Neonatal Dehydration Research Articles

LEUCINOSIS IN THE PRACTICE OF A NEONATOLOGIST (clinical case)

Background. Leucinosis ("maple syrup urine disease ") is a hereditary disease with an autosomal recessive type of inheritance, the basis of which is a violation of the metabolism of organic amino acids. The disease is characterized by the development of a life-threatening condition, accompanied by developmental delay, suppression of neuro-reflex excitability, a specific smell of urine (the smell of "maple syrup"), ketoacidosis, hypoglycemia. There are five clinical phenotypes of leucinosis: classic, intermediate, intermittent, E3-deficient, and thiamine-sensitive. Aim: To expand the knowledge of pediatricians and neonatologists regarding the clinical and paraclinical features of the course of leucinosis. Materials and methods. The article presents a clinical case of clinical-paraclinical and molecular-genetic features of the course of leucinosis with manifestation in the neonatal period. Description of a clinical case. Boy I., from the third pregnancy, which occurred against the background of anemia of the 1st century and chronic pyelonephritis. The first pregnancy ended with the birth of a boy who died at the age of 2 months due to the manifestations of neonatal dehydration and convulsive syndrome (14 years ago); second pregnancy - miscarriage at 6 weeks of pregnancy. From the 5th day of life, the child's restlessness, refusal to eat, weak sucking and weight loss were noted. During the 7-8th day of life, the child had an expiratory moan. On the 9th day, tonic convulsions appeared. During the stay at the NICU, a positive result of neonatal screening for leucine was obtained twice. According to the results of the conducted molecular genetic research, a mutation of the BCKDHA gene, namely the variant c.632C>T (p.Thr 211 Met) was found in a homozygous state, which confirmed the diagnosis of type Ia leucinosis. Conclusion. The presented clinical case demonstrates that leucinosis is a disease that manifests non-specific and multisystem lesions, is difficult to diagnose and, in the case of untimely started specific treatment, rapidly progresses in the neonatal age and can lead to the development of metabolic decompensation and end in death.

Multicentric Trial Across India to Evaluate the Impact of Temperature Variation on Neonatal Dehydration

Multicentric Trial Across India to Evaluate the Impact of Temperature Variation on Neonatal Dehydration

Impact of Seasonal Variation in Temperature on Dehydration in Neonates

Impact of Seasonal Variation in Temperature on Dehydration in Neonates

The Relationship Between Breastfeeding Frequency and Neonatal Dehydration Hypernatremia

Objective:Inadequate breastfeeding is the most important cause of neonatal dehydration hypernatremia (NDH). This study aimed to define the relationship between breastfeeding frequency and NDH.Methods:A total of 934 infants (574 isonatremic and 360 with NDH) were enrolled in this cross-sectional study at Ghaem Hospital, Mashhad, Iran, in 2014–2022, assigned into low feeding frequency (<8 times/day) and proper feeding frequency (≥8 times/day) groups, and compared for NDH intensity according to a researcher-made questionnaire.Results:The admission age (p= .001) and weight (t(931) = 1.864, p = .063), urination frequency (t(931) = −8.742, p = .001), defecation frequency (t(931) = −5.372, p = .001), serum sodium (t(931) = 13.541, p = .001), urea (t(931) = 9.721, p = .001), and creatinine levels (t(931) = 7.613, p = .001) showed significant differences between the two groups. Interestingly, 56.27% of infants with NDH and only 10.28% of isonatremic infants had low feeding frequencies.Conclusions:Low feeding frequency and duration were associated with weight loss and increased serum sodium levels. A group of infants who had a feeding frequency of less than eight times a day, a history of cesarean delivery, breast problems, and a lack of let-down reflex was associated with an increased incidence of low weight; higher levels of serum sodium, urea, and creatinine; and reduced frequency of urination and stool passage.

A prospective observational study to evaluate the association of various maternal risk factors with increasing incidence of term neonatal jaundice

