Severe neonatal hypernatraemia: a population based study

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

Treatment of Hypernatremia in Breastfeeding Neonates: A Systematic Review

“…bolus infusions administered in 14 patients while 31 had ongoing maintenance fluids. There were no adverse effects related to treatment and the authors described a mean drop of 12.7 mEq/L in 24 h of SNa [26] .…”

“…There were no systematic reviews focusing on specifics of treatment and its outcomes and no randomized clinical trials. There were 7 retrospective [10,[21][22][23][24][25] and 2 prospective studies [26,27] with ≥ 5 patients included. Only 2 articles performed direct comparisons regarding different treatments [10,22] ( Table 1 ), while the remaining studies described types of treatment and outcomes and were kept in the review for descriptive purposes only ( Table 2 ).…”

“…One article was a case series of neonates with severe hypernatremia treated with peritoneal dialysis (PD), and we decided to keep it in the review due to its data regarding outcomes of this specific therapy [25] . Three articles included late preterm infants [22,26,28] and we also decided to keep it in the review as these sample included otherwise healthy neonates whose only likely predisposing factor related to hypernatremic dehydration was inadequate breastfeeding. These infants had a birth weight >2,000 g and were not admitted for other issues related to prematurity.…”

“…A prospective population-based surveillance study by Oddie et al [26] described i.v. bolus infusions administered in 14 patients while 31 had ongoing maintenance fluids.…”

Severe hypernatremic dehydration in a breastfed infant

“…In recent years a higher incidence of hypernatremic dehydration in neonates has been reported. Inadequate breastfeeding techniques might be responsible, hence it has been noticed more often in primiparous mothers (2)(3)(4).…”