Hypernatremic dehydration in exclusively breast fed neonates: a clinical study

Abstract

Introduction: Neonatal hypernatremic dehydration is a very serious condition and there has been an increase in the incidence of hypernatremic dehydration in breast fed infants in the first week of life. Hypernatremia in neonates is found to be due to inadequate breast feeding or insufficient milk production. This study was conducted to look at the prevalence, clinical symptoms, signs and risk factors associated with hypernatremia in exclusively breast fed healthy neonates.

Methodology: A Retrospective cross-sectional study conducted at KVG Medical College Sullia on 29 neonates with hypernatremic dehydration who were recruited during the period from June 2016 to April 2017. Healthy term neonates with birth weight more than 2.5kg, on exclusive breast feeding were considered for the study. Maternal problems regarding breast feeding were assessed. Serum sodium level more than 145meq/L was considered as hypernatremia in our study.

Results: Out of 32 neonates with hypernatremic dehydration, 29 were enrolled in the study as 3 were excluded because of low birth weight. Male babies were affected more than female babies with 16 (55.17%) and 13 (44.83%) respectively. The main presenting features were fever (100%), poor feeding (65.52%) and jaundice (51.72%). The maximum number of babies who had hypernatremic dehydration presented in 46 hours to 60 hours of life (day 2-3). The results showed that the hours of life / day of presentation with hypernatremic dehydration has significant correlation with neonate’s serum sodium concentration (P value <0.05), indicating insufficient milk production in the mother during first few days. According to our study, babies born to primiparous women are more likely to be affected with hypernatraemic dehydration than multiparous women.

Conclusion: It is recommended that dehydration and problems related can be considered as prime reason for fever during the first few days of life in low-risk term neonates. Special attention to antenatal care, postnatal care regarding early initiation of breast feeding and careful watch of neonates during the first week of life could decrease the incidence of neonatal hypernatremia.