood pressure measurement was unsuccessful, while capillary blood glucose was 96g/dL. A saline bolus (10 mL/Kg)was administered. Venous blood gas analysis showed pH 7.39, lactate 4.3 mmol/L, HCO3-21.8 mmol/L, and Na+ 180 mEq/L.

Neonatal hypernatremic dehydration in breastfed neonates: a prospective study unmasking the influences of breastfeeding practices and early weight monitoring

Introduction: Hypernatremic dehydration in neonates is an uncommon but serious reason for re-hospitalization, especially in exclusively breastfed neonates. The aim was to study the incidence, associated maternal and neonatal characteristics and risk factors, and presenting features of neonatal hypernatremic dehydration (NHD). Methods: A prospective study design was employed to enroll full-term newborns admitted with serum sodium concentrations of ≥145 mEq/L from April 2022 to March 2023 at a tertiary care rural hospital. Maternal and neonatal characteristics and breastfeeding practices of these mother-baby pairs were recorded and observed. Healthy control for every mother-baby pair was taken. Ethical clearance and informed consent were obtained from mothers. Result: 34 newborns out of total 672 NICU admissions were admitted due to NHD, with an incidence of 4.7%. Primiparous mothers were 23 (67.6%) in the cases and 10 (29.4%) in the control group (p = 0.0017). Disparity in maternal breastfeeding practices of cases, such as delayed initiation time 2.3 h vs. 1.27 h (p < 0.0001), less frequency of breastfeeding 6.5 times vs. 9.3 times (p < 0.0001), and duration of breastfeeding sessions 23.3 min vs. 32 min (p = 0.0014) respectively in cases and controls were found to be potential contributing factors. 61.7% of mothers had breast issues in the cases and 17.6% in the control group (p = 0.0002) with average LATCH score of 4.29 in cases as compared to 8.08 in controls (p < 0.0001) at time of baby’s admission to NICU. The average neonatal age at presentation was six days and average weight loss was 11.4% in cases vs. 2.8% in controls (p < 0.0001). The main presenting features were excessive weight loss 30 (88.2%), lethargy 20 (58.8%), jaundice 18 (52.9%) and fever 14 (41.1%). Conclusion: Neonatal hypernatremic dehydration (NHD) poses a significant clinical challenge, particularly in full-term, exclusively breastfed healthy neonates. We found an incidence of 4.7%. Delayed initiation of breastfeeding, inadequate breastfeeding techniques, and maternal breast-related issues were significant contributors to NHD. Primiparous mothers were found to be at higher risk, emphasizing the need for targeted breastfeeding education and support for primiparous mothers. The study reaffirmed the critical role of frequent and effective duration of breastfeeding and daily weight monitoring for preventing NHD.

Refractory seizure in a neonate with severe hypernatraemic dehydration – A case report

Hypernatraemic dehydration is a common clinical condition seen in neonates especially when they lose weight by more than 10%. Such neonates should be carefully followed up for rising sodium levels and need to be encouraged adequate feeding to prevent complications. Term-appropriate neonate born to a non-consanguineous couple with an uneventful perinatal period was brought to the paediatric emergency room on day 15 of life with multiple seizures and was diagnosed with hypernatraemic dehydration. Her brain imaging demonstrated sagittal venous thrombosis with intraventricular haemorrhage and parenchymal bleeding with infarct. She was managed with respiratory support and fluid management. Parents were counselled regarding the guarded prognosis. She was discharged against medical advice.

Clinical Predictors of Sodium Disturbance in Children Presenting with Acute Watery Diarrhea in a Tertiary Hospital of Bangladesh

