Neonatal Hypernatremic Dehydration Research Articles

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

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.

Hipernatremik dehidratasyon tanısı ile takip edilen yenidoğan olgularımızın retrospektif değerlendirilmesi

Aim: The aim of our study is to evaluate the demographic characteristics and epidemiological risk factors of neonatal hypernatremic dehydration and to discuss the precautions applied in our clinic in order to reduce the number of dehydration cases in the light of the literature. Patients and Methods: Newborns who were hospitalized in our neonatal intensive care unit with the diagnosis of HD, whose serum sodium level was &amp;gt;147 mmol/L and born at &amp;gt;37 weeks were evaluated retrospectively. Babies with illnesses that would adversely affect nutritional status were excluded from the study. Results: Mean gestational week of 54 cases included in the study was 39.19±1.07.22. The mean birth weight was 3244.06±458.46 gr. while the mean weight of hospitalization was 2880.28±514.54 gr. The percent of weight loss was found to be 8.51±3.14%. The mean age of hospitalization was 3.7±2.05 days and the mean duration of hospitalization day was 2.26±1.42 days. On admission, 11 (20.4%) patients had fever, 6 (11.1%) patients had jaundice, 3 (5.6%) patients had discomfort, 30 (55.5%) patients had more than one complaint and dehydration was detected in 4 (7.4%) patients during control admission of pediatric outpatient clinic. On physical examination, 46 (85.2%) patients had mild dehydration, 7 (13%) had moderate dehydration, and 1 (1.9%) patient had severe dehydration. The mean serum sodium value of the patients was 150.44±3.62 mmol/L, mean serum urea value was 45.5±18.13 mg/dl, and mean serum creatinine value was 0.79±0.34 mg/dl at the time of admission. The etiologies of dehydration were breast milk insufficiency in 37 (68.5%) cases, inability to breastfeed effectively due to nipple problems in 2 (3.7%) cases, and errors in breastfeeding technique in 15 (27.7%) cases. A positive correlation was found between the degree of dehydration and percent of weight loss and the serum sodium value (p&amp;lt;0.001). Discussion: In our study, it was found that the most common cause of hypernatremic dehydration was breast milk insufficiency. Considering other reasons, giving breastfeeding education to mothers before discharge from the hospital seems to be important in preventing hypernatremic dehydration.

Brain Injury Patterns in Neonates With Hypernatremic Dehydration: Single Center Experience

To find out the incidence, spectrum, and topographical distribution of brain lesions in neonatal hypernatremic dehydration. We prospectively enrolled 100 consecutive neonates admitted with hypernatremic dehydration. 93 neonates underwent magnetic resonance imaging brain to identify the nature and site of neurological injury. Neuroradiological lesions were found in 42 (45.2%) babies. Edema was the most common finding in 37 (39.8%), followed by hemorrhage in 13 (13.9%) and thrombosis in 6 (6.4%). Edema predominantly affected juxtacortical/subcortical white matter followed by periventricular white matter and centrum semiovale, posterior part of internal capsule, and basal ganglia/thalamus. Occipital horns of lateral ventricle were the main sites of hemorrhage. Thrombotic lesions predominantly involved sagittal, straight and transverse sinuses. Brain lesions were observed only in severe hypernatremia group. In neonatal hypernatremic dehydration, edema was the most common neurological lesion, followed by hemorrhage and thrombosis. Subcortical/juxtacortical white matter was the most commonly affected site.

Clinical profile and outcome of neonates admitted in sick newborn care unit with hypernatremic dehydration and association with breastfeeding in a tertiary care hospital in Northern India

