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Stichtenoth G, Gonser M, Hentschel R, Janke E, Maul H, Schmitt A, Steppat S, Werner J, Herting E. Betreuung von Neugeborenen in der Geburtsklinik (Entwicklungsstufe
S2k, AWMF-Leitlinien-Register-Nr. 024–005, März 2021). Z Geburtshilfe Neonatol 2024; 228:137-150. [PMID: 38608666 DOI: 10.1055/a-2195-3995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Affiliation(s)
- Guido Stichtenoth
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - Markus Gonser
- Universitätsspital Zürich, Klinik für Geburtshilfe, Zürich, Schweiz
| | - Roland Hentschel
- Neonatologie/Intensivmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg
| | - Evelin Janke
- Katholische Bildungsstätte für Berufe im Sozial- und Gesundheitswesen GmbH, Akademie St. Franziskus, Lingen (Ems)
| | - Holger Maul
- Geburtshilfe und Pränatalmedizin, Asklepios Klinik Barmbek, Hamburg
| | - Anne Schmitt
- Hochschule für Technik und Wirtschaft des Saarlandes, Saarbrücken
| | | | - Janne Werner
- Florence-Nightingale-Krankenhaus, Kaiserswerther Diakonie, Düsseldorf
| | - Egbert Herting
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
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Saba L, Hanna C, Creo AL. Updates in hyponatremia and hypernatremia. Curr Opin Pediatr 2024; 36:219-227. [PMID: 38174733 DOI: 10.1097/mop.0000000000001324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW Hyponatremia and hypernatremia are commonly encountered electrolyte abnormalities that require timely and careful intervention, as they can be associated with significant morbidity and mortality. RECENT FINDINGS This review article addresses the etiology, presentation, diagnosis, and management of both hyponatremia and hypernatremia, emphasizing the latest advancements and emerging trends in pediatric care. SUMMARY A methodical approach is needed to accurately assess and treat hyponatremia and hypernatremia. Both conditions continue to rely on serum and urine testing, however newer tests such as copeptin and stimulated testing may hold promise to further refine testing in the future.
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Affiliation(s)
- Leslie Saba
- Department of Pediatric and Adolescent Medicine, Mayo Clinic
| | - Christian Hanna
- Division of Pediatric Nephrology and Hypertension, Department of Pediatric and Adolescent Medicine, Mayo Clinic
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic
| | - Ana L Creo
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Tanwar P, Kapoor K, Kumar A, Gangopadhyay S, Gera R. Clinical Profile and Outcome of Young Infants With Hypernatremic Dehydration Presenting to the Emergency Department. Pediatr Emerg Care 2024; 40:e10-e15. [PMID: 37586360 DOI: 10.1097/pec.0000000000003028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the clinical profile and outcome of young infants presenting to the pediatric emergency department with hypernatremic dehydration. METHODS A prospective observational study was conducted at a tertiary care teaching hospital over a period of 18 months. All outborn sick young infants aged 2 months or younger who presented to the emergency department with symptoms and signs of possible sepsis and/or dehydration were screened, and those with hypernatremia were enrolled in the study. Those infants born at less than 37 weeks of gestation and gross congenital anomaly were excluded. Hypernatremic dehydration was defined as serum sodium levels (Se Na+)higher than 145 mEq/L. Variables used in the study were defined as per standard definitions. Acute kidney injury was defined and staged using serum creatinine as per modified neonatal Kidney Disease Improving Global Outcome guidelines. Clinical presentation, laboratory parameters, and comorbidities were compared among outcome groups (survived and died). RESULTS Of 1124 outborn young infants who met the eligibility criteria for screening, 63 were diagnosed to have hypernatremic dehydration and 55 were enrolled. The hospital-based period prevalence of hypernatremic dehydration in young infants was 4.89%. The median age of presentation was 17 days (10-30). Male-to-female ratio was 1.1:1. Seventy-three percent were first in birth order. Feeding pattern showed 61.8%, 30.9%, and 7.3% of infants were exclusively breastfed, top fed, and mixed fed, respectively. The median serum sodium at the time of admission was 160 (153.5-167) mg/dL. Three (5.5%) infants had mild, 39 (70.9%) had moderate, and 13 (23.6%) had severe hypernatremic dehydration. There was statistically significant correlation between median platelet count with severity of hypernatremic dehydration. The mean time taken to correct serum sodium level was 3.30 ± 1.60 days. The case fatality rate was 41.8%. Those who died had statistically more severe hypernatremic dehydration, acute kidney injury, sepsis, and need for ventilation. CONCLUSIONS Acute kidney injury stage 3, shock, and need for ventilation are associated with poor outcome in infants with hypernatremic dehydration.
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Affiliation(s)
- Priya Tanwar
- From the Department of Paediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Kanika Kapoor
- From the Department of Paediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ajay Kumar
- From the Department of Paediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sukanya Gangopadhyay
- Department of Biochemistry, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rani Gera
- From the Department of Paediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Zieg J, Narla D, Gonsorcikova L, Raina R. Fluid management in children with volume depletion. Pediatr Nephrol 2024; 39:423-434. [PMID: 37452205 DOI: 10.1007/s00467-023-06080-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/06/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
Volume depletion is a common condition and a frequent cause of hospitalization in children. Proper assessment of the patient includes a detailed history and a thorough physical examination. Biochemical tests may be useful in selected cases. Understanding the pathophysiology of fluid balance is necessary for appropriate management. A clinical dehydration scale assessing more physical findings may help to determine dehydration severity. Most dehydrated children can be treated orally; however, intravenous therapy may be indicated in patients with severe volume depletion, in those who have failed oral therapy, or in children with altered consciousness or significant metabolic abnormalities. Proper management consists of restoring circulatory volume and electrolyte balance. In this paper, we review clinical aspects, diagnosis, and management of children with volume depletion.
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Affiliation(s)
- Jakub Zieg
- Department of Pediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Deepti Narla
- Department of Pediatric Nephrology, Akron Children's Hospital, Cleveland, OH, USA
| | - Lucie Gonsorcikova
- Department of Pediatrics, First Faculty of Medicine, Charles University in Prague and Thomayer University Hospital, Prague, Czech Republic
| | - Rupesh Raina
- Department of Pediatric Nephrology, Akron Children's Hospital, Cleveland, OH, USA.
- Cleveland Clinic Akron General Medical Center, Akron, OH, USA.
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Zakerihamidi M, Moradi A, Ramazani A, Boskabadi H. Comparison of prognosis between hyperbilirubinemic infants with and without hypernatremia. J Neonatal Perinatal Med 2024; 17:161-167. [PMID: 38759028 DOI: 10.3233/npm-230144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
OBJECTIVES Hypernatremia may facilitate the diffusion of bilirubin through the blood-brain barrier and increase the risk of bilirubin encephalopathy. This study was conducted to compare the prognosis of jaundice infants with those with jaundice and hypernatremia. METHODS A total of 615 term infants with idiopathic jaundice with or without hypernatremia were enrolled in this cohort study with 24-months follow-up at Ghaem Hospital, Mashhad, Iran, between 2010 and 2022. An in-house questionnaire including the laboratory evaluation and neonatal characteristics was used as the data collection tool. The follow-up of neonatal development status was performed using the Denver test II at 6, 12, 18, and 24 months after discharging from hospital. RESULTS Normal outcomes were seen in 555 (90.2%) out of 615 studied infants, while 60 cases (9.8%) showed abnormal outcomes. Serum levels of sodium (P = 0.017), bilirubin (P = 0.001), urea (P = 0.024), and creatinine (P = 0.011) as well as hyperthermia (P = 0.046) and unconsciousness (P = 0.005) showed significant differences between the two groups. Approximately 16% of the newborns with both jaundice and hypernatremia, and 9% of those with only jaundice had unfavorable prognoses. Also, bilirubin level had the most predictive power (91.3%). CONCLUSIONS Our results suggest that hypernatremia or jaundice alone, may affect the prognosis of infants aged 2 years; but jaundice and hypernatremia together, will intensify the developmental problems in jaundice infants. However, the role of hyperbilirubinemia in the incidence of complications is more than hypernatremia.
