Clinical profile and outcome of neonates admitted in sick newborn care unit with hypernatremic dehydration and association with breastfeeding in a tertiary care hospital in Northern India


  • Mohit Bajaj Department of Pediatrics, Dr. RPGMC Tanda at Kangra, Himachal Pradesh, India
  • Chiranth R. Department of Pediatrics, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, India
  • Swati Mahajan Department of Pediatrics, Dr. RPGMC Tanda at Kangra, Himachal Pradesh, India
  • Pancham Chauhan Department of Pediatrics, Indira Gandhi Medica College, Shimla, Himachal Pradesh, India



Hypernatremia, Dehydration, Breastfeeding


Background: Neonatal hypernatremic dehydration is a very commonly seen potentially devastating condition. Inadequate breastfeeding, gastrointestinal losses, warm weather and improperly diluted mixed feeding are the main etiologies linked with neonatal hypernatremic dehydration. We conducted this study to evaluate the etiology, risk factors, clinical symptoms and outcomes of neonates admitted with hypernatremic dehydration and its association with breastfeeding from hilly region in northern India.

Methods: The authors retrospectively studied records from extramural sick newborn care unit (SNCU) from April 2018 to June 2019. Inclusion criteria for the study included admitted neonates with documented hypernatremia (serum sodium level >145 mmol/L).

Results: Nine hundred and twenty-two neonates were admitted in sick newborn care unit during this study period. One hundred and three (13.39%) newborns were admitted with hypernatremic dehydration at the time of admission. All newborns had deranged kidney function tests at time of admission. Most commonly found presenting complaints were poor feeding (85.71%), fever (45.71%), loose stools (42.8%) and decreased urine output (8%). The mean (SD) sodium on admission was 154.04 (7.41) meq/L. The mean (SD) time taken to correct hypernatremia was 35.6 (14.6) hours. Six of total admitted newborn developed neurological complications (2 had developed cerebral venous thrombosis and 4 had developed seizures). Mortality rate was 4.4%. Top fed neonates (50.41%) had higher percentage of mean sodium level and acute kidney injury at time of admission.

Conclusions: Hypernatremic dehydration is preventable and treatable condition. Looking in to and addressing etiology in a timely manner is main step in management. All mothers should be taught correct breastfeeding technique. More breast examination during prenatal and postnatal periods and careful neonatal weight record postnatally could decrease the incidence of neonatal hypernatremic dehydration. Top feeding should be discouraged and only exclusive breastfeeding for 6 months.


Author Biographies

Chiranth R., Department of Pediatrics, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, India

Senior Resident,

Swati Mahajan, Department of Pediatrics, Dr. RPGMC Tanda at Kangra, Himachal Pradesh, India

Senior Resident,


Laing IA, Wong CM. Hypernatremia in the first few days is the incidence rising. Arch dis child Fetal Neonatal Ed. 2002;87:F158-62.

Salim N, Jaiswal AN. Hypernatremia in the neonate: neonatal hypernatremia and hypernatremic dehydration in neonates receiving exclusive breastfeeding. Indian J Crit Care Med. 2017;21(1):30-3.

Clarke TA, Markarian M, Griswold W, Mendoza S. Hypernatremic dehydration resulting from inadequate breastfeeding. Pediatr. 1979;63:931-2.

Rowland TW, Zori RT, Lafleur WR, Reiter EO. Malnutrition and hypernatremic dehydration in breast-fed infants. JAMA. 1982;247:1016-7.

Thullen JD. Management of hypernatremic dehydration due to insufficient lactation. Clin Pediatr. 1988;27:370-2.

Lock M, Ray JG. Higher neonatal morbidity after routine early hospital discharge: Are we sending newborns home too early? CMAJ. 1999;161(3):249-53.

Gussler JD, Briesemeister LH. The insufficient milk syndrome: A bicultural explanation. Med Anthropol. 1980;145-74.

Roddy OF, Martin ES, Swetenburg RL. Critical weight loss and malnutrition in breastfed infants. Am J Dis Child. 1981;135:597-9.

Subramanian S, Agarwal R, Deorari A, Paul V, Bagga A. Acute renal failure in neonates. Indian J Pediatr. 2008;75:385-91.

Michael LM, Mioara DM, Debra LB, Carlos Ayus J. Breastfeeding-associated hypernatremia: are we missing the diagnosis? Pediatrics. 2005;116(3):6:e343-7.

Mansour, Ghayour-Mobarhan M, Esmaeily H, Sahebkar, Amirhossein, Ferns, Gordon AA. Neonatal Hypernatremia and Dehydration in Infants Receiving Inadequate Breastfeeding. Asia Pacific J Clin Nutr. 2010;19:301-7.

Kaplan JA, Siegler RW, Schmunk GA. Fatal hypernatremic dehydration in exclusively breast-fed newborn infants due to maternal lactation failure. Am J Forensic Med Pathol. 1998;19(1):19-22.

Chilton LA. Prevention and Management of hypernatremic dehydration in breast fed infants. West J Med. 1995:163(1):74-6.

Ahmad Bhat S, Hassan ZS, Ahmad Tak S. Clinical profile and outcome of neonates with hypernatremic dehydration-a tertiary care hospital-based study. Int J Contemporary Med Res. 2019;6(2):B1-4.

Oddie SJ, Craven V, Deakin K, Westman J, Scally A. Severe neonatal hypernatremia: a population-based study. Arch Dis Childhood Fetal Neonatal Ed. 2013;98(5):F384-7.

Yang WC, Zhao LL, Li YC, Chen CH, Chang YJ, Fu YC et al. Bodyweight loss in predicting neonatal hyperbilirubinemia 72 hours after birth in term newborn infants. BMC Pediatr. 2013;13:145.

Shah RH, Javadekar BB. Clinical profile and outcome of neonates admitted during summer months with dehydration and hypernatremia in tertiary care hospital of central Gujarat, India. Int J Contemo Pediatr. 2018;5(3):761-3.






Original Research Articles