Background: Sodium disturbances, either hyponatremia or hypernatremia, are the most common electrolyte imbalance encountered in managing children with acute watery diarrhoea. Early diagnosis and prompt management of these conditions by identifying clinical predicting factors in diarrheal children under 5 years of age are critically essential to prevent deaths in such children, especially in resource-limited settings. Our study aimed to evaluate clinical predicting factors associated with sodium disturbance in children hospitalized with acute watery diarrhea.&#x0D; Materials and Methods: In this cross-sectional study, 121 children of 2 months to 5 years of age admitted in the Department of Pediatrics, Chittagong Medical College Hospital, Chattogram for acute watery diarrhea were included. Clinical features and sodium levels on admission were recorded. Children were grouped in hyponatremia (serum sodium &lt;135mmol/l), hypernatremia (serum sodium &gt;145mmol/l) and normonatremia (serum sodium 135–145mmol/l) and compared.&#x0D; Results: Of the 121 children, 18 (14.9%) were hyponatremic, 71 (58.7%) isonatraemic, and 32 (26.4%) hypernatraemic. Logistic regression analysis revealed that children who did not receive ORS before admission, had severe dehydration and lethargy on admission would be more likely to have hyponatremic dehydration. Children who were younger, received concentrated ORS, thirsty and had convulsions on admission would be more likely to have hypernatremic dehydration than children with isonatremia.&#x0D; Conclusion: The type of ORS used and age appears to be good predictors of sodium disturbance in children admitted with AWD.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 71-75

An exhaustive battle of salt: A challenging case of Adipsic Diabetes Insipidus following resection of Craniopharyngioma

Introduction: Even though rare, Adipsic Diabetes Insipidus (ADI) is a potentially life-threatening complication of craniopharyngioma: due to the mass effect of the tumor or perioperative consequences leading to severe hypernatremic dehydration. Even in expert hands, management of water balance, in the absence of thirst is extremely challenging. Case Description: A 25-year-old gentleman, an electrician presented to the neurosurgical casualty with worsening headaches, impaired vision, and features of raised intracranial pressure over 2 months. He was found to have a large cystic suprasellar mass with well-defined margins measuring 2.7cm x 2.7cm x 3cm with chiasmal compression, suggestive of craniopharyngioma, complicating with bitemporal hemianopia, hypogonadotropic hypogonadism (LH 0.78IU/L, FSH 1.2IU/L, Testosterone 33ng/dL), secondary hypothyroidism, cranial diabetes insipidus, prediabetes sparing the cortisol axis. He underwent transcranial resection of the tumor, revealing WHO grade1 adamantinomatous craniopharyngioma followed by radiotherapy. The post-operative period was complicated with severe hypernatremia despite escalating doses and changing dosage forms of desmopressin from parenteral to nasal spray to oral tablets. Two weeks following discharge, he presented with severe hypernatremia (176mEq/L), polyuria, weight loss, hypotension, and altered sensorium where his lack of thirst was appreciated. Conclusions: In those with ADI, for the management of water balance, a “personalized approach” with the involvement of both patient and family is of paramount importance. With appropriate dose titration of desmopressin, careful fluid prescription, and frequent monitoring of electrolytes even at best centers, it is a battle that is hard to win.

Retrospective analysis of 102 neonatal cases hospitalized with diagnosis of the ongoing phenomenon of neonatal period: hypernatremic dehydration

Aim: The aim of this study was to examine the prevalence of hypernatremic dehydration (HD) among term neonates admitted to a tertiary care unit over a three-year period and to identify mother and neonate related risk factors associated with HD.&#x0D; Material and Method: Medical records of 102 term babies and their mothers were analyzed retrospectively. The gender, weight at birth, type of birth, postnatal day of diagnosis, weight and weight loss percentage at diagnosis, season and presenting complaint upon admission, feeding with human milk/formula/mixed, laboratory findings, usage of antibiotics as well as maternal age, parity, residence, level of education and presence of smoking were recorded. Serum sodium (Na) levels, severity of dehydration, age on admission, and length of stay in the neonatal intensive care unit (NICU) were recorded along with any significant effect of maternal demographic properties, residence, season, gender, and type of birth.&#x0D; Results: The average Na levels were found to be 152.1±4.2 mEq/L (max:166 mEq/L). Mild, moderate and severe hypernatremia were found in 34 (33%), 62 (61%) and 6 (6%) patients, respectively. More weight loss was observed in neonates born via cesarean section vs. vaginal delivery (12.8±3.0% vs. 11.6±3.5%, p=0.01). Higher serum Na levels (153.9±4.86 mEq/L vs. 151±2.34 mEq/L, p=0.008) and a greater median age at admission (4.5 [IQR4-6]) days vs. 3 [IQR3-4]) days, p=0.03) were reported for neonates born to mothers residing in rural/suburban vs. urban areas. Serum Na levels were not different based on the mother's level of education or parity (p=0.96 and p=0.29, respectively). There was no difference in serum Na levels (p=0.05) but the percentage of weight loss was higher when the mother smoked (14.3±3.8% vs. 11.7±3.1%, p=0.003). Serum Na and glucose levels were lower, antibiotics usage rates, and prevalence of mixed feedings were higher in early term infants (p=0.01, p=0.002, p=0.04 and p=0.04, respectively). Males had higher creatinine levels (0.89±0.27 mg/dl vs. 0.78±0.28 mg/dl, p=0.005), but there was no difference between the sexes in terms of day of admission, percentage of weight loss, or length of stay in NICU.&#x0D; Conclusion: Hypernatremic dehydration is a significant and increasingly prevalent problem of neonatal period. Serum Na levels and severity of dehydration in neonates may be affected by the type of birth, mother's smoking status, residence and early term birth. Counseling on breastfeeding, education of health professionals and caregivers on the signs and symptoms of dehydration, and monitoring of body weight are essential for the prevention, diagnosis, and treatment of HD.