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Affiliation(s)
- M Zakerihamidi
- Department of Midwifery, School of Medical Sciences, Islamic Azad University, Tonekabon Branch, Tonekabon, Iran
| | - A Moradi
- Orthopedic Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
- Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - A Ramazani
- Mashhad Ghaem Hospital, Ward of Neonatal Intensive Care Unit, Mashhad, Iran
| | - H Boskabadi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Tellerday JA, Calleo V. Massive Chronic Hypernatremia Associated With Failure to Thrive in a Pediatric Patient. Cureus 2023; 15:e42179. [PMID: 37602070 PMCID: PMC10439520 DOI: 10.7759/cureus.42179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Hypernatremia is a severe, potentially life-threatening condition that can manifest with altered mental status, coma, seizure, and even death. Values above 190 mmol/L are seldom reported in young pediatric patients and often have poor outcomes. We present a case of severe chronic hypernatremia secondary to failure to thrive (FTT) in a toddler, which led to significant pathology including bilateral metabolic strokes. A 21-month-old female was found unresponsive and brought to the hospital. The patient's childhood was complicated by prematurity, poor weight gain, and persistent postprandial emesis. On examination, the patient was tachycardic and obtunded. Her weight was below the first percentile. Initial laboratory results showed a sodium level of 197 mmol/L with marked dehydration. Normal saline boluses were given followed by maintenance fluids with the goal of sodium decrementation by 0.5 mmol/hour; nephrology assisted with fluid and electrolyte correction calculations. Imaging revealed metabolic strokes involving the brainstem and thalami. During hospitalization, hypokalemia and hypophosphatemia complicated the treatment course. Over the next 21 days, electrolytes normalized. She tolerated nasogastric feeding, gradually improved as she gained weight, and was discharged. Chronic hypernatremia must be fixed judiciously as rapid correction can cause significant harm. This unusual case reminds providers that florid electrolyte dyscrasias may be secondary to FTT and can lead to significant neurological sequelae. Careful fluid selection and calculations should be performed in these cases. Chronic hypernatremia should be considered in children with FTT with altered mental status, and the gradual correction of electrolytes should be performed to minimize patient harm.
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Muacevic A, Adler JR, Vieira F, Salazar A, Tuna M. Salt Poisoning Due to Inadequate Infant Formula Preparation: A Rare Cause of Hypernatremia and Massive Cerebral Hemorrhage in a Newborn. Cureus 2022; 14:e33045. [PMID: 36721612 PMCID: PMC9881600 DOI: 10.7759/cureus.33045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 12/29/2022] Open
Abstract
Salt poisoning is a rare cause of severe hypernatremia in children resulting from the ingestion of toxic amounts of sodium chloride, either from accidental or intentional administration of salted solutions. We present the case of a newborn admitted to a pediatric emergency department for lethargy and reduced oral intake; his laboratory evaluation showed severe hypernatremia ([Na+] of 174 mmol/L). The infant developed convulsive status epilepticus during treatment. Neuroimaging showed a tetraventricular hemorrhage, a large right-sided parenchymal hemorrhage with midline shift, and several left hemorrhagic foci. Etiologic evaluation for hypernatremia did not reveal a renal or extrarenal source of water loss nor an intercurrent illness to explain the reduced oral intake. A careful review of how the parents prepared the infant formula revealed an error in dosing the ratio of powder/water, resulting in hyperosmolar infant formula. The infant was diagnosed with salt poisoning as the major cause of hypernatremia. After careful correction of hypernatremia and the use of antiseizure medication, the patient improved and was discharged. The parents were given a careful review of instructions for infant formula preparation. Due to its rarity, a high index of suspicion is mandatory for a correct diagnosis of salt poisoning. Timely and adequate treatment is needed due to the high risk of intracerebral bleeding, seizures, and irreversible neurologic injury. Children, particularly newborns and infants, depend upon adults to ingest water and, thus, have more difficulty in maintaining electrolyte balance. Therefore, it is of utmost importance that parents are educated about childcare, particularly on the importance of careful infant formula preparation.
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del Castillo-Hegyi C, Achilles J, Segrave-Daly BJ, Hafken L. Fatal Hypernatremic Dehydration in a Term Exclusively Breastfed Newborn. CHILDREN 2022; 9:children9091379. [PMID: 36138688 PMCID: PMC9498092 DOI: 10.3390/children9091379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022]
Abstract
Hypernatremic dehydration in term newborns has steadily increased in incidence with increasing efforts to promote exclusive breastfeeding before hospital discharge, a key metric of the Baby-Friendly Hospital Initiative. The following report details a case of a term newborn infant who had evidence of poor intake while exclusively breastfeeding during his hospital stay that may not have been recognized by health care providers. The infant was discharged home and was subsequently found by the parents in cardiac arrest 12 h after discharge and was found to have hypernatremic dehydration. Although return of spontaneous circulation was achieved after fluid resuscitation, the infant sustained extensive hypoxic-ischemic brain injury due to cardiovascular collapse. Due to the infant’s extremely poor prognosis, life support was withdrawn at 19 days of age and the infant expired. This sentinel case demonstrates multiple pitfalls of current perceptions of normal vs. abnormal newborn feeding behavior, weight loss percentages, elimination patterns, and acceptable clinical thresholds believed to be safe for neonates. Newer data have shown that hypernatremia occurs commonly in healthy, term breastfed newborns at weight loss percentages previously deemed normal by most health professionals and hospital protocols. In-hospital strategies to prevent excessive weight loss and screening for hypernatremia in response to signs of inadequate feeding have the potential to prevent tens of thousands of readmissions for feeding complications a year, as well as hundreds of millions in health care costs.
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Affiliation(s)
- Christie del Castillo-Hegyi
- Department of Emergency Medicine, CHI St. Vincent, Little Rock, AR 72205, USA
- Fed is Best Foundation, Little Rock, AR 72223, USA
- Correspondence:
| | - Jennifer Achilles
- Fed is Best Foundation, Little Rock, AR 72223, USA
- TelePeds, Santa Fe, NM 87505, USA
| | | | - Lynnette Hafken
- Fed is Best Foundation, Little Rock, AR 72223, USA
- Holy Cross Hospital, Silver Spring, MD 20910, USA
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Zieg J. Diagnosis and management of hypernatraemia in children. Acta Paediatr 2022; 111:505-510. [PMID: 34716953 DOI: 10.1111/apa.16170] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 11/30/2022]
Abstract
Hypernatraemia is most commonly caused by excessive loss of solute-free water or decreased fluid intake; less often, the aetiology is salt intoxication. Especially infants, young children and individuals with a lack of access to water are at risk of developing hypernatraemia. Diagnosis is based on detailed history, physical examination and basic laboratory tests. Correction of hypernatraemia must be slow to prevent cerebral oedema and irreversible brain damage. This article reviews the aetiology, differential diagnosis and management of conditions associated with paediatric hypernatraemia. Distinguishing states with water deficiency from states with salt excess is important for proper management of hypernatraemic patients.
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Affiliation(s)
- Jakub Zieg
- Department of Paediatrics Second Medical Faculty Motol University HospitalCharles University Prague Czech Republic
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Wilde VK. Neonatal Jaundice and Autism: Precautionary Principle Invocation Overdue. Cureus 2022; 14:e22512. [PMID: 35228983 PMCID: PMC8873319 DOI: 10.7759/cureus.22512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/05/2022] Open
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Akdeniz O, Çelik M, Samancı S. Evaluation of Term Newborn Patients With Hypernatremic Dehydration. Turk Arch Pediatr 2022; 56:344-349. [PMID: 35005729 PMCID: PMC8655962 DOI: 10.5152/turkarchpediatr.2021.20153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/13/2020] [Indexed: 11/22/2022]
Abstract
Aim We aimed to evaluate the demographic, clinical, and laboratory findings and the management of newborns with hypernatremic dehydration (HDH). Materials and Methods A total of 85 term newborns with serum sodium (Na) levels higher than 145 mEq/L who admitted to our hospital between January 2011 and December 2018 were included in this study. Results Among all cases, 54.1% were female infants with the mean birth weight, weight loss ratio, and median age at diagnosis of 3095 ± 540 g, 13.6 ± 10%, and 8 (2-24) days, respectively. The most common presenting complaints were breastfeeding difficulties (90.5%), fever (63.5%), decreased urination (43.5%), jaundice (22.3%), and convulsion (15.3%). The mean sodium and potassium, and median blood urea and creatinine levels on admission were 167.9 ± 13.4 mEq/L, 5.4 ± 2.8 mmol/L, 213 mg/dL (11-476 mg/dL), and 2.4 mg/dL (0.52-9.96 mg/dL), respectively. There was metabolic acidosis in 67% and acute renal failure in 74.4% of patients, while peritoneal dialysis was performed in 12 of them. There was a positive correlation between weight loss ratio and admission age, serum urea, and creatinine levels; there was a negative correlation between weight loss and blood pH. Eight patients died (9.4%). Conclusions In our study, serum urea, creatinine, potassium, metabolic acidosis levels, convulsion, and dialysis requirements at the time of admission of the newborns with HDH were found to be higher in those who died compared to those who survived. Convulsion was a presenting complaint, and it was also observed during the treatment.
