Hypernatremic dehydratation in term infants Original Article

Öz

Aim: The characteristic features of hypernatremic dehydration and the risk factors in tehe development of hypernatremic dehydration in our neonatal intensive care unit were evaluated Material and Method: Term newborns recognized as hypernatremic dehydration between January 2006 December 2008 were included in the study The patients clinical characteristics laboratory findings additional diagnoses treatment modalities and periods were recorded prospectively Results: A total of 33 babies were included in the study during this period 57 6 of all cases were males and 18 2 were first children of their families Mean gestational age birth weight hospitalization time and serum sodium level were 38 3±1 2 weeks 3372±437 g 4 6±2 9 days and 151 9±6 4 mEq L respectively The most common presenting complaints were fever 30 3 jaundice 27 3 irritability 24 2 and breastfeeding difficulties 18 2 On the admission mean weight loss was 13 1±0 8 upper limit 23 90 of the infants were exclusively breastfeed On the other hand; insufficient breast milk was found in 78 inappropriate breast feeding method in 18 and nipple problems in 4 of the mothers Neurological findings were present in 39 4 of patients on admission The mean serum sodium level was 151 9±6 4 mEq L while intravenous fluids were administered in 97 of the patients serum sodium levels declined to normal values in a mean of 1 8±1 6 days Among all the patients 27 2 had infection bacteriemia plus urinary tract infection 3 were expased to traditional salt application to the body and 3 had intestinal malabsorption The average discharge time was 2 0±1 6 days Serum sodium values were found to be higher in the first babies but no relationship was found between the gender and type of delivery and the degree of hypernatremia The male gender was a risk factor in the development of neurological findings in hypernatremic dehydration Conclusions: It was remarkable that neonatal hypernatremic dehydration was seen mostly in breastfed newborns Being the first baby of parents was a risk factor for the development of hypernatremia and male gender was also a risk factor for the development of neurological findings in hypernatremic dehydration Turk Arch Ped 2009; 44: 84 8 Key words: Breastfeeding dehydration hypernatremia newborn

Anahtar Kelimeler

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Miadında doğan bebeklerde hipernatremik dehidratasyon Orijinal Araştırma

Öz

Amaç: Hipernatremik dehidratasyon tanısıyla yenidoğan kliniğine yatırılan bebeklerin değerlendirilmesi ve hipernatremi gelişiminde risk etmenlerinin belirlenmesi amaçlandı Gereç ve Yöntem: Ocak 2006 Aralık 2008 tarihleri arasında hipernatremik dehidratasyon tanısı alan ve miadında doğan bebekler çalışmaya alındı Geleceğe yönelik olarak hastaların klinik özellikleri laboratuvar bulguları ek tanıları tedavi süreleri ve tedavi şekilleri kaydedildi Bulgular: Bu dönemde çalışma grubunda 33 bebek vardı Grubun 57 6’sı n:18 erkek ve 18 2’si n:6 ilk bebek idi Ortalama gebelik haftası 38 3±1 2 hafta doğum ağırlığı 3372±437 gr ve hastaneye getirilme zamanı 4 6±2 9 gün olarak saptandı Bebeklerin getiriliş nedenleri 30 3 ateş 27 3 sarılık 24 2 huzursuzluk ve 18 2 emmemeydi Ortalama tartı kaybı 13 1±0 84 üst sınır 23 idi Bebeklerin 90’ı sadece anne sütü ile besleniyordu Annelerin 78’inde anne sütü yetersizliği 18’inde emzirme yöntemi yanlışlığı ve 4’ünde ise meme başı sorunu vardı Bebeklerin 39 4’ünde nörolojik bulgu saptandı Ortalama serum sodyum değeri 151 9±6 4 mEq L idi Bebeklerin 97’sine damar içi sıvı desteği verilirken sodyum değerleri 1 8±1 6 gün sonra normal değerlere geriledi Bebeklerin 27 2’sinde enfeksiyon bakteriyemi ve idrar yolu enfeksiyonu 3’ünde vücuda tuz uygulanması ve 3’ünde malabsorpsiyon saptandı Bebeklerin ortalama taburcu edilme zamanı 2 0±1 6 gündü Cinsiyet ve doğum şeklinin hipernatremi düzeyi ile anlamlı bir ilişkisi saptanmazken ilk bebeklerde serum sodyum değerinin daha yüksek olduğu gözlendi Erkek cinsiyetin hipernatremik dehidratasyonda nörolojik bulguların gelişiminde hafif bir risk etmeni olduğu belirlendi Göreceli risk=1 16 95 güvenilirlik aralığı 0 5 2 7 nbsp;Çıkarımlar: Çalışmamızda hipernatremi gelişen yenidoğanların büyük bir kısmının sadece anne sütü ile beslendiği belirlendi İlk bebek olmanın hipernatremi gelişiminde erkek cinsiyetin ise nörolojik bulguların gelişiminde bir risk etmeni oldukları saptandı Türk Ped Arş 2009; 44: 84 8 Anahtar kelimeler: Anne sütü dehidratasyon hipernatremi yenidoğan

