Hypernatremic dehydration in the newborn period

Hypernatremia is defined as a serum sodium level greater than 150 mEq/L. It is a common fluid and electrolyte abnormality in the newborn. Hypernatremia is an important problem in the newborn causing severe complications, neurological sequelas and mortality. Hypernatremia in newborn is usually derived from water balance problem rather than a problem of the sodium balance. The most frequent cause of the hypernatremic dehydration in newborn is insufficient breast feeding. Too much insensible liquid loss, excessive water loss from kidneys and specifically high sodium intake related to NaHCO3 which is used in the very low birth weight infant resuscitation are other important causes of hypernatremia. If hypernatremia in a newborn isn't treated in the right way, quick decreases in serum sodium level will cause brain edema and convulsions which is related to big osmolarity difference of extracellular and intracellular fluid. The aim of the ideal treatment is to decrease serum sodium 34 by less than 10-12mEq/L every 24 hr, with a rate of 0.5 mEq/L/hr. When restoration of intravascular volume, the sodium level of restoration fluid should be arranged by the level of patient's serum sodium level. If it is more than 175 mEq/L, restoration should be done with NaCl more concentrated than 0.9% NaCl. Ideal sodium level of the defisit solution on the starting of the treatment is 40 mEq/L. On the follow-up, serum sodium level should be evaluated every 4 hours. Required alterations should be done to obtain desired controlled slow decrease. Prevention and appropriate treatment of hypernatremia play an important role in reducing the risk of severe complications, morbidity and mortality.(31) Babies fed with mother milk have been considered to have increasing risk in cases of hypernatremic dehydration which may result in high mortality and morbidity accompanied by acute renal insufficiency, disseminated intravascular coagulation, convulsion, multiple cerebrovascular complications in last years. The purpose of this research is stating the demographic and epidemiologic specialities of neonatal hypernatremic dehydration, and defining the preventions which can be basis in the methods of decreasing the cases of dehydration. 31 of term and nearby term newborn diagnosed with hypernatremic dehydration in Newborn Unit from January 2006 to June 2008 were included. The avarage age of cases were found as 6,2+3,5 day and the avarage weight loss of them was %13. It is established that the hypernatremic dehydration is seen more in vaginal deliveries and newborns of primipara mothers. The most frequent reason of the cases to apply was jaundice(61,8%) and of them, it was seen an important number of cases(23,5%) were dehydrated. The medium serum level was found as 161,6+12,6 mmol/L. As consequence, it is very important for babies to be controlled in the first days of their lives (3rd and 7th days) to diagnose early and prevent hypernatremıc dehydration. It is evidenced that educating mother candidates related to the how to feeding and how to caring babies decrease hypernatremic dehydrations which are due to the feeding insufficiency.