Risk Factors and Neurological Outcomes of Neonatal Hypernatremia

Authors

1 Department of Pediatrics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Pediatrics, Hamadan University of Medical Sciences, Hamadan, Iran

3 Department of Community Medicine, Education Development Office, Hamadan University of Medical Sciences, Hamadan, Iran

Abstract

Background: Hypernatremia might lead to neurological and developmental disabilities. This study aimed to determine the frequency, risk factors, and one-year neurological prognosis of hypernatremia in newborns. The findings of the present study may assist the prevention of hypernatremia mortality and complications.
Methods: This cross-sectional study was conducted on all neonates admitted to the neonatal ward and the Neonatal Intensive Care Unit (NICU) of Bahrami Children's Hospital, Tehran, Iran from September 2013 to September 2014. All the newborns, who were diagnosed with hypernatremia (serum sodium>150 mEq/L) were included in this study. The data were collected using a form, which included clinical symptoms and risk factors for neonatal hypernatremia in addition to the laboratory data. Additionally, the patients were subjected to the developmental examination for one year. Another form was used during the follow-up period to collect all the relevant data.
Results: A total of 1,923 newborns were examined in the present study. The results demonstrated that 74 (3.8%) neonates had sodium levels of >150 mEq/L. Furthermore, jaundice was found to be the most prevalent presentation of hypernatremia, which was reported in 57% of the admitted neonates. Additionally, weight loss was the most common observation on the follow-up examinations. Neonates admitted at older ages (>7 days) had higher sodium levels (160.71±8.98 mEq/L). There were 18 neonates with seizures before or during the hospitalization and 19 (25.7%) cases showed abnormal development during the one-year follow-up. Moreover, a statistically significant relationship was observed between the abnormal development and the presence of seizure (OR: 2.543, CI: 1.358-4.763).
Conclusion: The findings of the current study demonstrated the critical role of weighing the newborns 72-96 h after birth and monitoring for jaundice in the prevention of the neonatal hypernatremia. Furthermore, seizures in these patients were associated with an increased risk of future developmental problems; however, more studies are required in this regard

Keywords

References

1. Martin RJ, Fanaroff AA, Walsh MC. Fanaroff and Martin's neonatal-perinatal medicine: diseases of the fetus and infant. New York: Elsevier Health Sciences; 2014.
2. Boskabadi H, Anvarifar F, Nourizadeh N. Could neonatal hypernatremia dehydration influence hearing status? Iran J Otorhinolaryngol. 2014; 26(74):13-8.
 3. Habibi M, Abourazzak S, Babakhouya A, Boubou M, Atmani S, Tizniti S, et al. Severe hypernatremic dehydration associated with cerebral venous and aortic thrombosis in the neonatal period. BMJ Case Rep. 2012; 2012:720114426.
4. Suliman OS. Dying for milk: a neonate with severe hypernatremia associated with inadequate breast feeding. Sudan J Paediatr. 2015; 15(2):55-62.
5. Trachtman H. Cell volume regulation: a review of cerebral adaptive mechanisms and implications for clinical treatment of osmolal disturbances: II. Pediatr Nephrol. 1992; 6(1):104-12.
 6. Breuning-Boers JM, van Dommelen P, van Wouwe JP, Verkerk PH. Weight loss, serum sodium concentration and residual symptoms in patients with hypernatremic dehydration caused by insufficient breastfeeding. Ned Tijdschr Geneeskd. 2006; 150(16):904-8.
7. Koklu E, Gunes T, Ozturk MA, Kose M, Kurtoglu S, Yuksel F. A review of 116 cases of breastfeedingassociated hypernatremia in rural area of central Turkey. J Trop Pediatr. 2007; 53(5):347-50.
8. Moritz ML, Manole MD, Bogen DL, Ayus JC. Breastfeeding-associated hypernatremia: are we missing the diagnosis? Pediatrics. 2005; 116(3): e343-7.
9. Unal S, Arhan E, Kara N, Uncu N, Aliefendioğlu D. Breast-feeding-associated hypernatremia: Retrospective analysis of 169 term newborns. Pediatr Int. 2008; 50(1):29-34.
10. Uras N, Karadag A, Dogan G, Tonbul A, Tatli MM. Moderate hypernatremic dehydration in newborn infants: retrospective evaluation of 64 cases. J Matern Fetal Neonatal Med. 2007; 20(6):449-52.
11. Bolat F, Oflaz MB, Güven AS, Özdemir G, Alaygut D, Doğan MT, 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.
 12. Boskabadi H, Maamouri G, Ebrahimi M, GhayourMobarhan M, Esmaeily H, Sahebkar A, et al. Neonatal hypernatremia and dehydration in infants receiving inadequate breastfeeding. Asia Pac J Clin Nutr. 2010; 19(3):301-7.
 13. 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(2):153-9.
14. Ibinda F, Zarnack H, Newton CR. Sodium disturbances in children admitted to a kenyan hospital: magnitude, outcome and associated factors. PloS One. 2016; 11(9):e0161320.
15. Zaki SA, Mondkar J, Shanbag P, Verma R. Hypernatremic dehydration due to lactation failure in an exclusively breastfed neonate. Saudi J Kidney Dis Transpl. 2012; 23(1):125-8.
16. Boskabadi H, Akhondian J, Afarideh M, Maamouri G, Bagheri S, Parizadeh SM, et al. Long-term neurodevelopmental outcome of neonates with hypernatremic dehydration. Breastfeed Med. 2017; 12(3):163-8.
17. Ergenekon E, Unal S, Gücüyener K, Soysal SE, Koç E, Okumus N, et al. Hypernatremic dehydration in the newborn period and long‐term follow up. Pediatr Int. 2007; 49(1):19-23.
18. Basiratnia M, Pishva N, Dehghani A. Prevalence of breastfeeding–associated hypernatremia among hospitalized hyperbilirubinemic neonates. Iran J Neonatol. 2014; 5(2):12-6.
Iranian Journal of Neonatology
Volume 8, Issue 3
September 2017
Pages 38-43

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