Cranial MRI in neonatal hypernatraemic dehydration

Korkmaz, Ayşe; Yiğit, Şule; Fırat, Murat; Oran, O

doi:10.1007/s002470050749

Cited by 31 publications

(19 citation statements)

References 11 publications

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“…However, inadequate breastfeeding may result in significant weight loss and hypernatremic dehydration (5-15), a potentially lethal condition that can be associated with severe complications (16,17).…”

Section: Discussionmentioning

confidence: 99%

Risk factors for excess weight loss and hypernatremia in exclusively breast-fed infants

Cağlar

Özer

Altugan

2006

Braz J Med Biol Res

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Data were prospectively obtained from exclusively breast-fed healthy term neonates at birth and from healthy mothers with no obstetric complication to determine risk factors for excess weight loss and hypernatremia in exclusively breast-fed infants. Thirty-four neonates with a weight loss ≥10% were diagnosed between April 2001 and January 2005. Six of 18 infants who were eligible for the study had hypernatremia. Breast conditions associated with breast-feeding difficulties (P < 0.05), primiparity (P < 0.005), less than four stools (P < 0.001), pink diaper (P < 0.001), delay at initiation of first breast giving (P < 0.01), birth by cesarean section (P < 0.05), extra heater usage (P < 0.005), extra heater usage among mothers who had appropriate conditions associated with breast-feeding (P < 0.001), mean weight loss in neonates with pink diaper (P < 0.05), mean uric acid concentration in neonates with pink diaper (P < 0.0001), fever in hypernatremic neonates (P < 0.02), and the correlation of weight loss with both serum sodium and uric acid concentrations (P < 0.02) were determined. Excessive weight loss occurs in exclusively breast-fed infants and can be complicated by hypernatremia and other morbidities. Prompt initiation of breast-feeding after delivery and prompt intervention if problems occur with breast-feeding, in particular poor breast attachment, breast engorgement, delayed breast milk "coming in", and nipple problems will help promote successful breast-feeding. Careful follow-up of breast-feeding dyads after discharge from hospital, especially regarding infant weight, is important to help detect inadequate breast-feeding. Environmental factors such as heaters may exacerbate infant dehydration.

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Section: Discussionmentioning

confidence: 99%

Risk factors for excess weight loss and hypernatremia in exclusively breast-fed infants

Cağlar

Özer

Altugan

2006

Braz J Med Biol Res

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“…Hypernatremic dehydration is assumed to be a rare complication of breastfeeding, 7 but recent reports have suggested that the incidence is increasing. [8][9][10][11] The failure to diagnose hypernatremic dehydration can have serious consequences, including seizures, intracranial hemorrhage, 12 vascular thrombosis, 13 and death. 14,15 The purpose of this study was to assess the incidence and complications of breastfeeding-associated hypernatremia among hospitalized neonates at a large pediatric tertiary care center in the United States.…”

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confidence: 99%

Breastfeeding-Associated Hypernatremia: Are We Missing the Diagnosis?

