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

Year 2023, , 579 - 585, 31.05.2023

Mine Özdil , Gonca Vardar

https://doi.org/10.32322/jhsm.1250219

Abstract

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.
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.
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.
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.

Keywords

Newborn, dehydration, hypernatremia, breastfeeding, weight loss

References

• World Health Organization. The Optimal Duration of Exclusive Breastfeeding: Report of the Expert Consultation. Geneva: World Health Organization, 2001.
• Livingstone VH, Willis CE, Abdel-Wareth LO, Thiessen P, Lockitch G. Neonatal hypernatremic dehydration associated with breast-feeding malnutrition: a retrospective survey. CMAJ 2000; 162(5): 647-52. 
• Adrogué HJ, Madias NE. Hypernatremia. N Engl J Med 2000; 342: 1493–9.
• Konetzny G, Bucher HU, Arlettaz R. Prevention of hypernatraemic dehydration in breastfed newborn infants by daily weighing. Eur J Pediatr 2009; 168: 815-8.
• Ferrández-González M, Bosch-Giménez V, López-Lozano J, Moreno-López N, Palazón-Bru A, Cortés-Castell E. Weight loss thresholds to detect early hypernatremia in newborns. J Pediatr (Rio J) 2019; 95: 689-5.
• Tomarelli G, Arriagada D, Donoso A, Diaz F. Extreme Neonatal Hypernatremia and Acute Kidney Injury Associated with Failure of Lactation. J Pediatr Intensive Care 2020; 9: 124-7.  
• Durrani NUR, Imam AA, Soni N. Hypernatremia in Newborns: A Practical Approach to Management. Biomed Hub 2022; 7: 55-69.
• Dewey KG, Nommsen-Rivers LA, Heinig MJ, Cohen RJ. Risk factors for suboptimal infant breastfeeding behaviour, delayed onset of lactation, and excess neonatal weight loss. Pediatrics 2003; 112: 607–19. 
• Taylor D, Durward A. Pouring salt on troubled waters. Arch Dis Child 2004; 89: 411–4.
• Sofer S, Ben-Ezer D, Dagan R. Early severe dehydration in young breast-fed newborn infants. Isr J Med Sci 1993; 29: 85–9.
• Rowland TW, Zori RT, Lafleur WR, Reiter EO. Malnutrition and hypernatremic dehydration in breast-fed infants. JAMA 1982; 247: 1016–7.
• Manganaro R, Marseglia L, Mamì C et al. Breast milk sodium concentration, sodium intake and weight loss in breast-feeding newborn infants. Br J Nutr 2007; 97: 344–8.
• Bischoff AR, Dornelles AD, Carvalho CG. Treatment of Hypernatremia in Breastfeeding Neonates: A Systematic Review. Biomed Hub 2017; 2: 1-10.
• Unal S, Arhan E, Kara N, Uncu N, Aliefendioğlu D. Breast feeding associated hypernatremia: Retrospective analysis of 169 term newborns. Pediatr Int 2008; 50: 29-34.
• Zanardo V, Pigozzo A, Wainer G, et al. Early lactation failure and formula adoption after elective caesarean delivery: cohort study. Arch Dis Child Fetal Neonatal Ed 2013; 98: F37.
• Ergenekon E, Unal S, Gücüyener K, et al. Hypernatremic dehydration in the newborn period and longterm follow up. Pediatr Int 2007; 49: 19–23.
• Uras N, Karadag A, Dogan G, Tonbul A, Tatli MM. Moderate hypernatremic dehydration in newborn infants: retrospective evaluation of 64 cases. J Matern Fetal Neonatal Med 2007; 20: 449–52.
• Moritz ML, Manole MD, Bogen DL, Ayus JC. Breastfeeding-associated hypernatremia: are we missing the diagnosis? Pediatrics 2005; 116: e343.
• Ünver Korğalı E, Cihan MK, Oğuzalp T, Şahinbaş A, Ekici M. Hypernatremic dehydration in breastfed term infants: retrospective evaluation of 159 cases. Breastfeed Med 2016; 12: 1-7.