<p><strong><em>Background: </em></strong><em>In our setting majority of the mothers were discharged on postnatal day 3.but over the past few years the NICU admissions also increased prolonging the hospital stay of mothers leading to increase in the hospital acquired infections for both mother and baby. This study was developed in this context. <strong></strong></em></p><p><strong><em>Objectives:</em></strong><em> The present study was performed with the purpose of establishing the incidence of neonatal jaundice in term neonates and the role of the various maternal factors being responsible for exaggerated physiological hyperbilirubinemia in term neonates. <strong></strong></em></p><p><strong><em>Methods: </em></strong><em>Using the NICE gestational age-based phototherapy chart, this study analysed serum bilirubin of the term newborns on their day 2 of life. Total 155 antenatal mothers were taken for study. Associations between maternal risk factors and neonatal jaundice and comparing risk factors in early-term, term, and late-term newborns were assessed using chi-squared or Fisher’s exact tests</em></p><p><strong><em>Results: </em></strong><em>Incidence of neonatal jaundice is 58.1% in this study. Age, BMI, weight gain of the mother had no significant correlation with neonatal jaundice. Blood group incompatibility had a positive corelation (P=.001) Gestational age at the time of delivery determines the neonatal outcome. (P=.001). As gestation advances the neonatal outcomes are better. Hyperbilirubinemia incidence more at 37 -38 weeks when compared to 39 weeks. Maternal comorbidities, amniotic fluid volume changes, mode of delivery didn’t have statistical significance. when new-born factors are considered birth weight, gender growth problems, blood group has no statistical significance whereas dehydration proved to be significant (P=.001). meconium-stained amniotic fluid[P-0.034] were found to be associated with the development of neonatal jaundice.</em></p><p><strong><em>Conclusions: </em></strong><em>The prevalence of jaundice is higher in this study. maternal and foetal blood group incompatibility, gestational age at delivery, meconium-stained amniotic fluid, neonatal dehydration was found to be associated with the development of neonatal jaundice.</em></p>

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.

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.

Birth Weight Loss Due to Neonatal Dehydration Which in Turn is Secondary to Low Milk Intake

Birth Weight Loss Due to Neonatal Dehydration Which in Turn is Secondary to Low Milk Intake

Consequences of the Ignored Insufficient Milk Syndrome

The Ignored Insufficient Milk Syndrome is the sum of mothers with low colostrum production and babies with birth weight loss, which is a sign of neonatal dehydration due to low intake (small volume) of colostrum in infants from mothers with Delayed Lactogenesis II. If neonatal dehydration is severe, and is not detected early, it can cause neurological damage to the newborn in the short, medium, and long term. Accepting weight loss as normal, means exposing them, unnecessarily, to a progressive risk of dehydration and brain damage of varying degrees, in the first 10 days of puerperium and exclusive breastfeeding. When the volume of colostrum ingested is insufficient, instead of conditioning growth and development, in terms of weight gain and adequate neurological functions, it conditions the opposite, weight loss and manifestations of neurological malfunction. In the other hand, it is been proven that all stressful factors in mothers, further inhibit and delay the onset of lactogenesis II. We do not doubt the unquestionable benefits of breastfeeding and that it is the best “Quality” food for neonates, but we insist that it is not enough in “Quantity” to satisfy neonatal nutritional needs during the first ten days of life. There is evidence that some of the “ten steps to successful breastfeeding”, like prohibiting supplementing babies with formula, and omitting step 6, while milk coming in occurs, do not provide the benefits highlighted and expected, they even have more risks than benefits for most infants and mothers.

Effects of spring- versus fall-calving on perinatal nutrient availability and neonatal vigor in beef cattle.

To determine the effect of calving season on perinatal nutrient availability and neonatal beef calf vigor, data were collected from 4 spring- (average calving date: February 14; n = 203 total) and 4 fall- (average calving date: September 20; n = 179 total) calving experiments. Time to stand was determined as minutes from birth to standing for 5 s. After birth, calf weight and size (length, heart and abdominal girth, and cannon circumference) were recorded. Jugular blood samples and rectal temperatures were obtained at 0, 6, 12, and 24 h postnatally in 6 experiments and at 48 h postnatally in Exp. 2 to 8. Data were analyzed with fixed effects of season (single point) or season, hour, and their interaction (over time, using repeated measures). Experiment was a random effect; calf sex was included when P ≤ 0.25. Within calving season, correlations were determined between calf size, vigor, and 48-h serum total protein. Fall-born calves tended to have lighter (P = 0.09) birth weight and faster (P = 0.05) time to stand than spring-born calves. Season did not affect (P ≥ 0.18) gestation length, other calf size measures, or 48-h serum total protein. Fall-born calves had greater (P ≤ 0.003) rectal temperature at 0, 24, and 48 h postnatal. Spring-born calves had greater (P ≤ 0.009) circulating glucose at 0 h, serum non-esterified fatty acids at 0 and 6 h, and plasma triglycerides at 0, 6, 12, and 48 h. Fall-born calves had greater (P ≤ 0.03) sodium from 6 to 48 h and magnesium from 0 to 24 h of age. Phosphorus was greater (P ≤ 0.02) at 6 and 12 h of age in spring-born calves. Spring-born calves had greater (P ≤ 0.04) aspartate aminotransferase at 12 and 24 h and creatine kinase at 0 and 12 h of age. Fall-born calves had greater (P ≤ 0.03) albumin, calcium, and chloride, had lower (P ≤ 0.03) bicarbonate and direct bilirubin, and tended to have greater (P = 0.10) anion gap (all main effects of calving season). Calf birth weight had a weak positive relationship (P ≤ 0.03) with 48-h serum total protein and time to stand in fall-born, but not spring-born, calves. Overall, fetal growth was restricted and neonatal dehydration was increased by warm conditions for fall-born calves, but vigor and metabolism were negatively affected by cold conditions in spring-born calves. These data suggest that calving season influences perinatal nutrient availability, which may impact the transition of beef calves to postnatal life.