Manole²,

et al. 2005

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ABSTRACT. Objectives. To assess the incidence and complications of breastfeeding-associated hypernatremic dehydration among hospitalized neonates.Study Design. A retrospective study was conducted at Children's Hospital of Pittsburgh over a 5-year period, to identify otherwise healthy term and near-term (>35 weeks of gestation) breastfed neonates (<29 days of age) who were admitted with serum sodium concentrations of >150 mEq/L and no explanation for hypernatremia other than inadequate milk intake.Results. The incidence of breastfeeding-associated hypernatremic dehydration among 3718 consecutive term and near-term hospitalized neonates was 1.9%, occurring for 70 infants. These infants were born primarily to primiparous women (87%) who were discharged within 48 hours after birth (90%). The most common presenting symptom was jaundice (81%). Sixty-three percent of infants underwent sepsis evaluations with lumbar puncture. No infants had bacteremia or meningitis. Infants had hypernatremia of moderate severity (median: 153 mEq/L; range: 150 -177 mEq/L), with a mean weight loss of 13.7%. Nonmetabolic complications occurred for 17% of infants, with the most common being apnea and/or bradycardia. There were no deaths. Diseases, Ninth Revision, Clinical Modification; MWH, Magee-Womens Hospital. T he benefits of breastfeeding to children are well established and include decreased incidence of a wide variety of acute infections and chronic diseases, as well as improved neurodevelopmental outcomes. 1,2 A serious potential complication of insufficient breastfeeding is severe hypernatremic dehydration. 3 Neonatal hypernatremic dehydration results from inadequate transfer of breast milk from mother to infant. Furthermore, poor milk drainage from the breasts results in persistence of high milk sodium concentrations. 4 This may exacerbate neonatal hypernatremia. 5,6 We refer to this as "breastfeeding-associated hypernatremia," with the clear understanding that this results only when breastfeeding is not properly established. Hypernatremic dehydration is assumed to be a rare complication of breastfeeding, 7 but recent reports have suggested that the incidence is increasing. [8][9][10][11] The failure to diagnose hypernatremic dehydration can have serious consequences, including seizures, intracranial hemorrhage, 12 vascular thrombosis, 13 and death. 14,15 The purpose of this study was to assess the incidence and complications of breastfeeding-associated hypernatremia among hospitalized neonates at a large pediatric tertiary care center in the United States. Conclusion. Hypernatremic dehydration requiring ABBREVIATIONS. ICD-9-CM, International Classification of METHODSChildren's Hospital of Pittsburgh is a 235-bed freestanding hospital with ϳ12 000 admissions per year. After approval was obtained from the institutional review board, a retrospective study was conducted to identify otherwise healthy term and near-term (gestation of Ն35 weeks) neonates admitted during a 5-year period with serum sodium concentrations of Ն150 mEq/L...

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“…Acute CNS dysfunctions as well as permanent CNS sequelae are seen in most infants and children with a serum sodium concentration of more than 158 mmol/l and clinical symptoms correlate with the level of the serum sodium concentration [5] . The overall mortality of severe hypernatremia (Na + levels 1 160 mmol/l) is described in the range of 10% [4,5] .…”

Section: Discussionmentioning

confidence: 99%

“…Brain hemorrhage, either massive hemorrhage or multiple small hemorrhages and thromboses, may occur when hypernatremia causes cellular dehydration with resultant brain shrinkage and tearing of cerebral vessels [4,5] . Acute CNS dysfunctions as well as permanent CNS sequelae are seen in most infants and children with a serum sodium concentration of more than 158 mmol/l and clinical symptoms correlate with the level of the serum sodium concentration [5] . The overall mortality of severe hypernatremia (Na + levels 1 160 mmol/l) is described in the range of 10% [4,5] .…”

Section: Discussionmentioning

confidence: 99%

Severe Hypernatremia in an Extremely Low Birth Weight Infant with Subsequent Normal Neurological Development

Sabir

Stannigel²,

Mayatepek³

et al. 2009

Neonatology

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Severe preterm hypernatremia is a life-threatening electrolyte disorder which mainly causes neurological complications such as brain edema, intracranial hemorrhages, hemorrhagic infarctions and thromboses. We report the case of an extremely low birth weight infant (520 g, 24+6 weeks of gestation) with severe hypernatremia of 199 mmol/l due to a failure in the preparation of an infusion on the 7th day of life. The infant subsequently showed no signs of central nervous system complications and no neurological symptoms due to this mishap so far. MRI scan performed after 4 months showed no evidence of cerebral complications including white matter injury. Even severe hypernatremia might not inevitably lead to central nervous system dysfunction and seizures in extremely low birth weight infants.

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Cranial MRI in neonatal hypernatraemic dehydration

Cited by 31 publications

References 11 publications

Risk factors for excess weight loss and hypernatremia in exclusively breast-fed infants

Risk factors for excess weight loss and hypernatremia in exclusively breast-fed infants

Breastfeeding-Associated Hypernatremia: Are We Missing the Diagnosis?

Severe Hypernatremia in an Extremely Low Birth Weight Infant with Subsequent Normal Neurological Development

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