Médecine néonatale et pédiatrique

Abstrait

A Clinical Study of Dehydration, Dyselectrolytemia, Hyperthermia and Azotemia among Neonates Admitted to Tertiary Care Centre

Naveen G Nadig, Khalilur Rehman G and Sachin KR

Background: Fever and hypernatremia are often found in neonates with excessive weight loss. In low-risk full-term infants, fever with no other symptoms during the first days of life is primarily related to dehydration and breast-feeding, Hypernatremia occurs primarily because of water deprivation and secondarily because of an accumulation of sodium in an attempt to maintain a proper circulating volume. Azotemia occurs in these patients as a consequence of impaired renal blood flow or decreased perfusion resulting from decreased blood volume. As the literature regarding the association between dehydration, dyselectrolytemia, hyperthermia and azotemia is less, a study on this subject would help in early detection, prevention and better management.

Objectives: To study the clinical, biochemical profile and outcome of neonates who presented with dehydration and hyperthermia to a tertiary care centre.

Methodology: All neonates admitted with dehydration and hyperthermia during the study period of 18 months, were enrolled for the study. Results: In this study of 241 neonates, most common symptom found were decreased voiding of urine (27.71%), followed by fever (26.29%), refusal to feed (24.29%), jaundice (19.43%) and convulsions (2.29%) and the most common biochemical derangement observed were Azotemia (69.52%), followed by hypernatremia (56.19) and hyperbilirubinemia (30.95%). 38.2% of the study subjects had sodium in the range of 151-160 mEq/L, followed by 26.1% (<150 mEq/L). The mean birth weight in the present study was 3+0.31 kg and the mean weight at presentation was 2.64+0.37 kg. The percentage of weight loss was 11.9%.

Conclusion: The results of our study provide support for the hypothesis that one of the main cause of fever during the first days of life is from dehydration resulting from difficulties at the initiation of breast feeding. Hypernatremic dehydration can be prevented by education of mothers regarding breastfeeding techniques, beginning in the antenatal period. Those with identifiable problems should be referred promptly for lactation management and supportive counselling. Also, close follow-up of infants should be done within the first week after hospital discharge for checking weight gain and adequate hydration.