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

Year 2022, , 55 - 60, 28.02.2022

Esma Keleş Alp

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

Cited By: 1

Abstract

Aim: The aim of our study is to evaluate the demographic characteristics and epidemiological risk factors of neonatal hypernatremic dehydration and to discuss the precautions applied in our clinic in order to reduce the number of dehydration cases in the light of the literature.
Patients and Methods: Newborns who were hospitalized in our neonatal intensive care unit with the diagnosis of HD, whose serum sodium level was >147 mmol/L and born at >37 weeks were evaluated retrospectively. Babies with illnesses that would adversely affect nutritional status were excluded from the study.
Results: Mean gestational week of 54 cases included in the study was 39.19±1.07.22. The mean birth weight was 3244.06±458.46 gr. while the mean weight of hospitalization was 2880.28±514.54 gr. The percent of weight loss was found to be 8.51±3.14%. The mean age of hospitalization was 3.7±2.05 days and the mean duration of hospitalization day was 2.26±1.42 days. On admission, 11 (20.4%) patients had fever, 6 (11.1%) patients had jaundice, 3 (5.6%) patients had discomfort, 30 (55.5%) patients had more than one complaint and dehydration was detected in 4 (7.4%) patients during control admission of pediatric outpatient clinic. On physical examination, 46 (85.2%) patients had mild dehydration, 7 (13%) had moderate dehydration, and 1 (1.9%) patient had severe dehydration. The mean serum sodium value of the patients was 150.44±3.62 mmol/L, mean serum urea value was 45.5±18.13 mg/dl, and mean serum creatinine value was 0.79±0.34 mg/dl at the time of admission. The etiologies of dehydration were breast milk insufficiency in 37 (68.5%) cases, inability to breastfeed effectively due to nipple problems in 2 (3.7%) cases, and errors in breastfeeding technique in 15 (27.7%) cases. A positive correlation was found between the degree of dehydration and percent of weight loss and the serum sodium value (p<0.001).
Discussion: In our study, it was found that the most common cause of hypernatremic dehydration was breast milk insufficiency. Considering other reasons, giving breastfeeding education to mothers before discharge from the hospital seems to be important in preventing hypernatremic dehydration.

Keywords

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

Hipernatremik dehidratasyon tanısı ile takip edilen yenidoğan olgularımızın retrospektif değerlendirilmesi