Background: Neonatal hypernatremic dehydration is a very commonly seen potentially devastating condition. Inadequate breastfeeding, gastrointestinal losses, warm weather and improperly diluted mixed feeding are the main etiologies linked with neonatal hypernatremic dehydration. We conducted this study to evaluate the etiology, risk factors, clinical symptoms and outcomes of neonates admitted with hypernatremic dehydration and its association with breastfeeding from hilly region in northern India.Methods: The authors retrospectively studied records from extramural sick newborn care unit (SNCU) from April 2018 to June 2019. Inclusion criteria for the study included admitted neonates with documented hypernatremia (serum sodium level &gt;145 mmol/L). Results: Nine hundred and twenty-two neonates were admitted in sick newborn care unit during this study period. One hundred and three (13.39%) newborns were admitted with hypernatremic dehydration at the time of admission. All newborns had deranged kidney function tests at time of admission. Most commonly found presenting complaints were poor feeding (85.71%), fever (45.71%), loose stools (42.8%) and decreased urine output (8%). The mean (SD) sodium on admission was 154.04 (7.41) meq/L. The mean (SD) time taken to correct hypernatremia was 35.6 (14.6) hours. Six of total admitted newborn developed neurological complications (2 had developed cerebral venous thrombosis and 4 had developed seizures). Mortality rate was 4.4%. Top fed neonates (50.41%) had higher percentage of mean sodium level and acute kidney injury at time of admission.Conclusions: Hypernatremic dehydration is preventable and treatable condition. Looking in to and addressing etiology in a timely manner is main step in management. All mothers should be taught correct breastfeeding technique. More breast examination during prenatal and postnatal periods and careful neonatal weight record postnatally could decrease the incidence of neonatal hypernatremic dehydration. Top feeding should be discouraged and only exclusive breastfeeding for 6 months. 

Weight loss monitoring reduces the occurrence of neonatal hypernatremic dehydration in breastfeeding neonates.

BackgroundExcessive weight loss enhances the incidence of neonatal hypernatremic dehydration (NHD). We compared the effect of a new breastfeeding policy against an old breastfeeding policy on neonatal weight change and the incidence of NHD.MethodsThis was a QA project between two sets of breastfeeding (BF) protocols for exclusively BF newborns. Under our old BF policy, a number of neonates had a significant loss of weight after birth and were admitted to the NICU due to NHD. We implemented a new BF policy that was used when a newborn loses>5% of previously recorded weight within a 24-h interval. Two groups were compared: the preintervention group (old BF policy) and postintervention group (new BF policy). Additionally, characteristics of newborns admitted to NICU were separately compared with the subgroup of pre- and post intervention dehydration groups.ResultsPreintervention = 1320 and postintervention = 1450. Neonates with weight loss of ≥ 5% within the first 24-h time interval were higher in the postintervention group (19.7%) as compared to the preintervention group (10.2%) (P < .05). However, the number of infants diagnosed to have NHD was lower in the postintervention group (0.68%) than in the preintervention group (1.66%), (P < .03). Neonatal characteristics were comparable between subgroups of dehydration.ConclusionAn intervention at ≥ 5% neonatal weight loss markedly reduces the incidence of NHD-associated NICU admissions.

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.

Neonatal Hypernatremic Dehydration and Thrombocytopenia: Its Prevalence and Relationship with Prognosis

Background: Understanding the risk factors for neonatal hypernatremic dehydration (NHD) may help to control the problem of these infants. Objectives: In this study, the level of platelets in NHD infants and its relationship with prognosis have been evaluated. Methods: This study consisted of 390 neonates who were referred to the Neonatal Clinic, Emergency Ward and Neonatal Intensive Care Unit in Ghaem Hospital, Mashhad, Iran from 2011-2017. Demographic data, symptoms of disease, physical examination, and laboratory investigations were evaluated in these patients. At first, based on the serum sodium level, the infants were divided into two groups: isonatremia (serum sodium level < 150 mEq/L) and hypernatremia (serum sodium level ≥ 150 mEq/L). In the next stage, the infants were divided into two groups: hypernatremic dehydration with normal platelet levels (platelet ≥ 150,000 /mcl) and hypernatremic dehydration occurring with thrombocytopenia (platelet < 150,000 /mcl). In the next step, the NHD infants were followed up using the questionnaire existing in Denver Developmental Test II (DDT II) at 6, 12, 18, 24, 30 and 36 months. Results: Thrombocytopenia was observed in 41 of patients with hypernatremia and 6 of isonatremic infants (P < 0.05). Significant differences were found between the groups of normal platelet and low platelet levels in terms of age, sex, weight loss, blood glucose, sodium, blood urea nitrogen, creatinine, complications and prognosis (P < 0.05). Conclusions: Our findings showed a strong relationship between hypernatremia and thrombocytopenia in NHD infants. There were more complications and worse prognosis in patients with thrombocytopenia (P < 0.05). © 2018, Iranian Journal of Pediatrics.

