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首页> 外文期刊>Journal of Clinical and Diagnostic Research >Hypernatremia and Acute Kidney Injury in Exclusive Breast Fed Babies-Time to Reconsider!
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Hypernatremia and Acute Kidney Injury in Exclusive Breast Fed Babies-Time to Reconsider!

机译：独家母乳喂养婴儿的高钠血症和急性肾损伤-重新考虑的时间！

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Hypernatremia in breast fed babies is not very commonly reported. But incidence seems to be increasing. Exact pathophysiology is not clear but hypothesised to be due to relative lactation failure in early postnatal period especially in primiparous mothers, and it can be severe enough to cause life threatening complication like Acute Kidney Injury (AKI) which is even less reported. Moreover, clinical presentation can be misleading even in presence of severe AKI. Presence of other co-morbidities further adds to the problems and may lead to adverse outcome.Aim: To study clinical presentation, severity and outcome in hypernatremic term breast fed young infants who develop AKI.Materials and Methods: This was a retrospective study in which data analysis of all consecutively admitted young infants, =2 months age, who had hypernatremia as well as deranged kidney functions in last six months, was done. AKI was assessed by neonatal RIFLE criteria. Analysis was done by student?s t-test or Fischer-exact test or one-way ANOVA (multiple groups) or non-parametric test as applicable. Pearson correlation coefficient was used to analyse correlation between groups. Statistical analysis of data was done using SPSS version 21.0.Results: Sixteen babies were included. Majority i.e., 81% (13/16 in each group) were born to primiparous women and were on exclusive breast feeding; 75% babies presented with poor oral acceptance and 56% with fever. Other complaints were lethargy, poor urine output and excessive crying. An 80% of the babies had severe AKI (AKI stage III). A total of 31% (5 out of 16) died. Mean serum sodium was 165±8.4 mEq/L with range of 156-183 mEq/L. Median creatinine value was 2.4 mg/dL. Presence of sepsis, requirement of mechanical ventilation, vasopressors, high mean values of blood urea and serum creatinine (p<0.05) were significantly associated with poorer outcome.Conclusion: Hypernatremia is severe enough to cause AKI in exclusive breast fed babies which is not uncommon and is difficult to recognize clinically. Presence of other co-morbidities like sepsis portends poorer outcome. High index of suspicion in all babies specially without predisposing factors may lead to early diagnosis and timely management.
机译：母乳喂养婴儿的高钠血症不是很普遍的报道。但是发病率似乎正在增加。确切的病理生理学尚不清楚，但据推测是由于产后早期相对泌乳衰竭引起的，尤其是在初产母亲中，它的严重程度足以引起危及生命的并发症，如急性肾损伤（AKI），这一点报道较少。此外，即使出现严重的AKI，临床表现也会产生误导。其他合并症的存在进一步加剧了问题，并可能导致不良后果。目的：研究高钠足月母乳喂养的AKI婴儿的临床表现，严重程度和预后。材料和方法：是一项回顾性研究，其中对所有连续入院的= 2个月大，最近六个月患有高钠血症和肾功能异常的婴儿进行了数据分析。通过新生儿RIFLE标准评估AKI。通过学生的t检验或Fischer精确检验或单向方差分析（多组）或非参数检验（适用时）进行分析。皮尔逊相关系数用于分析各组之间的相关性。使用SPSS 21.0版对数据进行统计分析。结果：包括16个婴儿。多数人，即81％（每组13/16）出生于初产妇女，并且只接受母乳喂养; 75％的婴儿口服不良，而56％的婴儿发烧。其他抱怨包括嗜睡，尿量少和哭闹过多。 80％的婴儿患有严重的AKI（AKI第三阶段）。共有31％（16人中有5人）死亡。平均血清钠为165±8.4 mEq / L，范围为156-183 mEq / L。肌酐中位数为2.4 mg / dL。败血症的存在，机械通气的需求，升压药，血尿素和血清肌酐的平均值高（p <0.05）与预后较差相关。结论：高钠血症严重到足以导致纯母乳喂养婴儿的AKI，并不少见，并且在临床上难以识别。其他合并症如败血症的存在预示着较差的结果。特别是在没有诱发因素的情况下，所有婴儿的高度怀疑指数可能导致早期诊断和及时处理。

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