Clinico-investigative profile of hypernatremia in neonates of rural western Maharashtra.
Abstract
Objectives: To study the Clinico-investigative profile and outcome of hypernatremia in neonates.
Methodology: Observational descriptive, longitudinal study conducted at the tertiary rural hospital from August 2021 to August 2022. All the babies with hypernatremia admitted to NICU during the above period were included in the study excluding the preterm babies presenting to our hospital for NICU care.
Results: The sex ratio of 1.3:1 was seen in our study with the majority (69%) of babies born to primigravida mothers and 58.7% of the mothers subjected to LSCS. The majority of cases were admitted on the 3rd to 5th day (mean age being 4.2 days). Feeding frequency was less than seven times a day in 91.3% of babies, which could be due to inexperience and inadequacy. 88% of the neonates with hypernatremia had more than 10% weight loss due to dehydration. Fever, lethargy, and irritability were present in the majority of the patients. CNS signs and symptoms at the time of presentation included seizures, decerebrate posturing, and retrocollis.
Conclusion: The higher occurrence, as compared to other studies was due to a combination of factors such as summer months, inadequate feeding, early presentation or detection on 3rd or 4th day of birth.
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References
Spasovski G et al Hyponatraemia diagnosis and treatment clinical practice guidelines. Nefrologia. 2017 Jul - Aug;37(4):370-380.
Schwaderer AL and Schwartz GJ. Treating hypernatremic dehydration. Pediatrics in Review 2005; 26(4): 148-151.
Chumlea WC1, Schubert CM, Reo NY, Sun SS, Siervogel RM. Total body water volume for white children and adolescents and anthropometric prediction equations: the Fels Longitudinal Study. Kidney Int. 2005 Nov;68(5):2317-22.
Kaplan JA, Siegler RW, Schmunk GA. Fatal Hypernatremic dehydration in exclusively breast-fed newborn infants due to maternal lactation failure. American Journal of Forensic Medicine & Pathology 1998;19:19-22.
Bhave G1, Neilson EG Body fluid dynamics: back to the future. Journal of American Society of Nephrology. 2011 Dec;22(12):2166-81
Kinik ST. Yenidoğanda Hiponatremi ve Hipernatremi. Türkiye Klinikleri Pediatrik Bilimler - Özel Konular [Internet]. 2008 [cited 2022 Sep 30];4(2):106–12. Available from: https://www.turkiyeklinikleri.com/article/tr-yenidoganda-hiponatremi-ve-hipernatremi-50631.html
Mansir T, Sarlangue J, Fayon M, Babin JP, Demarquez JL. Severe hypernatremia due to feeding error. Arch pediatrics. 2000; 7:430-432.
Smith RG. Severe hypernatremic dehydration in a newborn infant. Journal of pediatric & child Health 1998;3:413-5.
Bhat SR, Lewis P, David A, Liza SM. Dehydration and hypernatremia in breast-fed term healthy neonates. Indian Journal of Pediatrics. 2006;73:39-41.
Olguner M, Hakguder G, Ates O, Caglar M, Ozer E, Akgur FM. Urinary trypsin inhibitor present in fetal urine prevents intra amniotic meconium-induced intestinal damage in gastroschisis. Journal of pediatric Surgery. 2006;41:1407-12.
Cohn A. A simple method for assessing if weight loss is greater or less than 10%. Arch Diseases Child 2005;90: 88.
Adrogue HJ, Madias NE. Hypernatremia. New England Journal of Medicine. 2000;342:1493-1499.
Ng PC, Chan HB, Fok TF, Lee CH, Chan KM, Wong W, et at. Early onset of hypematraemic dehydration and fever in exclusively breast-fed infants. Journal of Pediatric & Child Health 1999; 35: 585-7.
Livingstone et al Neonatal hypernatremic dehydration associated with breast-feeding malnutrition: a retrospective survey Canadian Medical Association Journal 2000;162(5):647-52
Hall RT1, Simon S, Smith MT. Readmission of breastfed infants in the first 2 weeks of life. Journal of Perinatology. 2000 Oct-Nov;20(7):432-7.
Zachariassen G , Juvonen P. [Neonatal dehydration (dehydration fever) in newborn infants], Ugeskr Laeger. 2002 Oct 14;164(42):4930-4.
Van Dommelen P1, Boer S, Unal S, van Wouwe JP. Charts for weight loss to detect hypematremic dehydration and prevent formula supplementing. Birth. 2014 Jun;41(2): 153-9.
Boskabadi H1, Maamouri G, Ebrahimi M, Ghayour-Mobarhan M, Esmaeily H, Sahebkar A, Ferns GA. Neonatal hypernatremia and dehydration in infants receiving inadequate breastfeeding. Asia Pacific Journal of Clinical Neurology. 2010; 19(3):301 -7
Bolat F et al. What is the safe approach for neonatal hypematremic dehydration? A retrospective study from a neonatal intensive care unit. Pediatric Emergency Care. 2013 Jul;29(7):808-13
Uras N1, Karadag A, Dogan G, Tonbul A, Tatli MM. Moderate hypematremic dehydration in newborn infants: retrospective evaluation of 64 cases. J Matem Fetal Neonatal Med. 2007 Jun;20(6):449-52
FARHAT A.S., MOHAMADZADEH A., MAFINEJAD SH. Evaluation of hypernatremia and related factors among newborns admitted at emam-reza hospital iranian journal of kidney diseases (ijkd) july 2011 , volume 5 , number supllement 1; Page 20-21.
Penalver Giner O1, Gisbert Mestre J, Casero Soriano J, Bernal Ferrer A, Oltra Benavent M, Tomas Vila M. [Hypematremic dehydration associated with breast¬feeding]. An Pediatr (Bare). 2004 Oct;61(4):340-3.
Trotman H, Lord C, Barton M, Antoine M. Hypernatraemic dehydration in Jamaican breastfed neonates: a 12-year review in a baby-friendly hospital. Ann Trop Paediatr. 2004 Dec;24(4):295-300.
Boskabadi et al The Study of the Relationship between Hypernatremia in Neonates and Mode of Maternal Breast Feeding in Hospitalized Infants in Ghaem Hospital of Mashhad, Iran. The Iranian Journal of Obstetrics, Gynecology, and Infertility, 2014;16:1-9.
Reilev M, Borch K, Pryds OA. [Neonatal hypernatremic dehydration—why increasing incidence?]. Ugeskr Laeger. 2007 Mar 26;169(13): 1227-31.
Erdemir A1, Kahramaner Z, Cosar H, Turkoglu E, Kanik A, Sutcuoglu S, Ozer EA. Comparison of oral and intravenous fluid therapy in newborns with hypernatremic dehydration. Journal of Maternal-Fetal Neonatal Medicine. 2014 Mar;27(5):491-4.