Hypernatremic dehydration in exclusively breast fed neonates: a clinical study

Introduction: Neonatal hypernatremic dehydration is a very serious condition and there has been an increase in the incidence of hypernatremic dehydration in breast fed infants in the first week of life. Hypernatremia in neonates is found to be due to inadequate breast feeding or insufficient milk production. This study was conducted to look at the prevalence, clinical symptoms, signs and risk factors associated with hypernatremia in exclusively breast fed healthy neonates. Methodology: A Retrospective cross-sectional study conducted at KVG Medical College Sullia on 29 neonates with hypernatremic dehydration who were recruited during the period from June 2016 to April 2017. Healthy term neonates with birth weight more than 2.5kg, on exclusive breast feeding were considered for the study. Maternal problems regarding breast feeding were assessed. Serum sodium level more than 145meq/L was considered as hypernatremia in our study. Results: Out of 32 neonates with hypernatremic dehydration, 29 were enrolled in the study as 3 were excluded because of low birth weight. Male babies were affected more than female babies with 16 (55.17%) and 13 (44.83%) respectively. The main presenting features were fever (100%), poor feeding (65.52%) and jaundice (51.72%). The maximum number of babies who had hypernatremic dehydration presented in 46 hours to 60 hours of life (day 2-3). The results showed that the hours of life / day of presentation with hypernatremic dehydration has significant correlation with neonate’s serum sodium concentration (P value &lt;0.05), indicating insufficient milk production in the mother during first few days. According to our study, babies born to primiparous women are more likely to be affected with hypernatraemic dehydration than multiparous women. Conclusion: It is recommended that dehydration and problems related can be considered as prime reason for fever during the first few days of life in low-risk term neonates. Special attention to antenatal care, postnatal care regarding early initiation of breast feeding and careful watch of neonates during the first week of life could decrease the incidence of neonatal hypernatremia.

Long-Term Neurodevelopmental Outcome of Neonates with Hypernatremic Dehydration

Neonatal hypernatremic dehydration (NHD) is a dangerous condition that can lead to severe weight loss, renal impairment, and central nervous system complications. We aimed to evaluate the consequences of NHD in infants in their second year of life. This was a prospective case-control study in Ghaem hospital, Mashhad, Iran. Sixty-five healthy breastfed neonates (serum sodium concentration <150 mmol/L) and 65 hypernatremic (serum sodium concentration ≥150 mmol/L) neonates were followed up from 2008 to 2011. Maternal and neonatal factors were compared between the two groups together with their growth parameters, and developmental milestones (using Denver II developmental assessment scores) were assessed and compared in ages 6, 12, 18, and 24 months, respectively. The weight of infants at 6 months of age was significantly different between the two groups (7,264 ± 1,089 g vs. 7,596 ± 957 g, p = 0.009). Twenty-five percent of infants in the group who had developed NHD had a delay in development at 6 months of age, with corresponding values of 21% at 12 months, 19% at 18 months, and 12% at 24 months of age. Developmental delay was ∼0.3% for the control group at similar ages. The severity of hypernatremia was strongly correlated with poor developmental outcome at 6 months (p = 0.001). Serum sodium concentration of neonates was 153-195 mg/dL in the NHD group. Median peak serum sodium was 158 ± 16 in case group and 141 ± 9 in control group. Serious complications were cerebral edema (five cases), hemorrhage (five cases), and kidney stones (six cases). Hypernatremic dehydration has an adverse effect on child development especially in the first year of life, their prevalence decreases with advanced age. Growth problems are also present during their first year of life. The major signs and symptoms of infants with poor prognosis on admission were poor feeding (8 infants, 61.5%), seizure (3 infants, 23.1%), hyperthermia (1 infant, 7.7%), and lethargy (1 infant, 7.7%). NHD affects growth parameters and developmental milestones of children. Occasionally the child's weight gain was normalized by the end of first year of life; although developmental delay continued, its severity was reduced, with age.