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Affiliation(s)
- Osman Akdeniz
- Department of Pediatrics, Diyarbakir Children's Hospital, Diyarbakir, Turkey
| | - Muhittin Çelik
- Department of Pediatrics, Diyarbakir Children's Hospital, Diyarbakir, Turkey
| | - Serhat Samancı
- Department of Pediatrics, Diyarbakir Children's Hospital, Diyarbakir, Turkey
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Akbalık Kara M, Pınarbaşı AS, Çelik M. Peritoneal dialysis for term neonates in a neonatal intensive care unit. Pediatr Int 2022; 64:e15155. [PMID: 35616157 DOI: 10.1111/ped.15155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 01/01/2022] [Accepted: 01/28/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND This study aimed to evaluate the indications, complications, and outcomes of peritoneal dialysis (PD) in term neonates from a state hospital. METHODS The demographic, clinical, and laboratory data of 67 newborn term infants who underwent PD within the first 4 weeks of life between June 2014 and June 2019 were retrospectively analyzed. RESULTS Twenty-five patients (37.3%) were male, 42 (63.7%) were female. The mean gestational age was 38.3 ± 0.8 (range: 37-40) weeks and mean birthweight 3,100 ± 504.9 g (range: 1,800-5,000 g). The mean age of patients at the start of dialysis was 7.97 ± 8.34 days (range:1-44 days) and the mean duration for dialysis was 3 ± 5.42 days (range 1-40 days). The majority of patients who underwent PD had inborn error of metabolism (59.7%). The most common complication was dialysate leakage. Thirty-three neonates (49.2%) died during PD process because of underlying disease, 17 patients (25.4%) were referred to other centers, and 17 patients (25.4%) were discharged. There were seven acute kidney injury patients associated with hypernatremic dehydration. There were statistically significant differences between non-survivors and survivors in terms of dialysis duration, birthweight, weight at admission, requirements for mechanical ventilation, and inotrop agent, and also the renal angina index. CONCLUSIONS In our region, hypernatremic dehydration is still a one of the major cause for acute kidney injury (AKI) in newborns. In state hospitals, pediatric specialists must be present in neonatal intensive care units in order not to refer unstable patients to other centers and to provide high-quality patient care.
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Affiliation(s)
- Mehtap Akbalık Kara
- Department of Pediatric Nephrology, Gaziantep University Medical Faculty, Gaziantep, Turkey
| | - Ayşe Seda Pınarbaşı
- Department of Pediatric Nephrology, Diyarbakır Children's Hospital, Diyarbakır, Turkey
| | - Muhittin Çelik
- Department of Neonatology, Gaziantep University Medical Faculty, Gaziantep, Turkey
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Wilde VK. Breastfeeding Insufficiencies: Common and Preventable Harm to Neonates. Cureus 2021; 13:e18478. [PMID: 34659917 PMCID: PMC8491802 DOI: 10.7759/cureus.18478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 11/05/2022] Open
Abstract
Insufficient milk intake in breastfed neonates is common, frequently missed, and causes preventable hospitalizations for jaundice/hyperbilirubinemia, hypernatremia/dehydration, and hypoglycemia - accounting for most U.S. neonatal readmissions. These and other consequences of neonatal starvation and deprivation may substantially contribute to fully preventable morbidity and mortality in previously healthy neonates worldwide. Previous advanced civilizations recognized this problem of breastfeeding insufficiencies and had an infrastructure to solve it: Wetnursing, shared nursing, and prelacteal feeding traditions used to be well-organized and widespread. Modern societies accidentally destroyed that infrastructure. Then, modern reformers missing a few generations of direct knowledge transmission about safe breastfeeding invented a new, historically anomalous conception of breastfeeding defined in terms of exclusivity. As that new intervention has become increasingly widespread, so too have researchers widely reported associated possible harms of the longer neonatal starvation/deprivation and later infant under-nutrition periods that it creates when breastfeeding is insufficient. Early insufficient nutrition/hydration has possible long-term effects including neurodevelopmental consequences such as attention deficit hyperactivity disorder, autism, cerebral palsy, cognitive and developmental delay, epilepsy, hearing impairment, kernicterus, language disorder, mood disorders, lower IQ, and specific learning disorder. Current early infant feeding guidelines conflict with the available evidence. Recent reform efforts have tended to focus on using more technology and measurement to harm fewer neonates instead of proposing the indicated paradigm shift in early infant feeding to prevent more harm. The scientific evidence is already sufficient to mandate application of the precautionary principle to feed neonates early, adequate, and often milk before mothers' milk comes in and whenever signs of hunger persist, mitigating possible risks including death or disability. In most contexts, the formula is the best supplementary milk for infants at risk from breastfeeding insufficiencies. National-level reviews of scientific evidence, health policy, and research methods and ethics are needed to initiate the early infant feeding paradigm shift that the data already support. Policy experiments and related legislative initiatives might also contribute to the shift, as insurers might decline or be required by law to decline reimbursing hospitals for costs of this type of preventable hospitalization, which otherwise generates profit.
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Affiliation(s)
- Vera K Wilde
- Methods, Ethics, and Technology, Independent Researcher, Berlin, DEU
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Tuzun F, Duman N, Ozkan H. Response to the letter regarding fluid therapy in term newborns. J Matern Fetal Neonatal Med 2021; 35:8112-8113. [PMID: 34365874 DOI: 10.1080/14767058.2021.1961732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Funda Tuzun
- Division of Neonatology, Department of Pediatrics, Facult of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Nuray Duman
- Division of Neonatology, Department of Pediatrics, Facult of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Hasan Ozkan
- Division of Neonatology, Department of Pediatrics, Facult of Medicine, Dokuz Eylul University, Izmir, Turkey
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Zia MTK, Golombek S, Nitkowski-Keever S, Paudel U. Weight loss monitoring reduces the occurrence of neonatal hypernatremic dehydration in breastfeeding neonates. Int J Pediatr Adolesc Med 2021; 9:22-26. [PMID: 35573072 PMCID: PMC9072242 DOI: 10.1016/j.ijpam.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/14/2021] [Indexed: 11/30/2022]
Abstract
Background Excessive weight loss enhances the incidence of neonatal hypernatremic dehydration (NHD). We compared the effect of a new breastfeeding policy against an old breastfeeding policy on neonatal weight change and the incidence of NHD. Methods This was a QA project between two sets of breastfeeding (BF) protocols for exclusively BF newborns. Under our old BF policy, a number of neonates had a significant loss of weight after birth and were admitted to the NICU due to NHD. We implemented a new BF policy that was used when a newborn loses>5% of previously recorded weight within a 24-h interval. Two groups were compared: the preintervention group (old BF policy) and postintervention group (new BF policy). Additionally, characteristics of newborns admitted to NICU were separately compared with the subgroup of pre- and post intervention dehydration groups. Results Preintervention = 1320 and postintervention = 1450. Neonates with weight loss of ≥ 5% within the first 24-h time interval were higher in the postintervention group (19.7%) as compared to the preintervention group (10.2%) (P < .05). However, the number of infants diagnosed to have NHD was lower in the postintervention group (0.68%) than in the preintervention group (1.66%), (P < .03). Neonatal characteristics were comparable between subgroups of dehydration. Conclusion An intervention at ≥ 5% neonatal weight loss markedly reduces the incidence of NHD-associated NICU admissions.
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Butler B, Trotman H. Hypernatremic Dehydration in Breast Fed Infants: Lessons from a Baby-Friendly Hospital. J Trop Pediatr 2021; 67:6024570. [PMID: 33277904 DOI: 10.1093/tropej/fmaa083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIM To determine the incidence, presentation and outcome of all neonates admitted to the University Hospital of the West Indies with a diagnosis of breastfeeding associated hypernatremic dehydration during a 15-year period and make comparisons with an earlier study done at the institution. METHODS A retrospective review of the files of neonates admitted to the neonatal unit with breastfeeding associated hypernatremic dehydration between January 2002 and December 2016 was conducted. Data on maternal and neonatal demographics, presentation, laboratory results and outcome were extracted and descriptive analyses performed. Statistical significance was taken at the level p < 0.05. RESULTS Eighty neonates were entered into the study, 79 were inborn giving an incidence of 2.5 per 1000 live births. Fifty-five (71%) mothers were primiparous, with a mean ± SD age of 29.5 ± 5.6 years and mean ± SD length of hospital stay 2.6 ± 1.5 days. Fifty-six (71%) neonates were exclusively breastfed with a mean ± SD age at presentation of 5.6 ± 3.8 days, mean ± SD percentage weight loss of 16.3% ± 6.1% and a mean serum ± SD sodium of 156.1 ± 8.3 mmol/l. Fifty-four (68%) neonates were admitted from home and 22 (28%) from the postnatal ward. Complications seen included acute kidney injury 6 (8%), seizures 2 (3%), hypotonia 1 (1%) and bradycardia 1 (1%). The neonates were detected earlier, presented with a significantly lower mean serum sodium, urea and creatinine (p < 0.05), had less severe complications and no deaths compared with neonates in the previous study. CONCLUSION Early intervention can make a positive impact on the severity and complications of breastfeeding associated hypernatremia.
