Hypernatremia and Acute Kidney Injury in Exclusive Breast Fed Babies-Time to Reconsider!

• Main Authors: Shobha Sharma, Sanjukta Poddar, Anita Yadav, Pradeep Kumar Debata, Neelam Roy
• Format: Article
• Language: English
• Published: JCDR Research and Publications Private Limited 2019-03-01
• Series: Journal of Clinical and Diagnostic Research
• Subjects: diagnosis; kidney function; sepsis
• Online Access: https://jcdr.net/articles/PDF/12736/39854_CE[Ra1]_F(AC)_PF1(AG_KM)_PFA(KM)_PB(NC_AG)_PN(SL).pdf

Introduction: 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.