Hypernatremia in the Neonate: Neonatal Hypernatremia and Hypernatremic Dehydration in Neonates Receiving Exclusive Breastfeeding.

Aims and Objectives:Evaluation of neonatal hypernatremia and hypernatremic dehydration in neonates receiving exclusive breastfeeding.Introduction:Neonatal hypernatremia is a serious condition in the newborn period. We present infants with hypernatremic dehydration due to breast milk (BM) hypernatremia. Hypernatremic dehydration in breast-fed newborns is usually secondary to insufficient lactation. We present the neonatal hypernatremia and hypernatremic dehydration encountered between January and December, 2012, its causes and treatment.Methodology:This was a retrospective study. We analyzed records of babies admitted to the Neonatal Intensive Care Unit who were investigated and found to have hypernatremia and whose mother's BM sodium (BM Na) was done.Inclusion Criteria:(1) Babies with serum Na >145 meq/l, (2) euglycemia, (3) normocalcemic, (4) no clinical and lab evidence of sepsis, (5) exclusive breast feeds.Exclusion Criteria:Neonates not satisfying any mentioned criterion.Results:BM Na correlated strongly with neonatal hypernatremia in exclusively breast-fed babies who did not otherwise have any risk factor.Conclusion:Elevated BM Na is an important etiological factor in neonatal hypernatremia.

Evidence Based Weighing Policy during the First Week to Prevent Neonatal Hypernatremic Dehydration while Breastfeeding.

BackgroundNeonatal hypernatremic dehydration is prevented by daily neonatal weight monitoring. We aim to provide evidence-based support of this universally promoted weighing policy and to establish the most crucial days of weighing.MethodsWeight measurements of 2,359 healthy newborns and of 271 newborns with clinical hypernatremic dehydration were used within the first seven days of life to simulate various weighting policies to prevent hypernatremic dehydration; its sensitivity, specificity and positive predictive value (PPV) of these policies were calculated. Various referral criteria were also evaluated.ResultsA policy of daily weighing with a cut-off value of -2.5 Standard Deviation Score (SDS) on the growth chart for weight loss, had a 97.6% sensitivity, 97.6% specificity and a PPV of 2.80%. Weighing at birth and only at days two, four and seven with the same -2.5 SDS cut-off, resulted in 97.3% sensitivity, 98.5% specificity and a PPV of 4.43%.ConclusionA weighing policy with measurements restricted to birth and day two, four and seven applying the -2.5 SDS cut-off seems an optimal policy to detect hypernatremic dehydration. Therefore we recommend to preferably weigh newborns at least on day two (i.e. ~48h), four and seven, and refer them to clinical pediatric care if their weight loss increases below -2.5 SDS. We also suggest lactation support for the mother, full clinical assessment of the infant and weighing again the following day in all newborns reaching a weight loss below -2.0 SDS.

Hypernatremia in children

Hypernatremia results from a deficit of total body water in relation to the total body's sodium stores. This is caused by two main mechanisms: 1) net water depletion exceeding sodium losses or 2) increased sodium gain exceeding water gain. Net water depletion occurs when increased water loss exceeds sodium loss, either due to extrarenal losses (increased evaporative water losses, hypernatremic dehydration caused by diarrhea) or to renal losses (central and nephrogenic diabetes insipidus, intrinsic renal disease). Insufficient water intake occurs with neonatal hypernatremic dehydration secondary to lactation failure, essential hypernatremia or osmoreceptor dysfunction. Increased sodium gain can be caused by iatrogenic hypernatremia, administration of concentrated infant formula, deliberate abusive water restriction and deliberate or non-accidental salt poisoning. Hypernatremia results in a movement of water across cell membranes from the intracellular to the extracellular space, resulting in cellular dehydration, which, in cells of the central nervous system results in brain shrinkage leading to tearing of cerebral blood vessels and neurological complications. As a protective mechanism, idiogenic osmoles accumulate inside the brain cells to help them retain water intracellularly. However this may lead to cerebral edema during rapid rehydration as these idiogenic osmoles attract water inside the neurons. As the appropriate management of hypernatremia invariably depends on the underlying mechanism and cause, a methodical history taking and clinical examination, with the judicious use of laboratory tests will lead to a precise etiological diagnosis to enable appropriate and timely therapy.