Dehydration in Newborns Admitted to Intensive Care for Ehs Nouar Fadela

Introduction: Dehydration (DSH) in newborns can have potentially fatal consequences such as cerebral oedema, intracranial haemorrhage, subdural haematoma, hydrocephalus and gangrene. In light of the increasing number of newborns with dehydration, there is a strong need to increase awareness and raise suspicion in the diagnosis of this potentially fatal condition. Objective: To describe dehydration in the newborn, its complications and the method of appropriate management. Patients and method: Retrospective descriptive and analytical study, from January 1, 2019 to May 31, 2021. Study population: We included all newborns and infants aged 0 to 30 days, hospitalized during the period with clinical and biological signs of dehydration. Hypernatremia was defined by a natremia ≥ 150 mmol/L. Data were collected in Excel and analysed using R 3.5.0 software. Conclusion: Neonatal dehydration is not as rare as is commonly believed. Feeding difficulties in newborns may result in inadequate secretion of sodium into the breast milk. Monitoring the mother and newborn in the first week of life for successful establishment of breastfeeding is essential. In an otherwise healthy newborn, poor feeding and weight loss may be a reason to suspect hypernatremia. Neonatal hypernatremia due to breast milk hypernatremia is now a well-established entity and should be sought in all newborns with hypernatremia. There is no reason to stop breastfeeding even if the sodium level in the breast milk is high as it decreases over time. Breastfeeding is still extremely beneficial for the baby and should be strongly recommended.

Integrating Population Variants and Protein Structural Analysis to Improve Clinical Genetic Diagnosis and Treatment in Nephrogenic Diabetes Insipidus.

Congenital nephrogenic diabetes insipidus (NDI) is a rare genetic disorder characterized by renal inability to concentrate urine. We utilized a multicenter strategy to investigate the genotype and phenotype in a cohort of Chinese children clinically diagnosed with NDI from 2014 to 2019. Ten boys from nine families were identified with mutations in AVPR2 or AQP2 along with dehydration, polyuria–polydipsia, and severe hypernatremia. Genetic screening confirmed the diagnosis of seven additional relatives with partial or subclinical NDI. Protein structural analysis revealed a notable clustering of diagnostic mutations in the transmembrane region of AVPR2 and an enrichment of diagnostic mutations in the C-terminal region of AQP2. The pathogenic variants are significantly more likely to be located inside the domain compared with population variants. Through the structural analysis and in silico prediction, the eight mutations identified in this study were presumed to be disease-causing. The most common treatments were thiazide diuretics and non-steroidal anti-inflammatory drugs (NSAIDs). Emergency treatment for hypernatremia dehydration in neonates should not use isotonic saline as a rehydration fluid. Genetic analysis presumably confirmed the diagnosis of NDI in each patient in our study. We outlined methods for the early identification of NDI through phenotype and genotype, and outlined optimized treatment strategies.

Characterization of full term newborns with hypernatremic dehydration

The hypernatremic neonatal dehydration is a severe condition whose incidence has increased in recent years resulting in complications leading to the hospitalization of the newborn. Describe the clinical and laboratory characteristics of term-newborns with Hypernatremic Dehy dration diagnosis. Descriptive observational study of hospitalized term- newborns due to hypernatremic dehydration between a period from 2014 to 2016. Term newborns over 37 weeks with clinical signs of dehydration (dry mucous membranes, depressed fontanel, tear less crying, signs of the cutaneous pleat), and/or excessive weight loss greater than 7% and serum sodium greater than 145 mEq/L were included. Sociodemographic and biochemical variables were recorded for analysis. 43 neonates were included. 60.5 percent of their mothers were pri- miparous, 90 percent of neonates received exclusive breastfeeding, mothers reported breastfeeding problems in 76.7 percent. Incoming neonates reported weight loss compared to birth weight at 15.3% on average. 83.3% had public health insurance. 65.1% had dehydration clinical signs at entry and 83.5% transient neurological signs. The average sodium was 155 mEq/L at revenue. The sodium decrease in the first 24 hours of handling was 7.74 mEq/L (0.32mEq/L per hour). The correction of the hypernatremia was 55.8% by oral intake and 4 days hospital stay on average. The feeding's problems came up in a (76%), primiparous mothers in an (88.4%). 90.6 percent of this population administered exclusive breastfeeding, results that can help to alert the health professional to timely identification, warning signs, and early post-discharge control and preventive measures.

