Retrospective evaluation of newborn cases who were followed up with the diagnosis of hypernatremic dehydration

Yıl 2022, Cilt: 32 Sayı: 1, 55 - 60, 28.02.2022

Esma Keleş Alp

https://doi.org/10.54005/geneltip.1028077

Cited By: 1

Öz

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 >147 mmol/L and born at >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<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.

Anahtar Kelimeler

newborn, weight loss, hypernatremia, dehydration, breast milk insufficiency, education

Hipernatremik dehidratasyon tanısı ile takip edilen yenidoğan olgularımızın retrospektif değerlendirilmesi

Öz

Amaç: Çalışmanın amacı neonatal HD olgularının demografik özelliklerini ve epidemiyolojik risk faktörlerini ortaya koyarak, dehidratasyon olgularının sayısını azaltmak amacıyla kliniğimizde uygulanan önlemleri literatür eşliğinde tartışmaktır.
Hastalar ve Yöntem: Yenidoğan servisimize hipernatremik dehidratasyon tanısı ile yatırılmış ve serum sodyum değeri 147 mmol/L ve üzeri olan, 37 hafta ve sonrası doğan bebekler retrospektif olarak değerlendirildi. Beslenmeyi olumsuz etkileyecek hastalığı olan bebekler çalışma dışı bırakıldı.
Bulgular: Çalışmaya alınan 54 olgunun ortalama doğum haftası 39,19±1,07 idi. Doğum ağırlıkları ortalama 3244,06±458,46 gr. iken, yatış ağırlıkları ortalama 2880,28±514,54 gr. idi. Yüzde ağırlık kaybı ise %8,51±3,14 olarak bulundu. Hastalar ortalama 3,7±2,05 günlükken yatmış ve hastanede 2,26±1,42 gün kalmışlardı. Başvuru şikayeti 11 (%20,4) hastada sadece ateş, 6 (%11,1) hastada sadece sarılık, 3 (%5,6) hastada sadece huzursuzluk, 30 (%55.5) hastada ise birden fazla başvuru şikayeti varken, 4 (%7,4) hastanın rutin kontrolünde dehidratasyon saptandı. Fizik muayenede 46 (%85,2) hastada hafif düzeyde, 7 (%13 ) hastada orta düzeyde, 1 (%1,9) hastada ise ağır düzeyde dehidratasyon bulguları vardı. Hastaların başvuru anındaki ortalama serum sodyum değeri 150,44±3,62 mmol/L, serum üre değeri 45,5±18,13 mg/dl, serum kreatinin değeri 0,79±0,34 mg/dl idi. 37 (%68,5) vakada anne sütü yetersizliği, 2 (%3,7) vakada meme başı sorunları nedeniyle etkin emzirememe, 15(%27,7) vakada ise emzirme tekniğindeki yanlışlıklar nedeniyle dehidratasyon gelişmişti. Dehidratasyon derecesi ve yüzde ağırlık kaybı ile serum sodyum değeri arasında pozitif korelasyon (p<0.001) saptandı.
Sonuç: Çalışmamızda hipernatremik dehidratasyona en sık anne sütü yetersizliğinin yol açtığı bulunmuştur. Diğer nedenler de göz önüne alınarak annelere hastaneden taburculuk öncesi emzirme eğitiminin verilmesi hipernatremik dehidratasyonu önlemede önemli görünmektedir.

Anahtar Kelimeler

Yenidoğan, kilo kaybı, hipernatremi, dehidratasyon, anne sütü yetersizliği, eğitim

Kaynakça

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