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Affiliation(s)
- B Butler
- Department of Child & Adolescent Health, Faculty of Medical Sciences, University of the West Indies, Mona, St. Andrew, Jamaica
| | - H Trotman
- Department of Child & Adolescent Health, Faculty of Medical Sciences, University of the West Indies, Mona, St. Andrew, Jamaica
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Boskabadi H, Zakerihamidi M, Moradi A. Predictability of prognosis of infantile hypernatremic dehydration: a prospective cohort study. J Matern Fetal Neonatal Med 2020; 35:66-74. [PMID: 31937159 DOI: 10.1080/14767058.2020.1712698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Infantile hypernatremic dehydration (IHD) is a life-threatening disease with potential cerebral adverse effects.Purpose: This study was conducted to evaluate the prognosis of IHD.Methods/Search strategy: Using convenience sampling 183 term infants with IHD (Na+ > 150 mg/dl) were enrolled in a cohort study with 36 months follow-up during 2007-2017. A researcher-made questionnaire was used for data collection. Follow-up visits were performed using the Denver Developmental Screening II test after discharging from hospital. The t-test, chi-square test, regression models, and receiver-operating characteristic curve were performed for data analysis.Findings/results: 17.5% of neonates were diagnosed with abnormal outcomes. Postpartum breast growth, breastfeeding frequency and duration, convulsion, consciousness, urination frequency, urea, Cr, sodium and brain CT scan (p = .000) showed significant differences (p < .05) between the infants with normal and abnormal outcomes. Combination of the above variables had a high predictive power (98.6%) for determining the unfavorable prognosis in infants with IHD.Implications for practice: Sodium, urea and creatinine are high-sensitive/specific determinants of IHD prognosis. Combination of some risk factors is highly predictive for unfavorable prognosis of IHD.Implications for research: Combination of variables such as sodium, urea, creatinine, lethargy, state of fontanels, convulsion, loss of consciousness, state of the breast during postpartum, inverted nipple and brain CT scan has a high predictive power in the determination of unfavorable prognosis in IHD.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, School of Medical Sciences, Islamic Azad University, Tonekabon Branch, Tonekabon, Iran
| | - Ali Moradi
- Orthopedic Research Centre, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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18
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Zakerihamidi M, Boskabadi H, Sezavar M. Evaluation of neonatal jaundice based on the severity of hyperbilirubinemia. J Clin Neonatol 2020. [DOI: 10.4103/jcn.jcn_81_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Tomarelli G, Arriagada D, Donoso A, Diaz F. Extreme Neonatal Hypernatremia and Acute Kidney Injury Associated with Failure of Lactation. J Pediatr Intensive Care 2019; 9:124-127. [PMID: 32351767 DOI: 10.1055/s-0039-3400469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 10/20/2019] [Indexed: 01/31/2023] Open
Abstract
Hypoalimentation is an important cause of hypernatremic dehydration in neonates; however, extreme values of plasma sodium make it necessary to investigate the differential diagnosis. We report the case of a 20-day-old newborn who was admitted with severe hypernatremic dehydration, with plasma sodium of 213 mEq/L and oliguric acute renal failure. The patient was treated with intravenous fluids for correction of dehydration and peritoneal dialysis for adequate sodium correction. During the etiological study, a 10-fold increase in the concentration of sodium in breast milk was detected. Peritoneal dialysis was an effective therapy in the management of the extreme hypernatremia with sodium correction within the recommended rate. At the 1-year follow-up appointment, the child had normal renal function, normal for age psychomotor development, and neurological physical was unremarkable. In conclusion, we report a case of an unusual extreme hypernatremia with discussion of the underlying pathophysiology and, more importantly, the effective treatment with a mixed approach with intravenous fluids and peritoneal dialysis.
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Affiliation(s)
- Gianfranco Tomarelli
- Pediatric Intensive Care Unit, Hospital Clínico Metropolitano La Florida, Santiago, Chile
| | - Daniela Arriagada
- Pediatric Intensive Care Unit, Hospital Clínico Metropolitano La Florida, Santiago, Chile
| | - Alejandro Donoso
- Pediatric Intensive Care Unit, Hospital Clínico Metropolitano La Florida, Santiago, Chile
| | - Franco Diaz
- Pediatric Intensive Care Unit, Hospital Clínico Metropolitano La Florida, Santiago, Chile
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20
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Weight loss thresholds to detect early hypernatremia in newborns. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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21
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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; 95:689-695. [PMID: 30030986 DOI: 10.1016/j.jped.2018.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/05/2018] [Accepted: 06/05/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE The literature indicates a single universal cut-off point for weight loss after birth for the risk of hypernatremia, without considering other factors. The aim of this study was to construct and internally validate cut-off points for the percentage weight loss associated with the risk of hypernatremia, taking into account risk factors. METHODS A prospective study with a three-day follow-up was conducted in 165 neonates with a gestational age ≥35 weeks. The main outcome variable was mild or moderate hypernatremia (serum sodium≥145mmol/L). Secondary variables (risk factors) were maternal and infant variables. A multivariate logistic regression model was constructed to predict hypernatremia, obtaining its probability and the optimal discriminant cut-off point for hypernatremia (receiver operating characteristic analysis). Based on this point, threshold weight loss values were obtained according to the other variables. These values were internally validated by bootstrapping. RESULTS There were 51 cases (30.9%) of hypernatremia. The mean percentage weight loss for hypernatremic infants was 8.6% and 6.0% for the rest. Associated variables in the multivariate model included greater weight loss, male gender, higher education level, multiparity, and cesarean delivery. The model had an area under the receiver operating characteristic curve of 0.84 (sensitivity=77.6%; specificity=73.2%). Similar values were obtained in the bootstrapping validation. The lowest percentage weight loss was 4.77%, for cesarean delivery in male infants of mothers with a higher education level. CONCLUSIONS The weight loss percentage values depended on the type of delivery, parity, newborn gender, and level of maternal education. External studies are required to validate these values.
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Affiliation(s)
| | | | - Jose López-Lozano
- Hospital Vega Baja, Servicio de Medicina Preventiva, Alicante, Spain
| | | | - Antonio Palazón-Bru
- Universidad Miguel Hernández de Elche, Departamento de Medicina Clínica, Alicante, Spain.
| | - Ernesto Cortés-Castell
- Universidad Miguel Hernández de Elche, Departamento de Farmacología, Pediatría y Química Orgánica, Alicante, Spain
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Rosinger AY. Biobehavioral variation in human water needs: How adaptations, early life environments, and the life course affect body water homeostasis. Am J Hum Biol 2019; 32:e23338. [PMID: 31631450 DOI: 10.1002/ajhb.23338] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/15/2019] [Accepted: 09/17/2019] [Indexed: 01/22/2023] Open
Abstract
Body water homeostasis is critical for optimal physiological and cognitive function for humans. The majority of research has illustrated the negative biological consequences of failing to meet water needs. The human body has several mechanisms for detecting, regulating, and correcting body water deficits and excesses. However, variation exists in total water intake and how people meet those water needs as well as thirst thresholds and how well people tolerate water restriction. An evolutionary and developmental framework provides an underexplored perspective into human water needs by examining how adaptations, early life experiences and environments, as well as life course changes in health states and behaviors may shape these critical factors in body water homeostasis. This article first reviews biological and behavioral adaptations to water scarcity among animals and humans. It then examines human variation in water intake in a mostly water secure environment through the analysis of National Health and Nutrition Examination Survey dietary data and the link between water intake patterns and hydration biomarkers. Next, it reviews existing evidence of how maternal water restriction in utero and during lactation shape vasopressin release, thirst thresholds, drinking patterns, and body water homeostasis for the infant. Early life water restriction appears to have implications for hydration status, body size, and cardiovascular health. Finally, it examines how life course changes in health states and behaviors, including obesity, sleep, and parasitic infection, affect body water homeostasis. This article poses new questions about the plasticity and shaping of human water needs, thirst, and hydration behaviors.
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Affiliation(s)
- Asher Y Rosinger
- Department of Biobehavioral Health, Pennsylvania State University, State College, Pennsylvania.,Department of Anthropology, Pennsylvania State University, State College, Pennsylvania
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23
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Abstract
Hypernatremic dehydration in exclusively breast-fed neonates is associated with a free water deficit secondary to inadequate fluid intake. It is a common but underrecognized problem in the primary care setting, as the degree of dehydration can be underestimated due to fluid shifts. Neonates of primiparous mothers and those who experience greater weight loss in the first week of life are at higher risk of developing hypernatremic dehydration and most often present for care between 6 and 10 days of life. No consensus treatment guidelines exist, but most experts recommend a goal reduction rate of serum sodium levels of 0.5 mEq/L per hour with correction over 48 hours. Serum sodium level greater than 160 mEq/L is a risk factor for morbidity and mortality. Complications of hypernatremic dehydration, with seizure being most common, usually occur during improper correction. Several small studies have documented varying degrees of neurodevelopmental delay on long-term follow-up of patients admitted for hypernatremic dehydration treatment as a neonate. [Pediatr Ann. 2019;48(5):e197-e200.].