• Manganaro R, Mamì C, Marrone T, Marseglia L, Gemelli M. Incidence of dehydration and hypernatremia in exclusively breast-fed infants. J Pediatr 2001; 139: 673–5.
• Oddie SJ, Craven V, Deakin K, Westman J, Scally A. Severe neonatal hypernatraemia: a population-based study. Arch Dis Child Fetal Neonatal Ed 2013; 98: 384-7.
• Boskabadi H, Maamouri G, Ebrahimi M, et al. Neonatal hypernatremia and dehydration in infants receiving inadequate breastfeeding. Asia Pac J Clin Nutr 2010; 19: 301-7.
• Bhat SR, Lewis P, David A, Liza SM. Dehydration and hypernatremia in breast-fed term healthy neonates. Indian J Pediatr 2006; 73: 39-41.
• Escobar GJ, Gonzales VM, Armstrong MA. Rehospitalization for neonatal dehydration: A nested case-control study. Arch Pediatr Adolesc Med 2002; 156: 155–61.
• Akgün A, Katar S, Taşkesen M, Obek MN. Yenidoğan döneminde önemli bir sorun: hipernatremik dehidratasyon. Göztepe Med J 2010; 25: 126-31.
• Bülbül A, Can E, Uslu S, Nuhoglu A. Hypernatremic dehydration in term infants. Turk Arch Ped 2009; 44: 84-8.
• Yaseen H, Salem M, Darwich M. Clinical presentation of hypernatremic dehydration in exclusively breast-fed neonates. Indian J Pediatr 2004; 71: 1059-62.
• Tayman C, Tonbul A, Aydemir S, Kösüs A, Tatlı MM. Clinical findings and treatment recommendations of hypernatremic dehydration due to breast milk. Dicle Med J 2010; 37: 254-62.
• Keleş-Alp E. Retrospective evaluation of newborn cases who were followed up with the diagnosis of hypernatremic dehydration. Genel Tıp Derg 2022; 32: 55-60.
• van Dommelen P, Boer S, Unal S, van Wouwe JP. Charts for weight loss to detect hypernatremic dehydration and prevent formula supplementing. Birth 2014; 41:153-9.  
• Evans KC, Evans RG, Royal R, Esterman AJ, James SL. Effect of caesarean section on breast milk transfer to the normal term newborn over the first week of life. Arch Dis Child Fetal Neonatal Ed 2003; 88: F380-2.
• Diaz-Castro J, Pulido-Moran M, Moreno-Fernandez J, et al. Gender specific differences in oxidative stress and inflammatory signaling in healthy term neonates and their mothers. Pediatr Res 2016; 80: 595-601.
• Akdeniz O, Celik M, Samancı S. Evaluation of term newborn patients with hypernatremic dehydration. Turk Arch Pediatr 2021; 56: 344-9.
• Boskabadi H, Rakhshanizadeh F. Neonatal hypernatremic dehydration and thrombocytopenia: its prevalence and relationship with prognosis. Iran J Pediatr 2018; 28: e65742.
• Ash-Bernal R, Wise R, Wright S. Acquired Methemoglobinemia: A Retrospective Series of 138 Cases at 2 Teaching Hospitals. Medicine 2004; 83: 265-73.
• Banderali G, Martelli A, Landi M, et al. Short and long term health effects of parental tobacco smoking during pregnancy and lactation: a descriptive review. J Transl Med 2015; 13: 327.
• Mennella JA, Yourshaw LM, Morgan LK. Breastfeeding and smoking: short-term effects on infant feeding and sleep. Pediatrics 2007; 120: 497-502.
• Humenick SS, Hill PD, Thompson J, Hart AM. Breast-milk sodium as a predictor of breastfeeding patterns. Can J Nurs Res 1998; 30: 67-81. 
• Koklu E, Gunes T, Ozturk MA, Kose M, Kurtoglu S, Yuksel F. A review of 116 cases of breastfeeding-associated hypernatremia in rural area of central Turkey. J Trop Pediatr 2007; 53: 347-50.
• Boskabadi H, Akhondian J, Afarideh M, et al. Long-Term Neurodevelopmental Outcome of Neonates with Hypernatremic Dehydration. Breastfeed Med 2017; 12: 163-8.