The prevalence of hyperglycemia in neonatal hypernatremic dehydration (NHD) and its correlation with prognosis in exclusively breastfed infants: A cohort study

BACKGROUND: Glucose changes are unknown in neonatal dehydration with hypernatremia. OBJECTIVE: Was to investigate glucose status in neonatal hypernatremic dehydration (NHD) and its correlation with NHD prognosis. MATERIAL AND METHODS: In this cohort study, serum glucose of 172 neonatal hypernatremic dehydration infants admitted to the Ghaem Hospital in Mashhad, Iran, was reviewed within the time frame of 2012 to 2017. The data were collected utilizing a questionnaire designed by the researchers to describe the characteristics of the mothers and neonates, as well as their laboratory and imaging study results. The neonatal hypernatremic dehydration infants were followed using the Denver Developmental Test II (DDT II) questionnaire at follow-up months 6, 12, 18, 24, 30, and 36. RESULTS: 134 infants (77.91%) had normal blood glucose levels and 38 infants (22.09%) had a hyperglycemic status. In both groups, the differences in infant age (p = 0.000), weight upon admission (p = 0.035), breastfeeding duration (p = 0.003), frequency of urination (p = 0.001), blood sugar (p = 0.000), sodium (p = 0.008), urea (p = 0.000), creatinine (p = 0.000), and pH upon admission (p = 0.002) were statistically significant. Developmental delays were higher in the neonatal hypernatremic dehydration group with hyperglycemia (p = 0.029). There was a significant correlation between sodium levels and blood sugar (p = 0.000). CONCLUSION: According to our study results, hyperglycemic neonatal hypernatremic dehydration infants had an older referral age; higher sodium, urea, and creatinine levels; lower weight upon admission; shorter breastfeeding duration; lower frequency of urination; and lower blood pH. Therefore, checking the blood sugar of infants with hypernatremia is recommended and high serum glucose is a poor prognosis criterion in infants with neonatal hypernatremic dehydration.

A Clinical Study of Hypernatremic Dehydration in Neonates at a Tertiary Care Hospital

A Clinical Study of Hypernatremic Dehydration in Neonates at a Tertiary Care Hospital

Acute Cerebral Venous sinus thrombosis as a Complication of Acute Hyponatremic Dehydration in Neonate: Case Report and Mini Review

Acute Cerebral Venous sinus thrombosis as a Complication of Acute Hyponatremic Dehydration in Neonate: Case Report and Mini Review

C-52 Neuropsychological Sequelae of Hypernatraemic Dehydration in Neonates – Working Towards the NHS England Five Year Forward View

Abstract Objective Neonatal breastfeeding is reported to have advantages for both physical and psychological well-being, including decreased incidence of infections, improved neurodevelopmental outcomes and a variety of lifelong health benefits. In some cases inadequate breastfeeding can lead to malnutrition and hypernatraemic dehydration. While the impact on physical health from hypernatraemic dehydration is well reported, the longer neurocognitive and quality of life (QoL) outcomes are rarely documented. Method We present neurocognitive profiles of two paediatric cases of hypernatraemic dehydration where significant brain damage had occurred. Neuropsychological assessments (Wechsler Intelligence Scale for Children, Children’s Memory Scale, Rey-Osterrieth Complex Figure Test, Delis-Kaplan Executive Function System and Wechsler Non-Verbal Scale of Ability, Strengths &amp; Difficulties Questionnaire) were administered within detailed clinical interview. Results Both children displayed cognitive performance within broad average level but with specific problems identified in working memory and processing speed, as well as immaturity and marked dysexecutive problems reported at home and school. These profiles are consistent with scan findings of injuries to the brain, including the frontal lobe. Conclusions We discuss the potential role for Pediatric Neuropsychologists in line with the NHS 5-year plan, in educating professionals involved in the care of pregnant women and their young babies regarding the impact of breastfeeding malnutrition and hypernatraemic dehydration on cognitive development and QoL. Education modules would aim to highlight implications of the potential devastating neuropsychological effects where malnutrition and hypernatraemic dehydration is severe, with the aim of increasing awareness of consequences and reducing the incidence of breastfeeding malnutrition and hypernatraemic dehydration and its potential lifelong neuropsychological effects.

