Between January 2014 to August 2015, 1510 neonates were admitted in the out born neonatal intensive care unit of our hospital. Chart review of neonates with moderate and severe hypernatremic dehydration (serum sodium >150 meq/L) was done. Neonates with documented hypernatremia and presenting without any prior treatment were included; those with proven sepsis were excluded. Hypernatremia was corrected using formula based on water deficit and solute deficit [4].

Forty-nine neonates were admitted with hypernatemic dehydration. The presenting complaints were fever (34.6%), poor feeding (42.8%), loose stools (40.8%), lethargy (26.5%), decreased urine output (8.2%), and weight loss (75.5%); 24.5% neonates presented with neurological complaints and examination revealed a doughy feel of skin in 90 % of the neonates. Thirty-three (67.3%) neonates were hospital-delivered and 6 (12.2%) had history of birth asphyxia. Seven neonates (14.8%) required ionotropes and five had culture positive sepsis. The mean (SD) time needed for correction of hypernatremia was 38.6 (15.1) hours. Mean (SD) percentage of dehydration on presentation was 16.3 (11.03). Mean (SD) sodium on admission was 157.7 (9.41) mEq/L. Hyperkalemia and metabolic acidosis was present in 21 (42.8%) and 39 (79.6%) neonates, respectively. The mean (SD) duration of hospital stay was 7.1 (4.8) days. Clinical and laboratory characteristics of neonates with hypernatremia compared to feeding status is shown in Table I. Exclusively top fed neonates had higher percentage of acute kidney injury, mean sodium level, mean creatinine value at presentation and were more dehydrated compared to other groups.

TABLE I Clinical and Laboratory Characteristics in Neonates With  Hypernatremic Dehydration (N=49)

Oddie, et al. [4] have reported an incidence of hypernatremic dehydration as 2.5/10000 live births and Moritz, et al. [5] found a 5-year incidence of breastfeeding associated hypernatremia among hospitalized neonate to be 1.9%. The mean (SD) age of presentation was 14.8 (8.3) days, which is comparable to previous studies (4-21 days). We found 61.2% neonates with >10% weight loss, which is comparable to study by Uras, et al. [5].

We did not find caesarian section (18.3%) to be a risk factor for hypernatremic dehydration as has been reported in previous studies [6,7]. A large number of home deliveries in the study population may account for this difference. Our study confirmed more cases of hypernatremic dehydration in primigravida mothers (46.9%) as previously also reported [8].

Limitations of present study include its retrospective design, lack of neurodevelopment follow-up, lack of correlation between breast milk sodium levels and hypernatremia, and not recording correction rate in serum sodium levels in first 6 and 24 hours.

Poor feeding is both a cause and a manifestation of hypernatremic dehydration. Exclusively breastfed neonates with hypernatremic dehydration have fewer complications. Fluid management is cornerstone of good outcome in hypernatremic dehydration and such cases can be managed at level II neonatal intensive care unit [10].

Contributors: MJ: Concept and design, analysis of data and manuscript drafting; SN: Collected the data and helped in data analysis, drafted the manuscript; AS: collected and analyzed the data, reviewed the literature, drafted the manuscript.

Funding: None; Competing interest: None stated.

1. Moritz ML, Ayus JC. Preventing neurological complications from dysnatremias in children. Pediatr Nephrol. 2005;20:1687-700.

2. Moritz ML, Ayus JC. The changing pattern of hypernatremia in hospitalized children. Pediatrics. 1999;104:435-9.

3. Maayan-Metzger A, Mazkereth R, Kuint J. Fever in healthy asymptomatic newborns during the first days of life. Arch Dis Child Fetal Neonatal Ed. 2003;88:F312-4.

4. Oddie S, Richmond S, Coulthard M. Hypernatraemic dehydration and breast feeding: A population study. Arch Dis Child. 2001;85:318-20.

5. 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;20:449-52.

6. Manganaro R, Mamì C, Marrone T, Marseglia L, Gemelli M. Incidence of dehydration and hypernatremia in exclusively breast-fed infants. J Pediatr. 2001;139:673-5.

7. Erdemir A, Kahramaner Z, Cosar H, Turkoglu E, Kanik A, Sutcuoglu S, et al. Comparison of oral and intravenous fluid therapy in newborns with hypernatremic dehydration. J Matern Fetal Neonatal Med. 2014;27:491-4.

8. Moritz ML, Manole MD, Bogen DL, Ayus JC. Breastfeeding-associated hypernatremia: are we missing the diagnosis? Pediatrics. 2005;116:e343-7.

9. Bolat F, Oflaz MB, Güven AS, Özdemir G, Alaygut D, Doðan 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;29:808-13.