Hypernatremia in children

Hypernatremia results from a deficit of total body water in relation to the total body's sodium stores. This is caused by two main mechanisms: 1) net water depletion exceeding sodium losses or 2) increased sodium gain exceeding water gain. Net water depletion occurs when increased water loss exceeds sodium loss, either due to extrarenal losses (increased evaporative water losses, hypernatremic dehydration caused by diarrhea) or to renal losses (central and nephrogenic diabetes insipidus, intrinsic renal disease). Insufficient water intake occurs with neonatal hypernatremic dehydration secondary to lactation failure, essential hypernatremia or osmoreceptor dysfunction. Increased sodium gain can be caused by iatrogenic hypernatremia, administration of concentrated infant formula, deliberate abusive water restriction and deliberate or non-accidental salt poisoning. Hypernatremia results in a movement of water across cell membranes from the intracellular to the extracellular space, resulting in cellular dehydration, which, in cells of the central nervous system results in brain shrinkage leading to tearing of cerebral blood vessels and neurological complications. As a protective mechanism, idiogenic osmoles accumulate inside the brain cells to help them retain water intracellularly. However this may lead to cerebral edema during rapid rehydration as these idiogenic osmoles attract water inside the neurons. As the appropriate management of hypernatremia invariably depends on the underlying mechanism and cause, a methodical history taking and clinical examination, with the judicious use of laboratory tests will lead to a precise etiological diagnosis to enable appropriate and timely therapy.

Protocolo de manejo en deshidratación hipernatrémica neonatal

Neonatal hypernatremic dehydration (NHD) is a severe condition associated with cerebral oedema, intracranial haemorrhage and gangrene. The management of these patients remains controversial due to the complications that have been reported if the correction of serum sodium occurs too quickly. We proposed a protocol to decrease serum sodium slowly. MethodA prospective study was performed with patients who had serum sodium >150 mEq. These patients were treated with a fast load of 0.9% saline solution and maintained with rehydrating solutions consisting of Na 50mEq/L + glucose 5%. Serum sodium was monitored at 12 and 24hrs. ResultsWe included 51 patients in the study, and we identified an NHD incidence of 10.2 cases per 1,000 live births. Average sodium at the time of admission was 158 mEq/L. The average reduction of sodium in the first 12hours was 0.53 ± 0.08 mEq/L/h. In the following 12hours, it was 0.46 ± 0.09 mEq/L/h. No patients presented neurological alterations. ConclusionsRehydration in the neonatal patient with NHD using 1 or 2 loads of 0.9% saline solution, and subsequent management with solutions consisting of Na 50 mEq/L + glucose 5%, were safe for decreasing serum Na levels slowly at a rate of 0.5 mEq/h.

What Is the Safe Approach for Neonatal Hypernatremic Dehydration?

The aims of this study were to evaluate the prevalence, complications, and mortality of hypernatremic dehydration in neonates and to compare the effect of correction rate at 48 hours on mortality and on neurological outcome in the short term. This retrospective study was conducted between January 2007 and 2011 in the neonatal intensive care unit. Term neonates were included. The patients were grouped as follows: group 1 = 150 to 160 mmol/L, group 2 = 161 to 170 mmol/L and group 3 = 171 to 189 mmol/L. Among 4280 neonates, 81 cases (1.8%) had hypernatremic dehydration. Groups 1, 2, and 3 consisted of 55, 23, and 3 patients, respectively. Mortality rates were as follows: 3.6%, 17.3%, and 66.6%. Mean serum sodium (Na) correction rates at 0 to 24 hours and 24 to 48 hours were 0.48 ± 0.2 versus 0.38 ± 0.31 mmol/L per hour (group 1) and 0.49 ± 0.21 versus 0.52 ± 0.28 mmol/L per hour (group 2), respectively. In 32 patients (58.1%) from group 1 and in 13 patients (56.5%) from group 2, correction rate of 0.5 mmol/L per hour or less was achieved. Twenty-two patients developed convulsions, which was the most common complication during therapy. Serum Na greater than 160 mmol/L at admission (odds ratio, 1.9; 95% confidence interval, 1.3-3.7) and serum Na correction rate of greater than 0.5 mmol/L per hour (odds ratio, 4.3; 95% confidence interval, 1.2-6.5) were independent risk factors for death or convulsion. There was a significant difference between groups 1 and 2 in Denver Developmental Screening Test II results (64.1% vs 30.7 %, P = 0.001). Hypernatremic dehydration is an important problem that should be managed properly to avoid adverse outcomes.