CLINICAL PROFILE AND OUTCOME OF NEONATES WITH HYPERNATREMIC DEHYDRATION - A TERTIARY CARE HOSPITAL BASED STUDY

Objectives: Materials And Methods: Clinical prole and outcome of neonates with hypernatremic dehydration. Cross sectional study conducted in a tertiary care centre in central India, includes sick neonates aged less than 28 days admitted in hospital for a period from April 2022 to March 2023, who found to have hypernatremic dehydration on admission with serum soidum &gt;150 mEq/L. Clinical and demographic information in relation to mother and baby were recorded. Out of total 2076 neonates admitted during t Results: he study period, 25 babies were diagnosed as a hypernatremic dehydration, showing an institute prevalence of 1.2%. Median age of presentation was 9 days, with female to male ratio 1.03. 92% of the babies were exclusively breast fed.76 % were born via normal delivery. Maximum presented with not accepting feed (96%), along with fever (64%), decreased urine output (52%), convulsions (28%). Admitted babies had a mean serum sodium level of 173.9 mEq/L, with as high as 200 mEq/L. 9 babies (36%) presented with shock,19 (76%) presented with evidence of kidney injury. Statistically signicant correlation was found between percentage of weight loss to mortality and serum sodium levels to mortality. Hypernatremic dehydration is a common Conclusion: medical emergency encountered in neonatal ICU and can be caused by poor feeding. Early diagnosis and appropriate treatment are crucial for survival and better prognosis.

Hypernatremic hemorrhagic encephalopathy as an unexpected critical complication in children: a case report from a tertiary hospital

Introduction: Hypernatremic hemorrhagic encephalopathy (HHE) is one of the complications of hypernatremic dehydration which is relatively uncommon in patients with hypernatremia. Severe hypernatremia might lead to brain shrinkage resulting in intracranial bleeding which can increase morbidity and mortality, especially in children. Hypernatremic hemorrhagic encephalopathy is harmful, but only limited cases are reported. This case highlights the role of cautious management of hypernatremic dehydration and the need for intense monitoring due to the unexpected complication of HHE. Case presentation: A 4 months old female infant presented with a decreased consciousness. She showed signs of shock along with acute diarrhoea and severe dehydration. Laboratory findings revealed severe hypernatremia and high septic marker. Rehydration and correction of hypernatremia were done, but during the process, several episodes of general tonic-clonic seizure occurred. A Head CT scan was done and showed subdural hemorrhage in the posterior interhemispheric fissure and intraventricular hemorrhage in the posterior horn of the right lateral ventricle. Conservative management was undertaken and the patient was clinically improved progressively. On the 11th day of hospitalization, the patient's condition had been significantly improved without neurological sequelae and was later discharged on the 11th day of hospitalization. Conclusion: Close monitoring of clinical, neurological, and laboratory examination is essential in the management of hypernatremic dehydration due to the possibility of HHE, even when on the right procedure. Once neurological complication is suspected, an immediate imaging study should be performed and modifying therapy is required.