Correction of hypernatremic dehydration in neonates with supervised breast-feeding: A cross-sectional observational study

BackgroundHypernatremic dehydration is an uncommon but a serious cause of readmission in neonates especially in the ones on exclusive breast-feeding. The management of such neonates is challenging as serious complications can occur both because of hypernatremic dehydration and its rapid correction. The aim was to study the clinical profile of neonates with hypernatremic dehydration and determine the outcome of these neonates after appropriate management. MethodsThis is a prospective cross-sectional observational study of neonates readmitted with hypernatremic dehydration in a tertiary care hospital in a 12-month period from March 2017 to February 2018. The inclusion criterion was as follows: all neonates with serum sodium >145 mEq/l. The exclusion criteria were as follows: neonates with hypoglycemia, positive sepsis screen and any other congenital diseases. Neonates with serum sodium between 145 and 160 mEq/l were treated with supervised quantified oral feeds at 150 ml/kg/day, unless they had features of shock. Neonates who had serum sodium ≥160 mEq/l were given intravenous (IV) fluids initially. ResultsA total of 2412 deliveries took place during the study period. Hypernatremic dehydration was reported in 46 (1.9%) of them, which required admission. We found that all these neonates were exclusively breast-fed, with 81.3% neonates born to primigravidae. One neonate presented with seizures, and one, with metabolic acidosis. More than 50% neonates had acute kidney injury (AKI) on admission. No neonates in our study developed central nervous system (CNS) complications such as cerebral venous thrombosis, convulsions or intracranial haemorrhage, and complete recovery from AKI was documented in all neonates. ConclusionHypernatremic dehydration can be a serious problem even in term healthy neonates especially in exclusively breast-fed neonates born to primiparous women. Our study shows that quantified oral feeding is effective in successful management of hypernatremic dehydration and not associated with the dreaded CNS complications due to rapid correction.

The relationship between hypernatremia and breast milk sodium levels in newborns with hypernatremic dehydration

Objectives: Breast-feeding with high sodium content milk may cause hypernatremic dehydration in neonates (NHD). The number of cases with NHD tends to increase particularly in the higher temperature seasons. In this prospective case-control study, the relationship between NHD and breast milk sodium (Na) levels and demographic features of NHD were investigated during the summer season. Methods: The study included term newborns admitted to the neonatal intensive care unit of our hospital with the diagnosis of hypernatremic dehydration between June 2009 and October 2009. Serum sodium level ≥ 150mEq/L was accepted as hypernatremia. Among 109 NHD patients, breast milk sodium level was evaluated in 50 cases. Term infants without hypernatremic dehydration were taken as the control group (50 cases). Results: Postnatal age at admission ranged between 2 and 12 days and mean serum Na concentration was 152 mEq/L (150-173 mEq/L). A significant weight loss of &amp;gt;10% was determined in 85% of cases. Breast milk Na was significantly higher in the hypernatremic group (24.3 ± 20.3 mEq/L) compared to the control group (12.6 ± 6.79 mEq/L) (p &amp;lt; 0.001). In primiparous mothers, the mean breast milk Na level was statistically higher than that of multipara mothers (21.16 ± 19.9 mEq/L vs 15.48 ± 9.96 mEq/L, p &amp;lt; 0.016). Conclusions: In this study, we demonstrated that high breast milk sodium level was closely related with NHD and being a primiparous mother appeared as a significant factor for high breast milk sodium content. In this respect, all pregnant women especially primiparous should be educated about infant nutrition and neonatal dehydration. Health care providers should emphasize importance of frequent milking and more fluid intake, especially in summer.

OSCE: Management of hypernatremic dehydration in neonates

Hypernatremic dehydration is a neonatal morbidity commonly seen in exclusively breast-fed neonates due to inadequate breast milk intake. This problem is generally missed by native practitioners as the degree of dehydration can be underestimated due to fluid shifts. Neonates of primiparous mothers, neonates born via caesarean section and those who experience greater weight loss in the first week of life are at higher risk of developing hypernatremic dehydration. No consensus treatment guidelines exist till date. Complications of hypernatremic dehydration like cerebral edema usually occur during improper correction.