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25
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Lewis J. Breast-Feeding Friendly, but Not Formula Averse. Pediatr Ann 2017; 46:e402-e408. [PMID: 29131919 DOI: 10.3928/19382359-20171019-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Breast-feeding is the optimal source of newborn nutrition in term infants and is associated with multiple short- and long-term health benefits. Establishment of breast-feeding may be difficult in a small subset of mothers, which can lead to adverse consequences in the newborn. Some of the consequences of suboptimal nutritional provision to the newborn, such as severe hyperbilirubinemia and breast-feeding-associated hypernatremic dehydration, can have devastating and long-lasting sequelae. Timely identification of mothers and newborns at risk for developing these complications is necessary to avoid significant morbidity and mortality. In these cases, the judicious use of formula supplementation may be considered. However, more studies are necessary to develop comprehensive formula supplementation criteria and guidelines for pediatric medical providers. [Pediatr Ann. 2017;46(11):e402-e408.].
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Paramasivam P, Earan SK, Arunagirinadhan A, Kantamneni S. Life Threatening Severe Hypernatraemic Dehydration in Neonates: A Report of Two Cases. J Clin Diagn Res 2017; 11:SD10-SD12. [PMID: 28892994 DOI: 10.7860/jcdr/2017/25312.10298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 05/05/2017] [Indexed: 11/24/2022]
Abstract
Hypernatraemic dehydration in neonates may lead to potentially lethal consequences like cerebral oedema, intracranial haemorrhage, hydrocephalus and gangrene. In the light of increase in the infants presenting with hypernatraemic dehydration, there is a definitive need to heighten the awareness and have a high degree of suspicion in diagnosis for this potentially lethal condition. We report two neonates of severe hypernatraemia with dehydration highlighting its diagnosis and management. Treatment of hypernatraemic dehydration involves correction of electrolyte imbalance by careful restoration of fluids and ensuring appropriate intake of calories. Promoting, protecting and supporting breastfeeding by careful breastfeeding assessment and including an early post partum follow up in the hospital protocol to detect any unusual weight loss in the newborn period plays a significant role in preventing this condition.
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Affiliation(s)
- Priyaja Paramasivam
- Postgraduate Student, Department of Paediatrics, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - Sujay Kumar Earan
- Assistant Professor, Department of Paediatrics, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - Arulkumaran Arunagirinadhan
- Professor, Department of Paediatrics, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - Shilpa Kantamneni
- Postgraduate Student, Department of Paediatrics, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
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Boskabadi H, Akhondian J, Afarideh M, Maamouri G, Bagheri S, Parizadeh SM, Mobarhan MG, Mohammadi S, Frens GAA. Long-Term Neurodevelopmental Outcome of Neonates with Hypernatremic Dehydration. Breastfeed Med 2017; 12:163-168. [PMID: 28328233 DOI: 10.1089/bfm.2016.0054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Neonatal hypernatremic dehydration (NHD) is a dangerous condition that can lead to severe weight loss, renal impairment, and central nervous system complications. We aimed to evaluate the consequences of NHD in infants in their second year of life. MATERIALS AND METHODS This was a prospective case-control study in Ghaem hospital, Mashhad, Iran. Sixty-five healthy breastfed neonates (serum sodium concentration <150 mmol/L) and 65 hypernatremic (serum sodium concentration ≥150 mmol/L) neonates were followed up from 2008 to 2011. Maternal and neonatal factors were compared between the two groups together with their growth parameters, and developmental milestones (using Denver II developmental assessment scores) were assessed and compared in ages 6, 12, 18, and 24 months, respectively. RESULTS The weight of infants at 6 months of age was significantly different between the two groups (7,264 ± 1,089 g vs. 7,596 ± 957 g, p = 0.009). Twenty-five percent of infants in the group who had developed NHD had a delay in development at 6 months of age, with corresponding values of 21% at 12 months, 19% at 18 months, and 12% at 24 months of age. Developmental delay was ∼0.3% for the control group at similar ages. The severity of hypernatremia was strongly correlated with poor developmental outcome at 6 months (p = 0.001). Serum sodium concentration of neonates was 153-195 mg/dL in the NHD group. Median peak serum sodium was 158 ± 16 in case group and 141 ± 9 in control group. Serious complications were cerebral edema (five cases), hemorrhage (five cases), and kidney stones (six cases). Hypernatremic dehydration has an adverse effect on child development especially in the first year of life, their prevalence decreases with advanced age. Growth problems are also present during their first year of life. The major signs and symptoms of infants with poor prognosis on admission were poor feeding (8 infants, 61.5%), seizure (3 infants, 23.1%), hyperthermia (1 infant, 7.7%), and lethargy (1 infant, 7.7%). CONCLUSIONS NHD affects growth parameters and developmental milestones of children. Occasionally the child's weight gain was normalized by the end of first year of life; although developmental delay continued, its severity was reduced, with age.
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Affiliation(s)
- Hassan Boskabadi
- 1 Neonatal Research Center, Ghaem Hospital, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Javad Akhondian
- 1 Neonatal Research Center, Ghaem Hospital, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Maliheh Afarideh
- 1 Neonatal Research Center, Ghaem Hospital, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Gholamali Maamouri
- 1 Neonatal Research Center, Ghaem Hospital, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Sepideh Bagheri
- 1 Neonatal Research Center, Ghaem Hospital, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Seyyed Mostafa Parizadeh
- 2 Biochemistry and Nutrition Research Center, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Majid Ghayour Mobarhan
- 2 Biochemistry and Nutrition Research Center, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Shabnam Mohammadi
- 3 Department of Basic Sciences, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran; Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Gordon A A Frens
- 4 Division of Medical Education, Mayfield House, University of Brighton , Brighton, United Kingdom
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Bischoff AR, Dornelles AD, Carvalho CG. Treatment of Hypernatremia in Breastfeeding Neonates: A Systematic Review. Biomed Hub 2017; 2:1-10. [PMID: 31988896 PMCID: PMC6945909 DOI: 10.1159/000454980] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 12/06/2016] [Indexed: 11/23/2022] Open
Abstract
Background/Aims Hypernatremic dehydration in term neonates is associated with inadequate fluid intake, usually related to insufficient lactation. The use of hypotonic fluids is appropriate to dilute serum sodium (SNa), but cerebral edema may develop when it happens abruptly. Our objective was to clarify how to correct hypernatremic dehydration properly. Methods The following databases were searched, limited to studies published until January 31st, 2016: Clinical Trials, MEDLINE/PubMed, EMBASE, LILACS, and the Cochrane Library. We included open-label trials, nonrandomized controlled trials, or prospective and retrospective case series evaluating relevant outcomes. Information regarding the way of administering the treatment, type of fluid used, rates of complications and outcomes, as well as the rate of SNa reduction were collected. Results Searches yielded 771 articles: 64 had the full text reviewed and 9 were included. No randomized clinical trials or systematic reviews focusing on treatment of hypernatremic dehydration and its outcomes were found. We found a scarcity of high quality studies and great methodology heterogeneity. Conclusions More severe hypernatremia is at greater risk of causing severe adverse effects of treatment. There is no consensus about the optimal rate of SNa drop in this population, but a slower correction appears to be safer. Questions as when parenteral fluids are indicated remain unanswered.
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Affiliation(s)
- Adrianne Rahde Bischoff
- Departmental Clinical Fellowship, Division of Neonatology, Department of Pediatrics, University of Toronto and the Hospital for Sick Children, Toronto, ON, Canada
| | | | - Clarissa Gutierrez Carvalho
- Departamento de Pediatria, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Serviço de Pediatria, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Eltonsy S, Blinn A, Sonier B, DeRoche S, Mulaja A, Hynes W, Barrieau A, Belanger M. Intrapartum intravenous fluids for caesarean delivery and newborn weight loss: a retrospective cohort study. BMJ Paediatr Open 2017; 1:e000070. [PMID: 29637114 PMCID: PMC5862158 DOI: 10.1136/bmjpo-2017-000070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To examine weight loss (WL) and excess weight loss (EWL) among newborns of caesarean delivery, comparing colloids plus crystalloids versus crystalloids only. Also, to examine different doses of intrapartum intravenous fluids on WL and EWL. DESIGN Comparative safety retrospective cohort study. SETTING University Teaching Hospital, Moncton, Canada. PATIENTS Mothers exposed to intravenous fluids with caesarean delivery between 2008 and 2016. INTERVENTIONS Exposure to colloids plus crystalloids was compared with crystalloids only, and dose-response analyses were performed for colloids, crystalloids and total intravenous fluids doses. Linear and logistic regression models were used, adjusting for potential confounders. MAIN OUTCOME MEASURES Infants' WL was measured at days 1, 2 and 3 post partum, and EWL defined as loss of >7% of birth weight. RESULTS From 801 mother-infant pairs, 176 were exposed to colloids plus crystalloids and 625 were exposed to crystalloids only (overall mean birth weight=3416 g, EWL=2%, 41.4% and 55.5% on days 1, 2 and 3, respectively). No significant difference in newborns' WL was observed on any of the days assessed. Adjusted OR (95% CI) of EWL was 1.0 (0.3 to 3.3) at 24 hours, 1.0 (0.7 to 1.5) at 48 hours and 1.4 (0.9 to 2.2) at 72 hours. No dose-response relationship was detected with type-specific and total intravenous fluids exposures. CONCLUSIONS The risk of EWL was similar with colloids plus crystalloids and crystalloids only, suggesting that both therapeutic options can be considered during caesarean delivery. The absence of dose-response relationships adds confirmatory evidence to the intravenous fluids safety profiles.