Management of Hypernatremia Dehydration in Three Neonates with Ichthyosis

Introduction: Ichthyosis is an epidermal disruption that increases insensible water loss. Hypernatremic dehydration is a consequence of skin disruption. This study reviewed the treatment of hypernatremic dehydration in patients with ichthyosis comparing to patients with intact skin. Case Presentation: We studied five neonates with hypernatremia, including three ichthyosis cases and two normal-skin neonates. This case-series study showed that the sodium correction rate is slower in infants with ichthyosis than in infants with normal skin. The first and second neonates needed less sodium than fluid intake than normal skin infants, although fluid requirement was lower in the third ichthyosis infant than in others due to less skin disruption in this infant. Conclusions: Fluid therapy in hypernatremic dehydration in ichthyosis patients is different from neonates with intact skin because of excessive insensible water loss in these patients. It may be needed to give more fluid and less sodium depending on the degree of skin disruption, which may not be determined by physical examination.

Diagnostic Pitfalls of a Newborn with Congenital Nephrogenic Diabetes Insipidus.

Congenital nephrogenic diabetes insipidus (NDI) is a rare cause of hypernatremia in newborns. Central diabetes insipidus (CDI) is the main differential diagnosis of NDI. NDI responds poorly to desmopressin acetate (DDAVP) treatment while this is the mainstay of CDI management. Therefore, an early and correct diagnosis of NDI is crucial to avoid the complications of inappropriate therapy. Here, we report a newborn with hypernatremia and hypotonic polyuria. The patient was initially responsive but subsequently unresponsive to intranasal DDAVP treatment in regard to urine output and serum sodium levels. A novel hemizygous missense mutation (c.632T>C, p.L211P) in the AVPR2 gene was found both in the baby and his mother, and the diagnosis of congenital NDI was established. After hydrochlorothiazide treatment and hypo-osmolar formula were given, urine volume was decreased, and serum sodium levels were normalized. Early recognition and appropriate management of NDI can prevent complications of hypernatremic dehydration in young infants.

Clinico-aetiological Profile and Outcome of Hypernatremic Dehydration in Term Neonates Admitted to the NICU at a Tertiary Care Centre in Udaipur, Rajasthan, India

Introduction: Hypernatremic dehydration is commonly found in the first week of neonatal life. Hypernatremia develops when water loss exceeds sodium loss, as in lactational failure with inadequate breastfeeding, or when sodium intake exceeds water intake disproportionately (salt poisoning), such as when neonates receive concentrated formula or top milk. The common presentations include lethargy, irritability, poor feeding, dehydration, reduced urinary frequency, significant weight loss, and fever. Aim: The aim of this study was to investigate the clinico- etiological profile and outcome of hypernatremic dehydration in term neonates admitted to the Neonatal Intensive Care Unit (NICU) at a tertiary care centre. Additionally, the study aimed to examine the factors contributing to hypernatremic dehydration. Materials and Methods: This prospective cohort study was conducted at the NICU, Department of Paediatrics, of Geetanjali Medical College, Udaipur, Rajasthan, India from February 2021 to July 2022. A total of 51 term neonates with a history of inadequate breastfeeding, maternal history of lactational failure, significant weight loss (&gt;10% weight loss within a short period of time), or dehydration fever, along with hypernatremia (serum sodium &gt; 145 mEq/L), were enrolled in the study. Data regarding serum sodium level, serum bilirubin level, Kidney Function Test (KFT), Ultrasonography of Kidney, Ureters and Bladder (USG KUB), and neuroimaging were collected for all study subjects and statistically analysed using the Chi-square test. Results: A total of 51 neonates were admitted to the NICU during the study period, with a mean age of 6.05±2.2 days (range 0-15 days) and a mean birth weight of 2810 grams. The study showed that the mean weight (in %) loss was 13.75±4.1 (range 10.1-21%). The study also revealed that 64.7% of the mothers of neonates experienced lactational failure, with a p-value &lt;0.05. The presenting complaints were poor feeding (92.2%), fever (45.1%), excessive crying (96.1%), and decreased urine output (47%). The mean Standard Deviation (SD) sodium level on admission was 155.3 mEq/L. Two neonates developed neurological complications (intracranial haemorrhage and cerebral oedema), and 62.7% of neonates developed Acute Kidney Injury (AKI). Conclusion: Hypernatremic dehydration poses a significant threat in early neonatal life and is often underdiagnosed. Common causes include a lack of awareness about exclusive breastfeeding, lactational failure, and improper breastfeeding techniques, as well as feeding problems due to inverted/flat nipples or cracked nipples/breast engorgement. These findings were observed in the present study.