P1-509 Study aetiology of lactation failure in neonatal affected by hypernatremic dehydration: a case control study

BackgroundInadequate milk supply in exclusively breastfed neonates can lead to neonatal hypernatremic dehydration in the first week of life. Identification of causes of lactation failure can help to find susceptible...

Hipernatremia neonatal: factores de riesgo

ABSTRACTHypernatremia in newborn. Risk factorsIntroduction : Neonatal hypernatremic dehydration is a very common problem and now frequently described in the literature. Objectives : To establish risk factors associated with hypernatremic dehydration. Design : Re-trospective, descriptive and analytical case control study. Place : Neonatal ward of the Hospital del Nino “Ovi-dio Aliaga Uria”. La Paz. Bolivia. Methods : 64 newborns admitted with dehydration. Case control study, from February 2008 to January 2009. We defi ned cases to neonates with hypernatremic dehydration and controls, neonates with hyponatremic or isonatremic dehydration. The variable of the study were: maternal age, age of the neonate, percentage of weight loss and mother- son days in the hospital, information to mother before discharge, socio economic status, serum sodium and bilirubin levels, and cranial ultrasound study. Results : Of 70 neonates, six were excluded because they were immediately transferred to intensive care, of the 64 patients, 31 had hypernatremic dehydration and 33 isonatremic or hyponatremic dehydration. The most important risk factors for hypernatremic dehydration were: more than 10% weight loss, no maternal information about the correct breast feeding technique, early discharge and the association with jaundice. The loss of 10% or more of the newborn weight increases 47 more times the risk of developing hypernatremic dehydration.

PP-327. Evaluation of breast milk sodium and neonatal hypernatremic dehydration

PP-327. Evaluation of breast milk sodium and neonatal hypernatremic dehydration

Breastfeeding-associated Neonatal Hypernatremic Dehydration in a Medical Center: A Clinical Investigation

Hypernatremic dehydration amongst exclusively breastfed neonates due to inadequate breastfeeding or underfeeding is a potentially devastating condition. We investigated the epidemiological and clinic features of hypernatremic dehydration. We retrospectively reviewed the medical records of neonates that were less than 28 days of age, weighing > or =2000 g with gestational age of 36 weeks born between January 2002 and December 2005, who had meet the criteria of hypernatremic dehydration, including (1) exclusively breastfed; (2) loss of weight 12% or more from birth weight; and (3) serum sodium concentration of at least 150 mmol/L at presentation, that had been subsequently admitted to our institution. Totally nine cases were found during this four-year period, an incidence of 2.3 per 1000 live births. Involved infants' age at presentation ranged from 3 days to 14 days (mean t Standard Deviation = 7 +/- [3.8]); five presented symptoms or signs within the first week of life. Study-involved infants featured a birth-weight loss ranging from 12% to 29% (mean +/- [SD] = 17.0 +/- [5.9]), and also hypernatremia (mean +/- [SD] = 153.5 +/- [3.2] mEq/L ). Sodium concentration of breast milk ranged from 15 mEq/L to 54 mEq/L (mean +/- [SD]= 36.0 +/- [14.32]). Subsequently, all were supplemented with breast milk or, alternatively, formula. None of the study-involved neonates suffered subsequent complications or a relapse of their condition. Neonatal hypernatremic dehydration due to inadequate breastfeeding or underfeeding would appear to be a rather common problem. In order to avoid serious morbidity and mortality, all breastfed infants should receive regular follow-up by health-care worker. Furthermore, we advocate that all mothers should be taught the skills of breastfeeding, and warning signs of breastfeeding failure and hypernatremia, accompanied with the monitoring of the weight of infants until growth commences, in order to reduce the likelihood of this condition arising, especially for first-time mothers.