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Affiliation(s)
- Sherif Eltonsy
- Centre de formation médicale du Nouveau-Brunswick, Moncton, Canada.,The Maritime SPOR SUPPORT Unit (MSSU), Moncton, Canada
| | - Alain Blinn
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Canada.,Dieppe Family Medicine Unit, Dieppe, Canada
| | | | - Steven DeRoche
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Canada.,Dieppe Family Medicine Unit, Dieppe, Canada
| | - Aubin Mulaja
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Canada.,Dieppe Family Medicine Unit, Dieppe, Canada
| | - William Hynes
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Canada.,Dieppe Family Medicine Unit, Dieppe, Canada
| | - André Barrieau
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Canada.,Dieppe Family Medicine Unit, Dieppe, Canada
| | - Mathieu Belanger
- Centre de formation médicale du Nouveau-Brunswick, Moncton, Canada.,Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Canada.,Dieppe Family Medicine Unit, Dieppe, Canada.,Research Centre, Vitalité Health Network, Moncton, Canada
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Morin C, Chevalier I. Severe Hypernatremic Dehydration and Lower Limb Gangrene in an Infant Exposed to Lamotrigine, Aripiprazole, and Sertraline in Breast Milk. Breastfeed Med 2017; 12:377-380. [PMID: 28481632 DOI: 10.1089/bfm.2017.0031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hypernatremic dehydration is well described in exclusively breastfed neonates, although life-threatening complications are rarely reported. MATERIALS AND METHODS The present article describes a case of severe hypernatremic dehydration in a previously healthy term neonate. Other published cases of severe complications of hypernatremic dehydration are discussed. RESULTS The exclusively breastfed neonate described had severe hypernatremic dehydration because of inadequate milk intake, with disseminated intravascular coagulation and right lower limb gangrene that required amputation of all five toes and surgical debridement of the metatarsals. The usual etiology of hypernatremic dehydration in this age group is insufficient breast milk intake. Here, the infant's mother was treated for bipolar disorder with lamotrigine 250 mg orally once daily, aripiprazole 15 mg orally once daily, and sertraline 100 mg orally once daily. CONCLUSIONS Awareness of these complications should prompt close follow-up of the infant with poor weight gain. The role of maternal medication as a risk factor for hypernatremic dehydration among exclusively breastfed infants needs to be further explored.
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Affiliation(s)
- Caroline Morin
- 1 Department of Pharmacy, CHU Sainte-Justine, Montreal, Canada
| | - Isabelle Chevalier
- 2 Department of Pediatrics, CHU Sainte-Justine, University of Montreal , Montreal, Canada
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Ünver Korğalı E, Cihan MK, Oğuzalp T, Şahinbaş A, Ekici M. Hypernatremic Dehydration in Breastfed Term Infants: Retrospective Evaluation of 159 Cases. Breastfeed Med 2017; 12:5-11. [PMID: 27991839 DOI: 10.1089/bfm.2016.0077] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The aim of this study was to reveal the frequency, presenting complaints, risk factors, complications, and ways for prevention of hypernatremic dehydration (HD) among term breastfed infants. METHODS The files of 159 breastfed term infants hospitalized because of HD between the years 2009 and 2014 were examined retrospectively in the Neonatal Intensive Care Unit of Sivas State Hospital, Turkey. The patients were classified according to serum sodium (Na) levels, group 1 (Na: 146-149 mEq/L, n = 68) and group 2 (Na ≥150 mEq/L, n = 91). RESULTS The most common complaint was fever (67.9%), and the most common physical finding was oral mucosal dryness (76%). There were positive correlations between serum Na levels and weight loss, hospital stay, admission age, admission to neonatal unit after discharge, serum urea levels, and body temperature (p < 0.05). The normalization period of Na levels was significantly longer (21.7 ± 8.8 versus 29.3 ± 17.8 hours, p = 0.03), and Na reduction rate was faster in group 2 (0.41 ± 0.3 versus 0.50 ± 0.3 mEq/L/hour, p = 0.02). Bradycardia was seen more commonly in group 2 (1.5% versus 16.5%, p = 0.002). CONCLUSIONS HD is a significant condition that should be treated appropriately to avoid serious complications.
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Affiliation(s)
- Elif Ünver Korğalı
- 1 Department of Pediatrics, Cumhuriyet University Faculty of Medicine , Sivas, Turkey
| | - Meriç Kaymak Cihan
- 2 Division of Pediatric Hematology-Oncology, Department of Pediatrics, Cumhuriyet University Faculty of Medicine , Sivas, Turkey
| | - Tahir Oğuzalp
- 3 Neonatal Intensive Care Unit, Sivas State Hospital , Sivas, Turkey
| | - Ali Şahinbaş
- 3 Neonatal Intensive Care Unit, Sivas State Hospital , Sivas, Turkey
| | - Mahmut Ekici
- 1 Department of Pediatrics, Cumhuriyet University Faculty of Medicine , Sivas, Turkey
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Lavagno C, Camozzi P, Renzi S, Lava SAG, Simonetti GD, Bianchetti MG, Milani GP. Breastfeeding-Associated Hypernatremia: A Systematic Review of the Literature. J Hum Lact 2016; 32:67-74. [PMID: 26530059 DOI: 10.1177/0890334415613079] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 09/21/2015] [Indexed: 11/17/2022]
Abstract
There are increasing reports on hypernatremia, a potentially devastating condition, in exclusively breastfed newborn infants. Our purposes were to describe the clinical features of the condition and identify the risk factors for it. We performed a review of the existing literature in the National Library of Medicine database and in the search engine Google Scholar. A total of 115 reports were included in the final analysis. Breastfeeding-associated neonatal hypernatremia was recognized in infants who were ≤ 21 days of age and had ≥ 10% weight loss of birth weight. Cesarean delivery, primiparity, breast anomalies or breastfeeding problems, excessive prepregnancy maternal weight, delayed first breastfeeding, lack of previous breastfeeding experience, and low maternal education level were significantly associated with breastfeeding-associated hypernatremia. In addition to excessive weight loss (≥ 10%), the following clinical findings were observed: poor feeding, poor hydration state, jaundice, excessive body temperature, irritability or lethargy, decreased urine output, and epileptic seizures. In conclusion, the present survey of the literature identifies the following risk factors for breastfeeding-associated neonatal hypernatremia: cesarean delivery, primiparity, breastfeeding problems, excessive maternal body weight, delayed breastfeeding, lack of previous breastfeeding experience, and low maternal education level.
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Affiliation(s)
- Camilla Lavagno
- Pediatric Department of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Pietro Camozzi
- Pediatric Department of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Samuele Renzi
- Pediatric Department of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Sebastiano A G Lava
- Pediatric Department of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland University Children's Hospital Berne and University of Berne, Switzerland
| | - Giacomo D Simonetti
- Pediatric Department of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland University Children's Hospital Berne and University of Berne, Switzerland
| | - Mario G Bianchetti
- Pediatric Department of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Gregorio P Milani
- Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Pediatric Emergency Department, Milan, Italy
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Bertini G, Breschi R, Dani C. Physiological weight loss chart helps to identify high-risk infants who need breastfeeding support. Acta Paediatr 2015; 104:1024-7. [PMID: 25283590 DOI: 10.1111/apa.12820] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/23/2014] [Accepted: 09/30/2014] [Indexed: 11/28/2022]
Abstract
AIM Healthy, full-term, exclusively breastfed infants are expected to lose weight in the first days after birth, but experts disagree about what constitutes a physiological neonatal weight loss and there is a lack of evidence-based data. Our study aimed to construct a centile chart of neonatal weight loss in a healthy population of exclusively breastfed term neonates. METHODS We retrospectively studied all infants born at an Italian centre that focused on natural childbirth from April 2007 to December 2012 and who complied with World Health Organization guidance on infant feeding. The infants' weight loss was recorded after 12, 24, 36, 48, 60 and 72 h of life. RESULTS We included 1760 healthy, full-term, singleton babies born by vaginal delivery. Their mean weight loss was 5.95 ± 1.73%, 72.2% had maximal weight loss before discharge, only 3.9% lost more than 9% of their birthweight, and no infant lost more than 10%. We measured the percentage weight change from birth and each time the infant was examined, summarising how their weight varied in the first 72 h of life. CONCLUSION Our normative chart of physiological weight loss provided an important instrument for identifying high-risk infants who required breastfeeding support.
