Hypernatremic Dehydration in Newborn Infants: A Review

Year 2015, Volume: 1 Issue: 2, 22 - 25, 30.01.2016

Jagadish Das

Abstract

Hypernatremic dehydration is a lethal condition in neonate which adversely affects central nervous system. Important causes of this condition in neonate are vomiting, diarrhea, improper preparation of infant formula, inadequate breast feeding and diabetes insipidus. Hypernatremic dehydration presents usually around tenth postnatal day. Clinical presentation is variable. Some present with lethargy; others are alert and hungry. Some are dehydrated whereas other are apparently hydrated. Treatment of hypernatremic dehydration consists of an emergency phase where restoration of vascular volume with 10 to 20 ml/kg of isotonic intravenous fluid is achieved followed by rehydration phase where sum of free water deficit and maintenance fluid volume is administered slowly. Rehydration is achieved with 5% dextrose in 0.2% normal saline, 5% dextrose in 0.45% normal saline or 0.9% normal saline according to serum sodium level. However, if the serum sodium is greater than 175 mmol/L, various amounts of 3% normal saline should be added. The daily maximum correction rate of serum sodium level should be 15 mmol/L. Addressing the etiological factors timely may be the proper way of prevention of such condition in neonate.

Keywords

Hypernatremia, dehydration, newborn, management

References

• Schwaderer AL and Schwartz GJ. Treating hypernatremic dehydration. Pediatrics in Review 2005; 26(4): 148-151. [DOI via Crossref] [Pubmed]
• Konetzny G, Bucher HU, Arlettaz R. Prevention of hypernatremic dehydration in breastfed newborn infants by daily weighing. Eur J Pediatr. 2009; 168: 815-818. [DOI via Crossref] [Pubmed]
• Cohn A. A simple method for assessing if weight loss is greater or less than 10%. Arch Dis Child 2005;90: 88. [DOI via Crossref] [Pubmed] [PMC Free Fulltext]
• Boskabadi H, Maamouri G, Ebrahimi M, et al. Neonatal hypernatremia and dehydration in infants receiving inadequate breastfeeding. Asia Pac J Clin Nutr. 2010;19: 301-307. [Pubmed]
• Bolat F, Oflaz MB, Gu¨ven AS, O¨zdemir G, Alaygut D, Dogan MT et al. What is the safe approach for neonatal hypernatremic dehydration? A retrospective study from neonatal intensive care unit. Pediatr Emer Care 2013; 29: 808-813. [DOI via Crossref] [Pubmed]
• 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(6):449-52. [DOI via Crossref] [Pubmed]
• Krishnamurthy S, Debnath S, Gupta P. Breast feedingassociated hypernatremic dehydration: A preventable tragedy in newborn infants. Journal of Case Reports 2011;1(1):1-5. [DOI via Crossref]
• Smith RG. Severe hypernatremic dehydration in a newborn infant. Pediatr Child Health 1998; 3(6):413-415. [Pubmed] [PMC Free Fulltext]
• Elamin A and Nair P. Case reports: hypernatremic dehydrationin infancy. Sudanese Journal of Pediartics 2007; 8: 161-170.
• Hilliard TN, Marsh MJ, Malcolm P, Murdoch lA, Wood BP. Sagittal smus thrombosis in hypernatremic dehydration. Arch Pediatr Adolesc Med. 1998; 152:1147-1149. [Pubmed]
• Brown WD, Caruso JM. Extrapontine myelinolysis with involvement of the hippocampus in three children with severe hypematremia. J Child Neurol. 1999;14: 428-433. [DOI via Crossref]
• Orainy IA, O'Gorman AM, Decell MK. Cerebral bleeding, infarcts, and presumed extrapontine myelinolysis in hypernatremic dehydration. Neuroradiology1999; 41:144-146. [DOI via Crossref]
• Palevsky PM. Hypernatremia. Semin Nephrol. 1998;18: 20- 30. [Pubmed]
• Rand SE, Kolberg A. Neonatal hypernatremic dehydration secondary to lactation failure. J Am Board Fam Pract. 2001; 14: 155-158. [Pubmed]
• Van Amerongen RH, Moretta AC, Gaeta TJ. Severe hypernatremic dehydration and death in a breast-fed infant. Pediatr Emerg Care.2001; 17: 175-180. [DOI via Crossref] [Pubmed]
• Molteni KH. Initial management of hypernatremic dehydration in the breastfed infant. Clin Pediatr. 1994; 33: 731- 740. [DOI via Crossref]
• Oh YJ, Lee JE, An SH, Kim YK, Kang SK, Kim JK et al. Severe hypernatremic dehydration in a breast-fed neonate. Korean Journal of Pediatrics 2007; 50(1):85-88. [DOI via Crossref]
• Laing IA. Hypernatraemic dehydration in newborn infants. Acta Pharmacol Sin 2002; 23(suppl): 48-51.