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Manipal Journal of Medical Sciences

Abstract

Background: Neonatal hypernatremic dehydration is a preventable but potentially severe condition most commonly caused by inadequate breast milk intake in the early neonatal period. We describe the clinical profile, maternal and perinatal risk factors, and short‑term outcomes among breastfed neonates admitted with neonatal hypernatremic dehydration to a tertiary neonatal unit in southern India.

Methods: We performed a retrospective observational review (July 2017–June 2022) of neonates ≥35 weeks gestation admitted with serum sodium >145 mmol/L or documented percentage weight loss ≥10% at a tertiary NICU. Demographic, delivery, feeding, clinical and laboratory data were extracted. Continuous data are presented as mean (SD) and categorical data as counts (%). Pearson correlation assessed the relationship between serum sodium and percentage weight loss; p < 0.05 was considered significant.

Results: Among 7,552 live births, 105 neonates met inclusion criteria (hospital-based prevalence 1.4%). Mean age at presentation was 4.1 (2.6) days. Mean serum sodium was 153.8 (5.0) mmol/L and mean weight loss 16.3% of birth weight. Seventy‑four percent of mothers were primiparous and 75.2% of deliveries were by cesarean section. Common presenting features were jaundice (82.9%), lethargy (47.6%) and poor feeding (41.9%). Serum sodium correlated positively with percentage weight loss (r = 0.25, p = 0.01). Complications occurred in 22 (21%) neonates as acute kidney injury (18%) and cerebral venous thrombosis (3%) and seizures predominated with sodium ≥160 mmol/L. There were no deaths.

Conclusion: Neonatal hypernatremic dehydration among breastfed neonates is an important cause of morbidity that is largely preventable. Routine early postnatal weight monitoring, prompt lactation support particularly for primiparous mothers and following cesarean delivery with early evaluation of neonates with significant weight loss or jaundice may reduce progression to severe hypernatremia and its complications.

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