Dehydration fever in exclusively breastfed neonates at a tertiary care center – A cross-sectional study

Background: Dehydration fever is one of the most common non-infectious causes of fever in newborns. It can be very dangerous and can lead to serious complications and even death. Early recognition of dehydration fever by serial monitoring of weight to detect inappropriate weight loss and early correction of dehydration fever can prevent disastrous complications in the baby. Aims and Objectives: The aim was to study the incidence and clinical profile of dehydration fever in exclusively breastfed neonates admitted at tertiary care hospital. The primary objective is to know the incidence of dehydration fever in exclusively breastfed neonates. Secondary objectives are to study the clinical and laboratory profile of dehydration fever and to study the management and outcome of dehydration fever in terms of morbidity and mortality. Materials and Methods: The study was conducted in the Department of Pediatrics of a tertiary care hospital in Ahmedabad, Gujarat. Neonates between 0 and 28 days of life born at full term (37–40 weeks of gestation), on exclusive breastfeeding and having an axillary temperature of &gt;37.5°C/100.4°F and clinical signs of dehydration were included in the study. Clinical and laboratory profile of neonates with dehydration fever was noted. Results: The incidence of dehydration fever was 4.71/100 neonates (152 out of 3225 neonatal admissions). Maximum cases were noted in May. The most common predisposing factor was primiparity (n = 119 [78.28%]), followed by the poor establishment of breastfeeding (n = 117 [76.97%]) and cesarean section delivery (n = 97 [63.81%]). Among 152 neonates with dehydration fever, 118 neonates (77.64%) had hypernatremic dehydration and 34 (22.36%) had isonatremic dehydration. All the neonates with dehydration fever were successfully treated. No deaths were observed in the present study. Conclusions: Dehydration fever is an important cause of neonatal fever in tropical countries like India, especially during the summer months. The present study highlights the need to be vigilant about dehydration, hypernatremia, and hyperbilirubinemia in breastfed neonates while emphasizing the need to promote exclusive breastfeeding. Dehydration fever can be prevented by educating mothers regarding breastfeeding techniques, beginning in the antenatal period. Those with identifiable problems should be referred promptly for lactation management and supportive counseling.

Abstract 11687: Diagnosis and Management of High-Risk Pulmonary Embolism in a Term Neonate

Case Presentation: A 5 day old, term infant born to a 39-year-old G1P0 with a history of diet-controlled gestational diabetes mellitus presented with hypernatremic dehydration in the setting of poor feeding. On hospital day 2, the infant suffered a bradycardic cardiac arrest requiring 2 minutes of CPR prior to return of spontaneous circulation. An echocardiogram (Figure 1A) revealed moderately depressed right ventricular (RV) function, elevated RV pressure and a large mobile mass extending from the main pulmonary artery (PA) into the left PA with obstruction of flow. D-dimer was markedly elevated at 2740 ng/mL. A subsequent CT angiogram revealed acute pulmonary emboli in the distal left and right branch PAs (Figure 1B). Additional imaging was obtained and showed dural venous sinus, left portal vein and right cephalic vein thromboses. The infant was managed with a heparin infusion and supportive therapy for the RV dysfunction and pulmonary hypertension including mechanical ventilation, inhaled nitric oxide as well as epinephrine and milrinone infusions. Over the course of two weeks, the infant improved clinically with normalization of RV function. Discussion: Neonatal pulmonary arterial thrombosis is an exceedingly rare phenomenon. The majority of cases described in the literature are associated with either an inherited thrombophilia or with underlying congenital heart disease, which were not found to be present in this case. However, this patient presented with severe dehydration and a history of maternal diabetes, both of which are risk factors for neonatal thrombosis. Fortunately, this patient responded to treatment with anticoagulation alone and did not require more invasive therapies, such as surgical thrombectomy or systemic and catheter-directed thrombolysis. Although rare, neonatal pulmonary arterial thrombosis can occur and delays in recognition and treatment may lead to significant RV dysfunction, morbidity, and even death.

Diffuse Miliaria Cristalina due to Severe Hypernatremic Dehydration: A Neonatal Case Report with a Current Literature Review

Diffuse Miliaria Cristalina due to Severe Hypernatremic Dehydration: A Neonatal Case Report with a Current Literature Review