Neonatal hypernatremic dehydration: clinical spectrum, risk factors and immediate outcomes at a tertiary care center, Karachi, Pakistan

Abstract

Objective: To determine the prevalence, clinical manifestations, risk factors and acute consequences of neonatal hypernatremic dehydration in late preterm and term newborns with or without dehydration.

Method: The retrospective, cross-sectional study was conducted from December 2020 to May 2022 at Aga Khan University Hospital, Karachi, and comprised data of neonates aged 1-28 days with diagnosis of neonatal hypernatremic dehydration admitted to the neonatal intensive care unit and step-down unit between June 10, 2015, and June 9, 2020. Demographic and clinical data along with risk factors, test results and outcomes, was retrieved from the medical records, and correlations were explored. Data was analysed using SPSS 25.

Results: Of the 6,525 admissions during the period, there were 84(1.28%) cases of hypernatremia; 47(56%) boys, 37(44%) girls, 71(84.5%) term neonates and 13(15.5%) late-term. The overall with mean gestational age was 37±2.6 weeks. Exclusive breastfeeding was observed in 61(72.6%) cases, primigravida mothers in 54(64.3%) cases, and early postnatal discharge in 27(32.1%) cases. Clinical presentations included poor feeding 48(57.1%), lethargy 43(51.2%), and fever 41(48.8%). Complications occurred in 19(22.6%) cases, with acute kidney injury being the most common complication 16(19%). Mortality was the outcome in 6(7.1%) cases, while 76(90.5%) cases were discharged in a stable condition. The severity of neonatal hypernatremic dehydration correlated significantly with serum creatinine, glucose, prothrombin time, and length of hospital stay (p<0.05).

Conclusion: Among neonatal hypernatremic dehydration, early recognition and management are crucial to combat morbidity and mortality.

Key Words: Hypernatremic dehydration, Neonates, Exclusive breastfeeding, Risk factors, Neonatal outcomes.