Anahtar Kelimeler

• Anne sütü, dehidratasyon, hipernatremi, yenidoğan

Kaynakça

1. Laing IA, Wong CM. Hypernatremia in the first few days: is the incidence increasing? Arch Dis Child Fetal Neonatal Ed 2002; 87: 158-62. (Full Text) / (PDF)
2. Macdonald PD, Ross SR, Grant L, Young D. Neonatal weight loss in breast and formula fed infants. Arch Dis Child Fetal Ne- onatal Ed 2003; 88: 472-6. (Abstract)
3. Manganaro R, Mamì C, Marrone T, Marseglia L, Gemelli M. In- cidence of dehydration and hypernatremia in exclusively breastfed infants. J Pediatr 2001; 139: 673-5. (Abstract)
4. Vatansever U, Duran R, Acunaş B. Tek başına anne sütü ile beslenen bebeklerde hipernatremik dehidratasyon. Trakya Univ Tip Fak Derg 2007; 24: 190-5. (Abstract) / (Full Text) / (PDF)
5. Molteni K H. Initial management of hypernatremic dehydration in the breastfed infant. Clin Pediatr 1994; 33: 731-40. (Abstract) (Full Text)
6. Bülbül L, Baysal SU, Gökçay G, Vehid HE, Bülbül A. Altı aylık süt çocuklarında yalnız anne sütü ile beslenme süresi ile kan hemoglobin düzeyi ve eritrosit indeksleri ilişkisi. Türk Ped Arş 2008; 43: 119-26. (Abstract) / (Full Text) / (PDF)
7. Unal S, Arhan E, Kara N, Uncu N, Aliefendioğlu D. Breastfeeding associated hypernatremia: Retrospective analysis of 169 term newborns. Pediatr Int 2008; 50: 29-34. (Abstract) / (Full Text) / (PDF)
8. Ergenekon E, Unal S, Gücüyener K, et al. Hypernatremic dehy- dration in the newborn period and long-term follow up. Pediatr Int 2007; 49: 19-23. (Abstract) / (Full Text) / (PDF)

9. Livingstone VH, Willis CE, Abdel-Wareth LO, Thiessen P, Loc- kitch G. Neonatal hypernatremic dehydration associated with breastfeeding malnutrition: a retrospective survey. CMAJ 2000; 162: 647-52. (Abstract) / (Full Text) / (PDF)
10. Neifert M R. Prevention of breastfeeding tragedies. Pediatr Clin North Am 2001; 48: 273-97. (Abstract) / (Full Text) / (PDF)
11. American Academy of Pediatrics Committee on fetus and newborn. Hospital stay for healthy term newborns. Pediatrics 1995; 96: 788-90. (Abstract) / (Full Text) / (PDF)
12. American Academy of Pediatrics, Work Group on breast fee- ding. Breastfeeding and the use of human milk. Pediatrics 1997; 100: 1035-7. (Abstract) / (Full Text) / (PDF)
13. Cooper WO, Atherton HD, Kahana M, Kotagal UR. Increased incidence of severe breastfeeding malnutrition and hypernat- remia in a metropolitan area. Pediatrics 1995; 96: 957-60. (Abstract) / (Full Text) / (PDF)
14. Gebara BM, Everett KO. Dural sinus thrombosis complicating hypernatremic dehydration in a breastfed neonate. Clin Pedi- atr 2001; 40: 45-8. (Abstract) (Full Text)
15. Jaramillo I, Lopez G, Hernandez H. Hypernatremic dehydrati- on and death in an infant. Pediatr Emerg Care 2003; 19: 62-3. (Abstract) (Full Text)
16. Musapasaoglu H, Agildere AM, Teksam M, Tarcan A, Gurakan B. Hypernatraemic dehydration in a neonate: brain MRI fin- dings. Br J Radiol 2008; 81: 57-60. (Abstract)
17. Escobar GJ, Gonzales VM, Armstrong MA, Folck BF, Xiong B, Newman TB. Rehospitalization for neonatal dehydration: anested case-control study. Arch Pediatr Adolesc Med 2002; 156: 155-61. (Abstract) (Full Text) / (PDF)
18. Rosenbloom AL. Permanent brain damage from hypernatre- mic dehydration in breastfed infants: patient reports. Clin Pe- diatr 2004; 43: 855-7. (Abstract) (Full Text)
19. Shroff R, Hignett R, Pierce C, Marks S, van’t Hoff W. Lifethre- atening hypernatraemic dehydration in breastfed babies. Arch Dis Child 2006; 91: 1025-6. (Abstract) (Full Text) / (PDF)
20. Moritz ML, Manole MD, Bogen DL, Ayus JC. Breastfeeding- associated hypernatremia: are we missing the diagnosis? Pe- diatrics 2005; 116: 343-7. (Abstract)
21. Arboit JM, Gildengers E. Breastfeeding and hypernatremia. J Pediatr 1980; 97: 335-6. (Abstract)
22. 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. (Abstract) / (Full Text) / (PDF)