Abstract

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

Keywords

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

References

• 1. American Academy of Pediatrics, Breastfeeding and the use of human milk. Work Group on Breastfeeding. Pediatrics 1997;100:1035-9.
• 2. Cağlar MK, Altugan FS, Ozer I. Exclusively Breastfeeding and hypernatremic dehydration. Iranian J Publ Health 2005;34.1-11.
• 3. Scariati PD, Grummer-Strawn LM, Fein SB. A longitudinal analysis of infant morbidity and the extent of breastfeeding in the United States. Pediatrics 1997;99:E5.
• 4. Reynolds A. Breastfeeding and brain development. Pediatr Clin North Am 2001;48:159- 71.
• 5. Laing I, Wong C. Hypernatraemia in the first few days: is the incidence rising? Arch Dis Child Fetal Neonatal Ed 2002;87:158-62.
• 6. Neiffert MR . Prevention of breastfeeding tragedies. Pediatr Clin North Am 2001;48:273- 97.
• 7. Smith RG. Severe hypernatremic dehydration in a newborn infant. Pediatr Child Health 1998;3:413-5.
• 8. Kapkan JA, Siegler RW, Schmunk GA. Fatal hypernatremic dehydration in exclusively breastfed newborn infants due to maternal lactation failure. Am J Forensic Med Pathol 1998;19:19-22
• 9. Moritz ML, Manole MD, Bogen DL, et al. Breastfeeding-associated hypernatremia: are we missing the diagnosis? Pediatrics 2005;116:e343-e347.
• 10. Unal S, Arhan E, Kara N, et al. Breast-feedingassociated hypernatremia: Retrospective analysis of 169 term newborns. Pediatr İnt 2008;50:29-34
• 11. Oddie S, Richmond S, Coulthard M. Hypernatremic dehydration and breast feeding. Arch Dis Childhood 2001;85(4):318-20. 12. Neville M, Morton J. Physiology and endocrine changes underlying human lactogenesis II. J Nutrition 2001;131:3005-8.
• 13. Berk E, İçağasıoğlu D, Büyükkayhan D, ve ark. Anne sütü ile yetersiz beslenen yenidoğanlarda hipernatremik dehidratasyon. Erciyes Tıp Dergisi 2010;32:5-8.
• 14. Özdemir ÖMA, Alkılıç L, Yıldırım N, ve ark. Hipernatremik dehidratasyon tanısı ile takip edilen yenidoğan olgularımızın değerlendirilmesi. Türkiye Klinikleri J Pediatr 2010;19:298-302.
• 15. Mutlu M, Bahat E, Aslan Y. Yenidoğanlarda hipernatremi. Türkiye Klinikleri J Pediatr 2008;17:130-4.
• 16. Macdonald PD. Postnatal weight monitoring should be routine. Arch Dis Child 2007;92:374-5.
• 17. Modi N. Avoiding hypernatraemic dehydration in healthy term infants. Arch Dis Child 2007;92;474-5.
• 18. Vatansever Ü, Duran R, Acunaş B. Tek başına anne sütü ile beslenen bebeklerde hipernatremik dehidratasyon. Trakya Univ Tıp Fak Derg 2007;24:190-3.
• 19. Molteni KH. Initial management of hypernatremic dehydration in the breast fed infant. Clin Pediatr 1994;33(12):731-40.
• 20. Anand SK, Robinson RG, Lieberman E. Neonatal hypernatremia associated with elevated sodium concentration of breast milk. J Pediatr 1980;96:66-8.
• 21. Bülbül A, Can E, Uslu S, ve ark. Miadında doğan bebeklerde hipernatremik dehidratasyon. Türk Ped Arş 2009;44:84-8.
• 22. Lain SJ, Roberts CL, Bowen JR, et al. Early discharge of infants and risk of readmission for jaundice. Pediatrics. 2015;135(2):314-21.
• 23. Hall RT, Simon S, Smith MT. Readmission of breast-fed infants in the first 2 weeks of life. J Perinatol 2000;20(7):432-7.
• 24. Burritt MF, Slockbower JM, Forsman RW, et al. Pediatric reference intervals for 19 biologic variables in healthy children. Mayo Clin Proc 1990;65(3):329-36.
• 25. Lo SF. Laboratory Testing in Infants and Children. In: Behrman RE, Kliegman RM, Jenson HB. Nelson Textbook of Pediatrics, eds. New York: Elsevier, 2016:3460-3464.
• 26. Lavagno C, Camozzi P, Renzi S, et al., Breastfeeding-Associated Hypernatremia A Systematic Review of the Literature. J Hum Lac 2016;32(1):67-74
• 27. Livingstone VH, Willis CE, Abdel-Wareth LO, et al. Neonatal hypernatremic dehydration associated with breast-feeding malnutrition: a retrospective survey. CMAJ 2000;162(5): 647-52.
• 28. Musapaşaoğlu H, Agildere AM, Teksam M, et al. Hypernatraemic dehydration in a neonate: brain MRI findings. Br J Radiol 2008;81:57-60
