Newborn hypernatremic dehydration: A prospective study reducing the usage of intravenous liquids in moderate cases

Abstract

Objectives

The rehydration approach for hypernatremic dehydration in newborns is challenging. A new treatment protocol was introduced in the NICU for moderate hypernatremic dehydrated (MHD) newborns to achieve safer and more effective serum sodium (Na+) correction.

Methods

A prospective study in a four-level NICU examined term and near term MHD (150–169 mEq/L) newborns. In a novel hypernatremic dehydration treatment protocol, 49 newly diagnosed MHD patients were in group 1, while 54 previously treated control MHD patients were in group 2.

Results

49 neonates received the novel treatment protocol (group 1), and data from 54 neonates were obtained from hospital records (group 2). Serum Na+ correction rate was significantly lower in group 1 compared to group 2, with a median serum Na+ level of 0.66 versus 1.05 mEq/L/h, p = 0.001. The proportion of patients who were treated with pure oral rehydration was significantly higher in group 1 compared to group 2 (67.3% vs 25.9%, p<0.001). Multiple regression analysis was performed to determine factors associated with use of intravenous rehydration: initial serum Na+ [odds ratio (OR):1.515, 95% confidence interval (CI) 1.17–1.94, p<0.001] and serum uric acid [OR: 1.495, 95% CI 1.092–2.00, p = 0.012] in model 2; belonging to Group 2 [OR: 28.267, 95% CI 10.321–53.69, p<0.001]; each additional delay in the day of postnatal admission [OR: 1.381, 95% CI 1.011–1.888, p = 0.043]; and initial serum Na+ [OR: 1.574, 95% CI 1.216–2.037, p = 0.001] in model 4 were significantly associated with intravenous rehydration.

Conclusions

Oral rehydration therapy offers slower sodium reduction and has a low treatment failure rate in MHD newborns. It can be the primary treatment approach, while intravenous therapy should be considered based on the patient’s overall clinical and biochemical status, not just initial sodium levels.