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Affiliation(s)
- Giovanna Bertini
- Division of Neonatology FARBA Department Careggi University Hospital Florence Italy
| | - Rita Breschi
- Division of Neonatology FARBA Department Careggi University Hospital Florence Italy
| | - Carlo Dani
- Division of Neonatology FARBA Department Careggi University Hospital Florence Italy
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Affiliation(s)
- Ranga Panagoda
- Department of Neonatal Registrar, Centenary Hospital for Women and Children, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Natalie De Cure
- Department of Obstetric Registrar, Obstetrics and Gynaecology, Centenary Hospital for Women and Children, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Ruth McCuaig
- Department of Obstetric Registrar, Obstetrics and Gynaecology, Centenary Hospital for Women and Children, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Alison L Kent
- Department of Senior Staff Specialist, Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Canberra, Australian Capital Territory, Australia.,Department of Neonatology, Australian National University Medical School, Canberra, Australian Capital Territory, Australia
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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. [PMID: 24698284 DOI: 10.1111/birt.12105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Most breast-fed newborns get the milk they need. However, very rarely milk intake is insufficient mostly as a result of poor breastfeeding techniques. Dramatic weight loss and hypernatremic dehydration may occur. Our aim was to construct charts for weight loss. METHODS A case-control study was performed. Charts with standard deviation score (SDS) lines for weight loss in the first month were constructed for 2,359 healthy breast-fed term newborns and 271 cases with breastfeeding-associated hypernatremic dehydration with serum sodium level > 149 mEq/L. Day 0 was defined as the day of birth. RESULTS Many cases with (or who will develop) hypernatremic dehydration (84%; +1 SDS line) fell below the -1 SDS line at day 3, the -2 SDS line at day 4, and the -2.5 SDS line at day 5 in the chart of the healthy breast-fed newborns. Weight loss of cases with permanent residual symptoms was far below the -2.5 SDS. CONCLUSIONS Already at an early age, weight loss differs between healthy breast-fed newborns and those with hypernatremic dehydration. Charts for weight loss are, therefore, useful tools to detect early, or prevent newborns from developing, breastfeeding-associated hypernatremic dehydration, and also to prevent unnecessary formula supplementing.
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Mulder PJ, Gardner SE. The healthy newborn hydration model: a new model for understanding newborn hydration immediately after birth. Biol Res Nurs 2014; 17:94-9. [PMID: 25504955 DOI: 10.1177/1099800414529362] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The normal small volume of breast milk produced in the first 2 days following birth may raise concerns about adequate hydration in breast-fed newborns. These concerns are further magnified when breast-fed infants lose ≥7% of their birth weight within 2 days postnatally. Weight loss following birth is presumably mostly water loss that could result in hypohydration and subsequent hypernatremic dehydration. However, excess fluid loss immediately following birth is a normal and necessary process. Furthermore, newborns exposed to excess fluid intake during labor may need to lose ≥7% of birth weight in the first 2 days following birth in order to achieve euhydration. Normal newborn fluid loss following birth confounds the use of weight loss as the sole measure of newborn hydration. We thus propose the healthy newborn hydration model that highlights the normalcy of newborn weight loss immediately following birth and the healthy newborn's compensatory mechanisms for preserving adequate hydration. We also recommend the use of serum sodium to measure intravascular osmolarity in addition to monitoring weight loss to obtain a more comprehensive newborn hydration assessment. Research is necessary in healthy newborns to identify relationships among fluids received in utero, newborn weight loss, and hydration, as evaluated with laboratory measures, in the first 2 days following birth. This information will guide clinicians in correctly identifying newborns with inadequate hydration who are in need of supplementary fluids versus newborns with adequate hydration for whom exclusive breast-feeding can be supported and encouraged.
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Affiliation(s)
| | - Sue E Gardner
- College of Nursing, University of Iowa, Iowa City, IA, USA
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King TL. The mismatch between postpartum services and women's needs: Supermom versus lying-in. J Midwifery Womens Health 2013; 58:607-8. [PMID: 24224531 DOI: 10.1111/jmwh.12138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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:F384-7. [PMID: 23512226 DOI: 10.1136/archdischild-2012-302908] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To describe incidence, presentation, treatment and short term outcomes of severe neonatal hypernatraemia (SNH, sodium ≥160 mmol/l). METHODS Prospective, population based surveillance study over 13 months using the British Paediatric Surveillance Unit. Cases were >33 weeks gestation at birth, fed breast or formula milk and <28 days of age at presentation. RESULTS Of 62 cases of SNH reported (7, 95% CI 5.4 to 9.0 per 1 00 000 live births), 61 mothers had intended to achieve exclusive breast feeding. Infants presented at median day 6 (range 2-17) with median weight loss of 19.5% (range 8.9-30.9). 12 had jaundice and 57 weight loss as a presenting feature. 58 presented with weight loss ≥15%. 25 babies had not stooled in the 24 h prior to admission. Serum sodium fell by median 12.9 mmol/l per 24 h (range 0-30). No baby died, had seizures or coma or was treated with dialysis or a central line. At discharge, babies had regained 11% of initial birth weight after a median admission of 5 (range 2-14) days. 10 were exclusively breast fed on discharge from hospital. CONCLUSIONS Neonatal hypernatraemia at this level, in this population, is strongly associated with weight loss. It occurs almost exclusively after attempts to initiate breast feeding, occurs uncommonly and does not appear to be associated with serious short term morbidities, beyond admission to hospital.
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Affiliation(s)
- Sam Joseph Oddie
- Bradford Neonatology, Bradford Royal Infirmary, West Yorkshire, UK.
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Erdemir A, Kahramaner Z, Cosar H, Turkoglu E, Kanik A, Sutcuoglu S, Ozer EA. Comparison of oral and intravenous fluid therapy in newborns with hypernatremic dehydration. J Matern Fetal Neonatal Med 2013; 27:491-4. [DOI: 10.3109/14767058.2013.819334] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Davanzo R, Cannioto Z, Ronfani L, Monasta L, Demarini S. Breastfeeding and neonatal weight loss in healthy term infants. J Hum Lact 2013; 29:45-53. [PMID: 22554678 DOI: 10.1177/0890334412444005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neonatal weight loss is universally recognized, yet poorly understood. Limited professional consensus exists on the definition of lower limit of safe weight loss. OBJECTIVE Our aim was to assess the extent of neonatal weight loss and its association with selected clinical variables in a population of healthy term infants cared for using a specific protocol on weight loss. METHODS We retrospectively considered 1003 infants consecutively admitted to the regular nursery of the Institute for Maternal and Child Health "Burlo Garofolo" (Trieste, Italy). We studied the relationship of selected variables with neonatal weight loss recorded during the hospital stay. We also analyzed all readmissions in the first month of life as a result of weight loss and its complications. RESULTS We observed a mean absolute weight loss of 228 g ± 83g, and a mean percent weight loss of 6.7% ± 2.2%. Weight loss ≥ 10% and > 12% were 6% and 0.3%, respectively. In multivariate logistic regression, cesarean section, hot season, any formula feeding, and jaundice not requiring phototherapy were independently associated with neonatal weight loss ≥ 8%. Conversely, low gestational age status was associated with lower weight loss. Readmission within the first month of life because of dehydration occurred in 0.3% of infants. CONCLUSIONS Breastfeeding, compared to formula feeding, may not be a risk factor for greater early neonatal weight loss, at least in contexts in which weight is routinely monitored, breastfeeding is repeatedly assessed and appropriately supported, and careful supplementation is prescribed to limit and promptly treat excess weight loss and its related complications.
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Affiliation(s)
- Riccardo Davanzo
- Division of Neonatology and NICU, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
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Ismail EA, Seoudi TM, Al-Amir M, Al-Esnawy AA. Neonatal suppurative parotitis over the last 4 decades: report of three new cases and review. Pediatr Int 2013; 55:60-4. [PMID: 23039834 DOI: 10.1111/j.1442-200x.2012.03738.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 09/04/2012] [Accepted: 09/05/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neonatal suppurative parotitis is a rare disease. Only 32 cases were reported in the English-language literature between 1970 and 2004. METHODS We searched Medline for acute, neonatal, bacterial, suppurative, parotitis, facial, preauricular swelling starting from 1970, limiting our search to the English-language literature. We reviewed all the reported cases together with three more managed in our department. RESULTS We identified nine new cases since 2004. The total number of patients reviewed was 44, including our patients. Most of them were male (77%). The majority developed unilateral inflamed parotid swelling (77%) and exuded pus from the ipsilateral Stensen duct. Fever was seen in fewer than half of them (47%). Premature babies constituted a third of the patients. Staphylococcus aureus was the leading causative agent (61%). Most patients responded well to conservative treatment with antibiotics (77%). The most frequently used combination of antibiotics was an anti-staphylococcal agent with either an aminoglycoside or a third-generation cephalosporin. A minority required surgical drainage. No deaths were reported in the group studied after 1970. CONCLUSION Neonatal suppurative parotitis is rare but easy to diagnose and if readily treated with appropriate antibiotics the outcome is excellent.