• 29. Yıldızdaş HY, Satar M, Tutak E, et al. May the best friend be an enemy of not recognized early:hypernatremic dehydration due to breastfeeding. Pediatr Emerg Care 2005;21:445-8.
• 30. Ergenekon E, Unal S, Gücüyener K, et al., Hypernatremic dehydration in the newborn period and long-term follow up. Pediatr Int 2007;49(1):19-23.
• 31. Atasay B, Günlemez A, Ünal S, et al. Hypernatremic dehydration in a breast fed neonate. Ankara Üniversitesi Tıp Fakültesi Mecmuası 2003;56(1):39-44.
• 32. The Kidney Disease Improving Global Outcomes (KDIGO) Working Group. Definition and classification of acute kidney injury. Kidney Int Suppl 2012;2:19-36.
• 33. Gartner LM, Morton J, Lawrence RA, et al. American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2005;115:496-506.
• 34. Akgün A, Katar S, Taşkesen M, ve ark. Yenidoğan döneminde önemli bir sorun: hipernatremik dehidratasyon. Göztepe Tıp Dergisi 2010;25:126-31.
• 35. Güzoğlu N, Kızılelma A, Sarı FN, ve ark. Hipernatremik Dehidratasyon Tanılı Yenidoğan Olgularımızın Değerlendirilmesi.Türkiye Çocuk Hast Derg 2013;3:124-7.
• 36. Çakır EP, Aliefendioğlu D, Tufan E, ve ark. Hipernatremik Dehidratasyon: Yenidoğanlarda Nadir Olmayan Bir Sorun. Türkiye Çocuk Hast Derg 2010;4(2):89-93.
• 37. Tayman C, Tonbul A, Aydemir S, ve ark. Anne Sütüne Bağlı Hipernatremik Dehidratasyonun Klinik Bulguları ve Tedavi Önerileri. Dicle Tıp Dergisi 2010;37(3):254-62.
• 38. Uras N, Karadağ A, Doğan G, et al. Moderate hypernatremic dehydration in newborn infants: retrospective evaluation of 64 cases. J Matern Fetal Neonatal Med 2007;20(6):449-52.
• 39. Manganaro R, Mami C, Marrone T, et al. Incidence of dehydration and hypernatremia in exclusively breast-fed infants. J Pediatr 2001;139:673-5.
• 40. Gül A, Takçı Ş, Albayrak SE, ve ark. Geç Prematüre ve Zamanında Doğmuş Bebeklerde Hipernatremik Dehidratasyon: Retrospektif Değerlendirme. Jinekoloji-Obstetrik ve Neonataloji Tıp Dergisi 2017;4(2):52-5.
• 41. Basiratnia MN, Pishva N, Dehghani A. Prevalence of Breastfeeding–associated Hypernatremia among Hospitalized Hyperbilirubinemic Neonates. Iran J Neon 2014;5:12-6.
• 42. Vestermark V, Hogdall CK, Birch M, et al. Influence of the mode of delivery on initiation of breast-feeding. Eur J Obstet Gynecol Reprod Biol 1991;38:33-8.
• 43. Harding D, Moxham J, Cairns P. Weighing alone will not prevent hypernatremic dehydration. Arch Dis Child Fetal Neonatal Ed 2003;88:349.
• 44. Kul M, Gürsel O, Kesik V, et al. Analysis of neonatal cases with hypernatremic dehydration. Gülhane Tıp Derg 2006;48(3):162-5.
• 45. Chilton LA. Prevention and management of hypernatremic dehydration in breast-fed infants. West J Med 1995;163:74-6.
• 46. Clarke TA, Markarian M, Griswold W, et al. Hypernatremic dehydration resulting from inadequate breast-feeding. Pediatrics 1979;63:931-2.
• 47. Roddey OF, Martin ES, Swetenburg RL. Critical weight loss and malnutrition in breastfed infants. Am J Dis Child 1981;135:597-9.
• 48. Rhuston AR, Lambert GP, Katcher AL, et al. Dehydration in breast-fed infants. JAMA 1982;248:646.
• 49. Ergin H, Şahin Ö,Özmert D, ve ark. Anne Sütüyle Beslenen Yenidoğanlarda Hipernatremik Dehidratasyon.Güncel Pediatri 2013;11(2):51-6.
• 50. Kesik V, Duranoğlu L, Sarıcı ÜS, ve ark. Hipernatremik dehidratasyon tanısı ile takip edilen yenidoğan olgularımızın değerlendirilmesi. Gülhane Tıp Dergisi 2006;48:162-5.
• 51. Cooper WO, Atherton HD, Kahana M, et al. Increased incidence of severe breastfeeding malnutrition and hypernatremia in a metropolian area. Pediatrics 1995;96:957-60.
• 52. Bolat F, Oflaz BM, Güven AS, et al. What Is the Safe Approach for Neonatal Hypernatremic Dehydration? A Retrospective Study From a Neonatal Intensive Care Unit. Pediatr Emerg Care 2013;29(7):808-13.
• 53. Sarıcı SÜ, Alpay F, Serdar MA, ve ark. Anne sütüne bağlı neonatal hipernatremik dehidratasyon: Bir olgu sunumu. T Klin Pediatri 2001;10:45-8.