Hypernatremia in Exclusively Breastfed Hospitalized Neonates in Harare, Zimbabwe - Abstract
Background: Newborns are at increased risk of hypernatremia due to their inability to control their fluid intake and their large body surface area to weight/ height ratio. The main cause of hypernatremia in neonates is dehydration from lactation failure, primarily due to low volume intake of breast milk.
The aim of this study was to determine factors associated with hypernatremia and outcomes of neonates admitted with hypernatremic dehydration at two tertiary institutions in Harare, Zimbabwe.
Methods: A hospital based cross sectional study was conducted between June and December 2017 on neonates admitted with hypernatremia at two institutions in Harare.
Results: A total of 160 exclusively breastfed neonates were recruited into the study with 15 deaths giving a case fatality rate of 9.4% (95%CI: 5.8-14.8). The mean age at admission was
6.6 days (SD ± 5.6), and more than half (58.1%), of the mothers were first-time-mothers. Eighty percent of the infants had been discharged within 24hours of delivery. Fever, poor feeding and jaundice were the most common symptoms at presentation. Weight loss was noted in 92.5% of neonates on admission, with 71.4% having lost ? 10% of their birth weight. More than 70% of the infants presented with dehydration. The mean sodium concentration was 163.8 (SD 14.4), mmol/l at admission. Acute kidney injury was the most common complication observed.
Conclusion: Neonatal hypernatremia is common in exclusively breastfed neonates particularly in infants of primiparous mothers. Common presentation was fever, loss of weight, jaundice and dehydration with a significant risk for mortality.