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Yildiz N, Erguven M, Yildiz M, Ozdogan T, Turhan P. Acute peritoneal dialysis in neonates with acute kidney injury and hypernatremic dehydration. Perit Dial Int 2012; 33:290-6. [PMID: 23123669 DOI: 10.3747/pdi.2011.00211] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the efficacy of acute peritoneal dialysis (PD) and clinical outcomes in neonates with acute kidney injury (AKI) and hypernatremic dehydration. ♢ METHODS The medical records of 15 neonates with AKI and hypernatremic dehydration who were treated with acute PD were reviewed. The diagnoses were AKI with hypernatremic dehydration with or without sepsis in 13 patients and AKI with hypernatremia and congenital nephropathy in 2 patients. The main indications for PD were AKI with some combination of oligoanuria, azotemia, hyperuricemia, and metabolic acidosis unresponsive to initial intensive medical treatment. ♢ RESULTS The mean age of the patients at dialysis initiation was 11.9 ± 9 days, and the mean duration of PD was 6.36 ± 4.8 days. In 7 patients (46.7%), hypotension required the use of vasopressors, and in 6 patients (40%), mechanical ventilation was required. Peritoneal dialysis-related complications occurred in 7 patients (46.7%), the most common being catheter malfunction (n = 6). Four episodes of peritonitis occurred in the 15 patients (26.7%), 2 episodes in patients with congenital renal disease and 2 episodes in patients with sepsis and multiorgan failure, who did not survive. Congenital renal disease, septicemia, and the need for mechanical ventilation were important factors influencing patient survival. All patients with no pre-existing renal disease or sepsis recovered their renal function and survived. ♢ CONCLUSIONS In neonates with AKI and hypernatremic dehydration, PD is safe and successful, and in patients without congenital renal disease or sepsis, the prognosis is good. Peritoneal dialysis should be the treatment of choice in neonates with AKI and hypernatremic dehydration who do not respond to appropriate medical treatment.
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Affiliation(s)
- Nurdan Yildiz
- Department of Pediatric Nephrology, Göztepe Teaching and Research Hospital, Istanbul, Turkey.
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Bilgin LK, Akcay F, Altinkaynak K, Altindag H. Hypernatremia in breastfed newborns: a review of 149 cases. J Trop Pediatr 2012; 58:332-4. [PMID: 21998132 DOI: 10.1093/tropej/fmr087] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Hjälmhult E, Lomborg K. Managing the first period at home with a newborn: a grounded theory study of mothers' experiences. Scand J Caring Sci 2012; 26:654-62. [PMID: 22309140 DOI: 10.1111/j.1471-6712.2012.00974.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The article aims to present a theoretical account of mothers' first period at home with their newborn in Norway. BACKGROUND Mothers' well-being affects their babies and is therefore an important priority for public health. Early discharge after childbirth is common in many countries. In Norway, this has been practised for 5-10 years but without any distinct agreement between maternity hospitals and the community health services and without documented follow-up care. Knowledge is lacking in how mothers deal with the first period at home with the baby. METHOD Seven focus group discussions were conducted with 26 mothers who had babies 1.5-3 months old. The grounded theory method was used to gather and analyse data. RESULTS The mothers were strongly concerned about preserving their control and integrity in the new situation. This main concern was resolved by the strategy of prioritizing newborn care. The strategy encompassed a process of developing competence as a mother, changing focus in relationships, stretching to the critical level and seeking recognition. These parallel processes were inter-related, sometimes mutually supportive and sometimes conflicting. When conflicts occurred, prioritizing newborn care guided mothers in finding solutions. Breaches of the implied conditions in health care tended to increase mothers' level of strain and uncertainty and to influence their efficacy in breastfeeding the baby. CONCLUSION Being a mother to a newborn is a dynamic and extensive process. Succeeding in breastfeeding seems especially sensitive and essential in motherhood. The idea that giving birth is a simple and normal situation may obscure the importance of seamless health care and the need for professional support and information.
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Affiliation(s)
- Esther Hjälmhult
- Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway.
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Chantry CJ, Nommsen-Rivers LA, Peerson JM, Cohen RJ, Dewey KG. Excess weight loss in first-born breastfed newborns relates to maternal intrapartum fluid balance. Pediatrics 2011; 127:e171-9. [PMID: 21173007 DOI: 10.1542/peds.2009-2663] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The objectives were to describe weight loss in a multiethnic population of first-born, predominantly breastfed, term infants and to identify potentially modifiable risk factors for excess weight loss (EWL). METHODS Data on prenatal breastfeeding intentions, demographic characteristics, labor and delivery interventions and outcomes, breastfeeding behaviors, formula and pacifier use, onset of lactogenesis, and nipple type and pain were collected prospectively. Logistic regression analyses identified independent predictors of EWL (≥10% of birth weight) by using a preplanned theoretical model. RESULTS EWL occurred for 18% of infants who received no or minimal (≤60 mL total since birth) formula (n = 229), including 19% of exclusively breastfed infants (n = 134) and 16% of infants who received minimal formula (n = 95). In bivariate analyses, EWL was associated (P < .05) with higher maternal age, education, and income levels, hourly intrapartum fluid balance, postpartum edema, delayed lactogenesis (>72 hours), fewer infant stools, and infant birth weight. In multivariate logistic regression analysis, only 2 variables predicted EWL significantly, namely, intrapartum fluid balance (adjusted relative risk for EWL of 3.18 [95% confidence interval [CI]: 1.35-13.29] and 2.80 [95% CI: 1.17-11.68] with net intrapartum fluid balance of >200 and 100-200 mL/hour, respectively, compared with <100 mL/hour) and delayed lactogenesis (adjusted relative risk: 3.35 [95% CI: 1.74-8.10]). CONCLUSIONS EWL was more common in this population than reported previously and was independently related to intrapartum fluid balance. This suggests that intrapartum fluid administration can cause fetal volume expansion and greater fluid loss after birth, although other mechanisms are possible.
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Affiliation(s)
- Caroline J Chantry
- University of California, Davis, Medical Center, Department of Pediatrics, 2516 Stockton Blvd, Sacramento, CA 95817, USA.
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Tjora E, Karlsen LC, Moster D, Markestad T. Early severe weight loss in newborns after discharge from regular nurseries. Acta Paediatr 2010; 99:654-657. [PMID: 20085550 DOI: 10.1111/j.1651-2227.2010.01692.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To study incidence and risk factors of early neonatal dehydration in a Norwegian population based cohort. METHODS Term neonates admitted to a paediatric department during 2002-2008 with a weight loss > or = 12% within three weeks of age were identified retrospectively through review of medical records. For each patient a sex-matched control group of two full-term infants was selected to assess risk factors for dehydration. RESULTS A total of 38 of 37 321 infants (1.0 per thousand) were admitted at a median age of 6 (interquartile range 5-12) days, and the admission rate increased during the study period (p for trend = 0.008). Simultaneously, mean nursery stay decreased from 3.5 to 2.7 days (p = 0.022). Mean weight loss was 15.0% of birth weight and 17 of 29 (58.6%) had serum sodium above 145 mmol/L. The only significant difference between patients and controls was that mothers of patients were older (32.3 +/- 5.0 vs. 29.4 +/- 5.4 years, p = 0.005). CONCLUSION Short nursery stay may be a risk factor for dehydration in newborn infants.
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Affiliation(s)
- E Tjora
- Department of Paediatrics, Haukeland University Hospital, Bergen, NorwaySection for Paediatrics, Department of Clinical Medicine, University of Bergen, Bergen, NorwayDepartment of Gynaecology, Haukeland University Hospital, Bergen, NorwayDepartment of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - L C Karlsen
- Department of Paediatrics, Haukeland University Hospital, Bergen, NorwaySection for Paediatrics, Department of Clinical Medicine, University of Bergen, Bergen, NorwayDepartment of Gynaecology, Haukeland University Hospital, Bergen, NorwayDepartment of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - D Moster
- Department of Paediatrics, Haukeland University Hospital, Bergen, NorwaySection for Paediatrics, Department of Clinical Medicine, University of Bergen, Bergen, NorwayDepartment of Gynaecology, Haukeland University Hospital, Bergen, NorwayDepartment of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - T Markestad
- Department of Paediatrics, Haukeland University Hospital, Bergen, NorwaySection for Paediatrics, Department of Clinical Medicine, University of Bergen, Bergen, NorwayDepartment of Gynaecology, Haukeland University Hospital, Bergen, NorwayDepartment of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
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Extreme hypernatraemia, breast-feeding and red skin. Pediatr Nephrol 2010; 25:379-80. [PMID: 19809835 DOI: 10.1007/s00467-009-1314-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 08/10/2009] [Accepted: 08/10/2009] [Indexed: 10/20/2022]
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Mulder PJ, Johnson TS, Baker LC. Excessive Weight Loss in Breastfed Infants During the Postpartum Hospitalization. J Obstet Gynecol Neonatal Nurs 2010; 39:15-26. [DOI: 10.1111/j.1552-6909.2009.01085.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Hypernatremia and Hyponatremia: Current Understanding and Management. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2009. [DOI: 10.1016/j.cpem.2009.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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